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Kai K, Ide T, Tanaka T, Yukimoto K, Irie H, Noshiro H, Aishima S. A Case of Multicystic Biliary Hamartoma with a Marked Peribiliary Gland Component Successfully Treated by Purely Laparoscopic Anatomical Liver Resection. J Gastrointest Cancer 2023; 54:996-999. [PMID: 36449146 PMCID: PMC10613131 DOI: 10.1007/s12029-022-00893-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Multicystic biliary hamartoma (MCBH) is an extremely rare benign liver lesion characterized by a gross well-circumscribed multicystic honeycomb appearance. This report presents a MCBH case with a marked peribiliary gland component which showed unusual histology. CASE PRESENTATION A 63-year-old Japanese male was admitted to our hospital for a detailed examination of a hepatic cystic lesion, which was originally detected 14 years ago and had slowly enlarged. A preoperative imaging study revealed a well-demarcated multicystic lesion without communication to the biliary tracts. The possible clinical diagnoses were mucinous cystic neoplasm (MCN) or MCBH. The lesion was successfully resected by purely laparoscopic right anterior sectionectomy. The cut surfaces of resected specimens grossly exhibited a well-circumscribed multicystic lesion with a thick septum. Histologically, the cyst wall was covered by cuboidal epithelial cells resembling epithelium of the bile duct while abundant small ducts, which morphologically resembled peribiliary glands, were observed among the fibrous stroma of the thick septum. Although possible pathological diagnosis varied, including intrahepatic cholangiocarcinoma, intraductal papillary neoplasm of the bile duct, biliary adenofibroma, MCN and MCBH, the lesion was finally diagnosed as MCBH with a marked peribiliary gland component. CONCLUSIONS MCBH can contain abundant peribiliary glands in the fibrous stroma. A pathologist should be careful not to diagnose such peribiliary glands in MCBH as neoplastic glands.
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Affiliation(s)
- Keita Kai
- Department of Pathology, Saga University Hospital, Nabeshima 5-1-1, Saga, 849-8501, Japan.
| | - Takao Ide
- Department of Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Tomokazu Tanaka
- Department of Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Kumpei Yukimoto
- Department of Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Hiroyuki Irie
- Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan
| | - Hirokazu Noshiro
- Department of Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Shinichi Aishima
- Department of Pathology, Saga University Hospital, Nabeshima 5-1-1, Saga, 849-8501, Japan
- Departments of Pathology & Microbiology, Faculty of Medicine, Saga University, Saga, Japan
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Lian J, Sun L, Yang Y, Li J, Zhang Y, Liu G, Hu W. Characteristics of multicystic biliary hamartoma: A case report. Front Surg 2023; 9:1074899. [PMID: 36684306 PMCID: PMC9852751 DOI: 10.3389/fsurg.2022.1074899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/14/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction Multicystic biliary hamartoma (MCBH) is a very rare hepatic benign neoplasm that manifests as a localized cystic-solid mass. Only 17 cases have been described in the literature to date. MCBH diagnosis is currently dependent on imaging and pathology following surgical resection and no precise standards are in place. Case Presentation This case study involves a middle-aged male patient with a history of drinking but no other liver diseases. A routine ultrasound examination showed a 6.0 × 5.5 cm inhomogeneous echo mass in the right lobe of the liver. The patient experienced no discomfort or other symptoms, and blood tests were normal. Imaging revealed a localized cystic-solid neoplasm in segment 6 of the liver that did not have the features of a malignant tumor. Surgical resection was performed. Based on imaging, macroscopic examination, and histological results, a final diagnosis of MCBH was made. Conclusion The imaging and pathological features of MCBH were summarized based on the published case reports to date. As a non-invasive examination, the imaging features will aid in the diagnosis of MCBH. Furthermore, these features, along with tumor size and patient symptoms, will facilitate clinicians in selecting surgical resection or follow-up for individual patients.
