Solitary peribiliary cyst mimicking cholangiocarcinoma

Peribiliary glands pathology in a large series of end-stage alcohol-related liver disease

The peribiliary glands are intramural or extramural structures with multiple functions related to bile secretion. The peribiliary glands can develop cystic alterations in several conditions, such as alcohol addiction. Peribiliary cysts can enlarge till being radiologically visible and mimic cancer. We studied 217 consecutive explanted livers for end-stage alcohol-related liver disease from the Pathology Unit of the Liver Unit at the King's College Hospital in Denmark Hill, with particular focus on peribiliary glands. Our cohort consisted of 31 females and 186 males, with a median age of 51 and of 56 years respectively. 92,2% had established cirrhosis, 73,3% had only alcohol-induced liver disease, whilst 26,7% had other co-morbidities. We found a mild ectasia of the peribiliary glands (<2 mm) in 37,8% and peribiliary cysts (> = 2 mm) in 22,6% of cases. The diameter of the peribiliary glands varied from 1 mm to 8 mm. Inflammation of the peribiliary glands was found in the majority of cases with dilatation (p value = 0,000). 4,6% of the peribiliary cysts had low-grade intraductal papillary neoplasm of the bile ducts confined to the peribiliary glands. Pancreatic heterotopia was found in 10,6% and associated with the presence of ectasia. Our findings fit with what is reported in literature, such as the alcohol-induced damage at the peribiliary glands. Moreover these results underline the possible role of peribiliary glands in the development of the intraductal papillary neoplasm of the bile ducts, the biliary counterpart of the branch type intraductal mucinous neoplasm of the pancreas.

A case of peribiliary hepatic cysts in a cirrhotic liver: A mimicker of Klatskin Tumor

Patients with end-stage liver disease may present to healthcare facilities with features of obstructive jaundice and a picture of hilar cholangiocarcinoma on radiological imaging. Careful observation and knowledge of the presence and higher prevalence of peribiliary hepatic cysts in a cirrhotic liver can aid in differentiating this benign entity from malignancy that may halt or delay the patients’ eligibility for receiving a liver transplant. We present a case of a patient with liver cirrhosis initially diagnosed as Klatskin tumor on imaging then as a simple case of multiple peribiliary hepatic cysts with the patient eventually undergoing successful liver transplantation.