RESUMEN
Approximately 60 cases of biliary papillomatosis have been reported in the world literature, while only 6 cases have been reported to be treated with liver transplantation. This rare disease, which is characterized by relapsing episodes of obstructive jaundice and cholangitis that lead to secondary cirrhosis and death from sepsis or liver failure, it is also considered premalignant because of its frequent malignant transformation (25-50%). We present a case of a 43-year-old white man with papillomatosis of intra- and extrahepatic biliary tree who sought care for repeated episodes of obstructive jaundice and cholangitis. The diagnosis was suspected after endoscopic retrograde cholangiopancreatography and confirmed by liver and common bile duct biopsies. The patient underwent orthotopic liver transplantation with Roux-en-Y hepatico-jejunostomy to treat end-stage liver cirrhosis. Fifteen months' follow-up revealed a patient with normal graft function and with no clinically or laboratory findings of disease recurrence or cancer development.
Asunto(s)
Conductos Biliares Extrahepáticos/virología , Conductos Biliares Intrahepáticos/virología , Sistema Biliar/virología , Enfermedades de la Vesícula Biliar/cirugía , Enfermedades de la Vesícula Biliar/virología , Trasplante de Hígado , Infecciones por Papillomavirus/cirugía , Adulto , Conductos Biliares Extrahepáticos/diagnóstico por imagen , Conductos Biliares Intrahepáticos/diagnóstico por imagen , Colangiopancreatografia Retrógrada Endoscópica , Conducto Colédoco/patología , Conducto Colédoco/virología , Estudios de Seguimiento , Enfermedades de la Vesícula Biliar/diagnóstico por imagen , Humanos , Hígado/patología , Hígado/virología , Masculino , Infecciones por Papillomavirus/diagnóstico por imagen , Infecciones por Papillomavirus/patología , Resultado del TratamientoRESUMEN
We examined whether retrograde intrabiliary adenoviral administration could induce safe and efficient transgene expression in hepatocytes. We administered recombinant adenovirus carrying a reporter lacZ gene retrogradely into the common bile duct of rats and evaluated the transduction efficiency of the lacZ gene in the liver histochemically by X-gal staining, and also quantitatively by a chemiluminescent reporter gene assay. Retrograde administration of adenovirus into the common bile duct was shown to successfully induce transgene expression in the liver. Although transgene expression induced by intrabiliary adenoviral administration was observed predominantly at periportal areas, a considerable number of cells expressing the transgene were detectable even in lobular and centrilobular areas. Furthermore, histochemical analysis revealed that intrabiliary adenoviral administration resulted in gene transfer into hepatocytes, but not into biliary epithelial cells. Transgene expression in the liver was transient, and pathological and biochemical analyses revealed that hepatic damage caused by intrabiliary adenoviral administration was not substantial. The results demonstrated in the present study suggest that retrograde administration of adenovirus into the common bile duct can induce safe and efficient transgene expression in hepatocytes without causing considerable adverse effects, supporting the feasibility of adenovirus-mediated gene transfer into hepatocytes in clinical settings by means of endoscopic retrograde cholangiography.
Asunto(s)
Adenoviridae , Conducto Colédoco/fisiología , Regulación de la Expresión Génica , Hepatocitos/fisiología , beta-Galactosidasa/genética , Animales , Animales Modificados Genéticamente , Conducto Colédoco/virología , Genes Reporteros , Vectores Genéticos , Hepatocitos/citología , Humanos , Hígado/citología , Hígado/enzimología , Pruebas de Función Hepática , Ratas , SeguridadRESUMEN
Clinically significant cytomegalovirus cholangitis is well recognized in patients with AIDS but is less common in other groups of immunocompromised patients. The authors describe a 59-year-old man who had undergone renal transplantation in whom this condition developed, and they emphasize that this diagnosis should be considered in renal transplant patients presenting with biliary obstruction. Careful examination of biopsy material for cytomegalovirus inclusion bodies is necessary.