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Affiliation(s)
- Jia Lian
- Department of Gastroenterology and Hepatology, The Third Central Hospital of Tianjin, Tianjin, China,Department of Gastroenterology and Hepatology, The Third Central Clinical College of Tianjin Medical University, Tianjin, China,Tianjin Key Laboratory of Extracorporeal LifeSupport for Critical Diseases, Tianjin, China,Artificial Cell Engineering Technology Research Center, Tianjin, China,Tianjin Institute of Hepatobiliary Disease, Tianjin, China,Correspondence: Jia Lian
| | - Lixia Sun
- Department of Gastroenterology and Hepatology, The Third Central Hospital of Tianjin, Tianjin, China,Department of Gastroenterology and Hepatology, The Third Central Clinical College of Tianjin Medical University, Tianjin, China,Tianjin Key Laboratory of Extracorporeal LifeSupport for Critical Diseases, Tianjin, China,Artificial Cell Engineering Technology Research Center, Tianjin, China,Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Yankai Yang
- Department of Gastroenterology and Hepatology, The Third Central Hospital of Tianjin, Tianjin, China,Department of Gastroenterology and Hepatology, The Third Central Clinical College of Tianjin Medical University, Tianjin, China,Tianjin Key Laboratory of Extracorporeal LifeSupport for Critical Diseases, Tianjin, China,Artificial Cell Engineering Technology Research Center, Tianjin, China,Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Jun Li
- Department of Gastroenterology and Hepatology, The Third Central Hospital of Tianjin, Tianjin, China,Department of Gastroenterology and Hepatology, The Third Central Clinical College of Tianjin Medical University, Tianjin, China,Tianjin Key Laboratory of Extracorporeal LifeSupport for Critical Diseases, Tianjin, China,Artificial Cell Engineering Technology Research Center, Tianjin, China,Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Ye Zhang
- Department of HepatobiliarySurgery, The Third Central Hospital of Tianjin, Tianjin, China
| | - Guiqiu Liu
- Department of Pathology, The Third Central Hospital of Tianjin, Tianjin, China
| | - Weijuan Hu
- Department of Radiology, The Third Central Hospital of Tianjin, Tianjin, China
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Shono N, Otomi Y, Otsuka H, Shinya T, Harada M. Multicystic Biliary Hamartoma With Xanthogranulomatous Inflammation on 18F-FDG PET/CT. Clin Nucl Med 2022; 47:882-884. [PMID: 36067085 DOI: 10.1097/rlu.0000000000004204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 70-year-old man with a liver tumor was pathologically diagnosed with multicystic biliary hamartoma with xanthogranulomatous inflammation. Plain CT revealed an inhomogeneous low-density liver tumor, measuring 43 × 35 mm. Dynamic contrast-enhanced CT revealed a cyst, measuring approximately 15 mm, with a ring-shaped enhancement, within the tumor. There was delayed enhancement on the outer portion of the tumor. Mild peripheral bile duct dilation was also observed. 18F-FDG PET/CT showed focal high uptake with an SUVmax of 5.2 near the cyst. The findings of this case mimicked that of intrahepatic cholangiocellular carcinoma.
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Affiliation(s)
- Nahomi Shono
- From the Department of Radiology, Tokushima University Hospital, Tokushima, Japan
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Wang CY, Shi FY, Huang WF, Tang Y, Li T, He GL. Intrahepatic multicystic biliary hamartoma: A case report. World J Clin Cases 2022; 10:9361-9367. [PMID: 36159400 PMCID: PMC9477665 DOI: 10.12998/wjcc.v10.i26.9361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/11/2022] [Accepted: 08/05/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Multicystic biliary hamartoma (MCBH) is a rare hamartomatous nodule of the liver, which has recently been described as a new category of hepatic nodular cystic lesion. Most of them are benign. The imaging findings are similar to those of many other hepatic cystic lesions, but MCBH also has some notable features, such as large cysts, smooth cyst walls, and lack of communication with the hepatic duct. Due to the non-specific radiology, preoperative diagnosis is difficult, and is usually diagnosed by postoperative pathology. Complete resection is the best treatment option, and the postoperative prognosis is good.
