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C A D, Thejeswi P, Prabhu S, Kini J. A rare encounter - Unveiling the mysteries of biliary hamartoma: A case report. Int J Surg Case Rep 2024; 122:110119. [PMID: 39116666 DOI: 10.1016/j.ijscr.2024.110119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/29/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024] Open
Abstract
INTRODUCTION Biliary hamartomas are rare congenital development anomaly of bile ducts, which are detected incidentally. They often present as multiple lesions on liver surface which resembles metastatic lesions. We report a case of acute calculous cholecystitis ultimately diagnosed to have asymptomatic multiple biliary hamartomas. CASE DESCRIPTION A 42-year-old male with no co-morbidities presented with pain in upper abdomen associated with fever and vomiting. Contrast enhanced computed tomography (CECT) of abdomen showed acute calculous cholecystitis, hepatomegaly with fatty changes in liver. On laparoscopy the liver was found to have grey-white nodular lesions of about 0.5 cm in diameter scattered on the surface of both the lobes. One of the lesion was biopsied along with cholecystectomy. DISCUSSION Biliary hamartoma commonly referred to as "von Meyenburg complexes" are uncommon lesions found in the liver which are usually asymptomatic. In this case the patient presented with symptoms of acute cholecystitis but the biopsy report from liver lesions proved to be benign biliary hamartoma which on initial impression looked like multiple liver secondaries. CONCLUSION We have described a case of an adult with multiple biliary hamartoma which was an incidental finding. Biliary hamartoma is a rare entity which can sometime mimic metastasis in the liver. Thus, histopathological confirmation is essential before planning any further treatment.
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Affiliation(s)
- Deepika C A
- Department of General Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Poornachandra Thejeswi
- Department of General Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Shivananda Prabhu
- Department of General Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Jyothi Kini
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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A Retrospective Case Control Study of Ductal Plate Malformation-like Features in Consecutive 200 Autopsies. Pathol Oncol Res 2017; 24:189-194. [DOI: 10.1007/s12253-017-0201-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 01/19/2017] [Indexed: 10/24/2022]
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Terada T. Human ductal plate and its derivatives express antigens of cholangiocellular, hepatocellular, hepatic stellate/progenitor cell, stem cell, and neuroendocrine lineages, and proliferative antigens. Exp Biol Med (Maywood) 2016; 242:907-917. [PMID: 27075931 DOI: 10.1177/1535370216644684] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Molecular mechanisms of human ductal plate (DP) development and differentiation (DD) are unclear. The author immunohistochemically investigated expressions of cholangiocellular antigens (CEA, CA19-9, EMA, MUC1, MUC2, MUC5AC, MUC6, mucins, CK7, and CK19), hepatocellular antigens (HepPar1, AFP, CK8, and CK18), hepatic stellate/progenitor cell (HSC) antigens or stem cell (SC) antigens (C-erbB2, CD56, chromogranin, synaptophysin, bcl2, NSE, NCAM, KIT, and PDGFRA), and proliferating antigen (Ki67) in 32 human fetal livers (HFL). The DD of human intrahepatic bile duct (IBD) could be categorized into four stages: DP, remodeling DP, remodeled DP, and immature IBD. All the molecules examined were expressed in the DP and DP derivatives. These results suggest that human DP or DP derivatives have capacities to differentiate into cholangiocellular, hepatocellular, HSC, SC, and neuroendocrine lineages. The data also suggest that NCAM, KIT/SC factor-signaling, NSE, HGF/MET signaling, PDGFa/PDGFRA signaling, chromogranin, synaptophysin, and CD56 play important roles in DD of DP and biliary cells of HFL. DP, DP derivatives, and IBD in HFL have proliferative capacity.
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Affiliation(s)
- Tadashi Terada
- Department of Pathology, Shizuoka City Shimizu Hospital, Shizuoka 424-8636, Japan
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Terada T. Hepatobiliary cystadenocarcinoma of the liver with features of ductal plate malformations. J Gastrointest Cancer 2016; 46:197-200. [PMID: 25656967 DOI: 10.1007/s12029-015-9688-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Tadashi Terada
- Department of Pathology, Shizuoka City Shimizu Hospital, Miyakami 1231 Shimizu-Ku, Shizuoka, 424-8636, Japan,
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Zhao L, Hosseini M, Wilcox R, Liu Q, Crook T, Taxy JB, Ferrell L, Hart J. Segmental cholangiectasia clinically worrisome for cholangiocarcinoma: comparison with recurrent pyogenic cholangitis. Hum Pathol 2015; 46:426-33. [PMID: 25600951 DOI: 10.1016/j.humpath.2014.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 11/18/2014] [Accepted: 11/26/2014] [Indexed: 12/24/2022]
Abstract
The aim of this study was to review the clinical, radiographic, and pathologic features of cases of benign segmental cholangiectasia in non-Asian US patients with clinical concern for cholangiocarcinoma and compare these features with cases of recurrent pyogenic cholangitis (RPC) in Asian patients. A total of 10 non-Asian US patients with benign segmental cholangiectasia were included in this study. Nine of them underwent partial hepatic resection due to cholangiographic findings of segmental cholangiectasia with mural thickening and/or proximal biliary stricture. One was found to have markedly dilated and thickened intrahepatic bile ducts at the time of autopsy. Clinical and radiographic findings were reviewed. Elastin stains and immunostains for immunoglobulin G4, cluster of differentiation (CD1a), and Langerin were performed. Six comparison cases of RPC in Asian US patients were also examined. Histologic examination of resection specimens revealed markedly dilated large intrahepatic bile ducts with variable degrees of mural fibrosis, periductal gland hyperplasia, inflammation, and liver parenchymal atrophy. These changes were not associated with a ductular reaction. There was no evidence of biliary dysplasia or biliary cirrhosis in any cases. No gross or microscopic feature definitively separated the Asian from non-Asian patients. The etiology of this disorder in non-Asian US patients is unclear. It does not appear to represent a localized variant of Caroli disease or primary sclerosing cholangitis. The high degree of similarity shared by these cases and classic RPC suggests a common pathogenic mechanism, although the pathologic features tend to be less well developed in the cases from the non-Asian US patients.