CASE SUMMARY When the patients have MCBH, the symptoms may not very typical, and they require a combination of imaging and pathology for diagnosis. Under normal circumstances, the prognosis of MCBH is good. However, in patients with MCBH, more cases need to be observed for verification.
CONCLUSION When the patients have MCBH, the symptoms may not very typical, and they require a combination of imaging and pathology for diagnosis. Under normal circumstances, the prognosis of MCBH is good. However, in patients with MCBH, more cases need to be observed for verification.
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Affiliation(s)
- Chen-Yu Wang
- The Second Clinical Institute Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Fu-Yang Shi
- The Second Clinical Institute Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Wei-Feng Huang
- The Second Clinical Institute Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Yan Tang
- The Second Clinical Institute Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Ting Li
- Department of Hepatobiliary Surgery II, Southern Medical University, Guangzhou 510282, Guangdong Province, China
| | - Guo-Lin He
- Department of Hepatobiliary Surgery II, Southern Medical University, Guangzhou 510282, Guangdong Province, China
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Hepatic Cysts: Reappraisal of the Classification, Terminology, Differential Diagnosis, and Clinicopathologic Characteristics in 258 Cases. Am J Surg Pathol 2022; 46:1219-1233. [PMID: 35778790 DOI: 10.1097/pas.0000000000001930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The literature on liver cysts is highly conflicting, mostly owing to definitional variations. Two hundred and fifty-eight ≥1 cm cysts evaluated pathologically using updated criteria were classifiable as: I. Ductal plate malformation related (63%); that is, cystic bile duct hamartoma or not otherwise specified-type benign biliary cyst (35 with polycystic liver disease). These were female predominant (F/M=2.4), large (10 cm), often multifocal with degenerative/inflammatory changes and frequently misclassified as "hepatobiliary cystadenoma." II. Neoplastic (13%); 27 (10.5%) had ovarian-type stroma (OTS) and qualified as mucinous cystic neoplasm (MCN) per World Health Organization (WHO). These were female, solitary, mean age 52, mean size 11 cm, and 2 were associated with carcinoma (1 in situ and 1 microinvasive). There were 3 intraductal papillary neoplasms, 1 intraductal oncocytic papillary neoplasm, 1 cystic cholangiocarcinoma, and 2 cystic metastasis. III. Infectious/inflammatory (12%). These included 23 hydatid cysts (including 2 Echinococcus alveolaris both misdiagnosed preoperatively as cancer), nonspecific inflammatory cysts (abscesses, inflammatory cysts: 3.4%). IV. Congenital (7%). Mostly small (<3 cm); choledochal cyst (5%), foregut cyst (2%). V. Miscellaneous (4%). In conclusion, hepatic cysts occur predominantly in women (3/1), are mostly (90%) non-neoplastic, and seldom (<2%) malignant. Cystic bile duct hamartomas and their relative not otherwise specified-type benign biliary cysts are frequently multifocal and often misdiagnosed as "cystadenoma/carcinoma." Defined by OTS, MCNs (the true "hepatobiliary cystadenoma/carcinoma") are solitary, constitute only 10.5% of hepatic cysts, and have a significantly different profile than the impression in the literature in that essentially all are perimenopausal females, and rarely associated with carcinoma (7%). Since MCNs can only be diagnosed by demonstration of OTS through complete microscopic examination, it is advisable to avoid the term "cystadenoma/cystadenocarcinoma" solely based on radiologic examination, and the following simplified terminology would be preferable in preoperative evaluation to avoid conflicts with the final pathologic diagnosis: (1) noncomplex (favor benign), (2) complex (in 3 subsets, as favor benign, cannot rule out malignancy, or favor malignancy), (3) malignant features.
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6
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Mu W, Su P, Ning S. Case Report: Incidentally Discovered a Rare Cystic Lesion of Liver: Multicystic Biliary Hamartoma. Pathol Oncol Res 2021; 27:628323. [PMID: 34257591 PMCID: PMC8262196 DOI: 10.3389/pore.2021.628323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/01/2021] [Indexed: 12/23/2022]
Abstract
Multicystic biliary hamartoma (MCBH) is an extremely rare cystic lesion of the liver. A 37-year old male patient was admitted to our hospital for incidentally discovered hepatic cystic lesions on abdominal ultrasonography. Abdominal contrast-enhanced computed tomography (CT) showed a multilocular cystic lesion in the segment VI, with mild enhancement in the septae and peripheral wall within the lesion. Only alanine transaminase (ALT) and carbohydrate antigen 19-9 (CA19-9) increased slightly above normal value. Preoperative tests suggested possibility of a benign mucinous cystic neoplasm (MCN) or intraductal papillary neoplasm of the bile duct (IPNB). Laparoscopic complete resection of the lesion was performed. Histopathological examination showed numerous variably sized ductal structures surrounded by periductal glands and fibrous connective tissues containing small blood vessels and smooth muscle bundles. Immunohistochemical staining (IHC) revealed that dilated ducts were positive for cytokeratin CK19, characteristic for biliary tract. Histopathological findings confirmed diagnosis of multicystic biliary hamartoma (MCBH). No recurrence occurred during 6 months follow-up. In conclusion, MCBH should be differentiating from hepatic cystic lesion and could be resected laparoscopically safely.
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Affiliation(s)
- Wentao Mu
- Department of Hepatobiliary Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, China
| | - Peng Su
- Department of Pathology, Qilu Hospital of Shandong University, Ji'nan, China
| | - Shanglei Ning
- Department of Hepatobiliary Surgery, General Surgery, Qilu Hospital of Shandong University, Ji'nan, China
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Pitchaimuthu M, Duxbury M. Cystic lesions of the liver-A review. Curr Probl Surg 2017; 54:514-542. [PMID: 29173653 DOI: 10.1067/j.cpsurg.2017.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/08/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Maheswaran Pitchaimuthu
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom; Department of HPB and Transplant Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
| | - Mark Duxbury
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
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8
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Morinaga T, Imai K, Yamashita YI, Yamao T, Kaida T, Nakagawa S, Hashimoto D, Chikamoto A, Sumiyoshi S, Mikami Y, Baba H. Multicystic biliary hamartoma with extremely elevated CA19-9: a case report. Scand J Gastroenterol 2017; 52:916-919. [PMID: 28485658 DOI: 10.1080/00365521.2017.1322140] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Multicystic biliary hamartoma (MCBH) is a rare cystic disease of the liver. We herein report a case of MCBH associated with extremely elevated levels of serum carbohydrate antigen (CA) 19-9. A 53-year-old man was referred to our hospital because of extremely elevated CA19-9 levels (more than 12,000 U/mL). Enhanced abdominal computed tomography and magnetic resonance imaging (MRI) revealed a multicystic tumor with a calcified wall in the left lobe of the liver, although no apparent intracystic nodule was detected. Because of the possibility of a malignant tumor, such as intraductal papillary neoplasm of the bile duct or cystadenocarcinoma, the patient underwent left hepatectomy. Based on the postoperative pathological findings, the lesion was diagnosed as MCBH. The serum CA19-9 level drastically decreased after surgery. We encountered a rare case of MCBH with extremely elevated CA19-9 levels.