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Affiliation(s)
- Lei Zhao
- Department of Pathology, University of Chicago, Chicago, IL 60637.
| | - Mojgan Hosseini
- Department of Pathology, University of California San Francisco, San Francisco, CA 94143
| | - Rebecca Wilcox
- Department of Pathology, University of Vermont, Burlington, VT 05405
| | - Qiang Liu
- Department of Pathology, Montefiore Medical Center, New York, NY 10467
| | | | - Jerome B Taxy
- Department of Pathology, NorthShore University Health System, Evanston, IL 60201
| | - Linda Ferrell
- Department of Pathology, University of California San Francisco, San Francisco, CA 94143
| | - John Hart
- Department of Pathology, University of Chicago, Chicago, IL 60637.
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Terada T. Human fetal ductal plate revisited. I. ductal plate expresses NCAM, KIT, MET, PDGFRA, and neuroendocrine antigens (NSE, chromogranin, synaptophysin, and CD56). Microsc Res Tech 2014; 77:814-24. [PMID: 25091524 DOI: 10.1002/jemt.22404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 06/27/2014] [Indexed: 01/03/2023]
Abstract
BACKGROUND The molecular mechanisms of ductal plate (DP) development and differentiation (DD) in human fetal livers (HFLs) are unclear. MATERIALS AND METHODS The author immunohistochemically investigated expressions of NCAM, KIT, KIT, PDGFRA, and neuroendocrine antigens in 32 HFLs. RESULTS The processes of human intrahepatic bile duct (IBD) DD could be categorized into four stages: DP, remodeling DP, remodeled DP, and mature IBD. NCAM was always expressed in DP and remodeling DP, but not in remodeled DP and mature IBD. The biliary elements were positive for cytokeratin (CK)7, 8, 18, and 19. The hepatoblasts were positive for CK8 and CD18, but negative for CK7 and CK19; however, periportal hepatoblasts showed biliary-type CKs (CK7 and CK19). NCAM was always expressed in DP and remodeling DP, but not in remodeled DP and mature IBD. KIT was occasionally (12/32 cases) expressed in DP and remodeling DP, but not in remodeled DP and mature IBD. NCAM expression was also seen in some hepatoblasts and hematopoietic cells and neurons. KIT was also expressed in some hepatoblasts, hematopoietic cells, and mast cells. MET and PDGFRA were strongly expressed in DP, remodeling DP, remodeled DP, and mature IBD. MET and PDGFRA were also strongly expressed in hepatoblasts and hematopoietic cells. MET and PDGFRA were not expressed in portal mesenchyme, portal veins, sinusoids, and hepatic veins. DP showed immunoreactive chromogranin, synaptophysin, neuron-specific enolase (NSE), and CD56. Expressions of chromogranin and CD56 were infrequently seen in remodeling DP. No expressions of these four neuroendocrine antigens were seen in remodeled DP and mature IBD. The nerve fibers were consistently positive for chromogranin, synaptophysin, NSE, and CD56 in the portal mesenchyme in the stages of remodeling DP, remodeled DP, and mature IBDs. CONCLUSIONS The data suggest that NCAM, KIT/stem cell factor-signaling, NSE, hepatocyte growth factor/MET signaling, PDGFα/PDGFRA signaling, chromogranin, synaptophysin, and CD56 play important roles in DD of biliary cells of HFL. They also suggest that the DP cells having neuroendocrine molecules give rise to hepatic stem/progenitor cells.
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Affiliation(s)
- Tadashi Terada
- Department of Pathology, Shizuoka City Shimizu Hospital, Shizuoka 424-8636, Japan
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Kwon JH, Kim MJ, Kim YH, Kang KJ, Kang YN, Kwon SY. Monosegmental hepatobiliary fibropolycystic disease mimicking a mass: report of three cases. Korean J Radiol 2014; 15:54-60. [PMID: 24497792 PMCID: PMC3909862 DOI: 10.3348/kjr.2014.15.1.54] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 09/11/2013] [Indexed: 11/15/2022] Open
Abstract
Hepatobiliary fibropolycystic diseases are a unique group of entities involving the liver and biliary tract, which are caused by abnormal embryologic development of the ductal plates at various stages. We experienced strange hepatobiliary fibropolycystic diseases with a complex mass composed of malformed ducts and biliary cysts, which did not belong to, and were different from, previously known malformations. They were unique in imaging and histologic features. We herein report three cases of monosegmental hepatobiliary fibropolycystic disease mimicking a mass.
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Affiliation(s)
- Jung Hyeok Kwon
- Department of Radiology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu 700-712, Korea
| | - Mi Jeong Kim
- Department of Radiology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu 700-712, Korea
| | - Young Hwan Kim
- Department of Radiology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu 700-712, Korea
| | - Koo Jeong Kang
- Department of Hepatobiliary Surgery, Keimyung University School of Medicine, Dongsan Medical Center, Daegu 700-712, Korea
| | - Yu Na Kang
- Department of Pathology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu 700-712, Korea
| | - Sun Young Kwon
- Department of Pathology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu 700-712, Korea
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Terada T. Projected focal nodular hyperplasia of the liver with pronounced atypical ductular reaction resembling ductal plate and expressing KIT. Hepatol Res 2012; 42:721-6. [PMID: 22686860 DOI: 10.1111/j.1872-034x.2012.00967.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
A 26-year-old woman was found to have a left abdominal tumor in the space among the hepatic left lobe, stomach and spleen. A laparoscopic examination revealed that the tumor was a projected liver tumor, and resection of the tumor was performed. Grossly, the tumor was not encapsulated and measured 4 cm × 4 cm × 5 cm. Microscopically, the tumor was composed of mature hepatocytes, fibrous septae, abnormal vessels and ductular reaction (DR). A pathological diagnosis of projected focal nodular hyperplasia (FNH) was made. Characteristically, the cells of the DR showed atypical features such as small cells and hyperchromatic nuclei. The DR assumed the features of ductal plate-like structures and immunohistochemically expressed KIT, suggesting that the cells of DR are stem cells and that when the stem cells proliferate they take a form of ductal plate-like structures, similar to fetal bile duct development. Immunohistochemically, the cells of DR were positive for cytokeratin (CK) AE1/3, CK CAM5.2, CK7, CK8, CK18, CK19, carcinoembryonic antigen (CEA), CA19-9, Ki-67 (labeling = 3%) and KIT, but negative for CK20, p53, TTF-1, CDX2, MUC1, MUC2, MUC5AC and MUC6. The hepatocytes were positive for CK CAM5.2, CK8, CK18 and Ki-67 (labeling = 4%), but negative for CK AE1/3, CK7, CK19, CK20, CEA, CA19-9, p53, KIT, TTF-1, CDX2, MUC1, MUC2, MUC5AC and MUC6. In conclusion, the author reported a projected FNH. The DR of the FNH showed atypical features such as small cells and hyperchromatic nuclei. The DR assumed features of ductal plate-like structures. KIT was positive in the DR in the FNH, suggesting that the cells of DR are liver stem cells, and proliferation of these cells take features of ductal plate-like structures, similar to embryonic biliary development. MUC apomucins are negative in the DR.
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Affiliation(s)
- Tadashi Terada
- Department of Pathology, Shizuoka City Shimizu Hospital, Shizuoka, Japan
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Abstract
OBJECTIVES The published natural history of congenital hepatic fibrosis (CHF) was examined to inform clinical decision making in autosomal recessive polycystic kidney disease (ARPKD). METHODS A systematic literature search of the data on CHF, ARPKD, Caroli disease, Caroli syndrome, and type V choledochal cyst was performed to extract data related to portal hypertension, infection, malignancy, mortality, and transplantation. RESULTS Information related to 1230 patients with CHF was extracted from 155 articles. Median and mean age at diagnosis were 2 and 11.2 years, respectively. Median and mean time followed after diagnosis were 5.0 and 7.5 years, respectively (range 0-38 years). Sequelae of portal hypertension (n = 409), cholangitis (n = 152), and malignancy (n = 21) were noted. The nature of the portal hypertension was similar to that in other pediatric conditions (164 with varices, 74 bleeding varices, 81 underwent portosystemic shunting). Documented cholangitis was fatal in 3 of 23 children who were infected after renal transplantation. Twenty-one patients developed hepatobiliary cancer, with the majority having cholangiocarcinoma (n = 19). Cholangiocarcinoma (CCA) was predominant in individuals older than 40 years with either Caroli syndrome or isolated CHF, not ARPKD (median and mean age at CCA diagnosis were 70.3 and 60.1 years, respectively; range 33-75 years). There was a relative paucity of data on combined liver-kidney transplantation. CONCLUSIONS Clinical decision making in ARPKD should reflect an understanding of the potential issues emanating from CHF. Accepted pediatric specific approaches to portal hypertension are warranted but must take into consideration the stage of renal insufficiency and potential plans for renal transplantation. Cholangitis is a major issue and necessitates anticipatory guidance and awareness. CCA, although a dreaded complication, does not appear to be a major issue during childhood. The indications for liver and combined liver-kidney transplantation are controversial and warrant further analysis.
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