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Affiliation(s)
- Takeshi Morinaga
- a Department of Gastroenterological Surgery, Graduate School of Life Sciences , Kumamoto University , Kumamoto , Japan
| | - Katsunori Imai
- a Department of Gastroenterological Surgery, Graduate School of Life Sciences , Kumamoto University , Kumamoto , Japan
| | - Yo-Ichi Yamashita
- a Department of Gastroenterological Surgery, Graduate School of Life Sciences , Kumamoto University , Kumamoto , Japan
| | - Takanobu Yamao
- a Department of Gastroenterological Surgery, Graduate School of Life Sciences , Kumamoto University , Kumamoto , Japan
| | - Takayoshi Kaida
- a Department of Gastroenterological Surgery, Graduate School of Life Sciences , Kumamoto University , Kumamoto , Japan
| | - Shigeki Nakagawa
- a Department of Gastroenterological Surgery, Graduate School of Life Sciences , Kumamoto University , Kumamoto , Japan
| | - Daisuke Hashimoto
- a Department of Gastroenterological Surgery, Graduate School of Life Sciences , Kumamoto University , Kumamoto , Japan
| | - Akira Chikamoto
- a Department of Gastroenterological Surgery, Graduate School of Life Sciences , Kumamoto University , Kumamoto , Japan
| | - Shinji Sumiyoshi
- b Department of Diagnostic Pathology , Kumamoto University Hospital , Kumamoto , Japan
| | - Yoshiki Mikami
- b Department of Diagnostic Pathology , Kumamoto University Hospital , Kumamoto , Japan
| | - Hideo Baba
- a Department of Gastroenterological Surgery, Graduate School of Life Sciences , Kumamoto University , Kumamoto , Japan
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9
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Gupta A, Pattnaik B, Das A, Kaman L. Von Meyenburg complex and complete ductal plate malformation along with Klatskin tumour: a rare association. BMJ Case Rep 2016; 2016:10.1136/bcr-2016-215220. [PMID: 27090552 DOI: 10.1136/bcr-2016-215220] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Von Meyenburg complexes (VMCs), or bile duct microhamartomas, are among the constellation of defects of ductal plate malformation. These present as multiple small intrahepatic cysts and are diagnosed incidentally. Association of intrahepatic VMCs with a bile duct cancer has rarely been reported. We describe a case of a 53-year-old man presenting with obstructive jaundice. Biochemistry and radiology gave a provisional diagnosis of a resectable Klatskin tumour. The patient underwent right hepatectomy with common bile duct and caudate lobe excision. The histopathological examination demonstrated intrahepatic VMCs with complete ductal malformation and malignancy at the hilum.
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Affiliation(s)
| | | | - Ashim Das
- Department of Histopathology, PGIMER, Chandigarh, India
| | - Lileswar Kaman
- Department of General Surgery, PGIMER, Chandigarh, India
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10
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A variant of multicystic biliary hamartoma presenting as an intrahepatic cystic neoplasm. Clin J Gastroenterol 2015; 8:162-6. [PMID: 26017582 DOI: 10.1007/s12328-015-0574-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 05/09/2015] [Indexed: 12/23/2022]
Abstract
A rare case of an intrahepatic multicystic tumor is described. A 26-year-old man visited our hospital because of abdominal discomfort. Contrast-enhanced computed tomography and magnetic resonance cholangiopancreatography revealed a 10 × 7 cm multicystic tumor of the bile duct in the right side of the liver. The gross appearance of the tumor resembled an intraductal papillary neoplasm of the bile duct, and right hepatectomy with regional lymphadenectomy was performed. Histologically, these cystic lesions were composed of variably and irregularly dilated duct structures lined by columnar epithelium resembling bile duct lining. There were no atypical cells and no papillary growth of the epithelial cells. Interestingly, the dilated ducts contained inspissated bile, and the inter-cystic parenchyma contained variable but irregularly distributed and hamartomatous hepatic parenchyma with an abnormal lobular pattern. Though it had atypical features of a hamartoma in some aspects (age, smooth muscle), this case could finally be regarded as a variant of multicystic biliary hamartoma.
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11
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Beard RE, Yee EU, Mortele KJ, Khwaja K. Multicystic biliary hamartoma: A report of a rare entity and a review of the literature. Int J Surg Case Rep 2014; 5:919-23. [PMID: 25460436 PMCID: PMC4275964 DOI: 10.1016/j.ijscr.2014.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 09/09/2014] [Accepted: 10/08/2014] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Multicystic biliary hamartoma is a rare liver tumor that was first described in 2005. Only nine cases are reported in the literature and all of them originate from Eastern patient populations, specifically Japan and Korea. PRESENTATION OF CASE Herein we report the occurrence of the tenth multicystic biliary hamartoma reported to date, arising in a Caucasian American woman initially presenting with abdominal pain. At 4.7 cm this is the second largest tumor reported to date and the only one arising in a Western patient population. DISCUSSION The patient underwent multimodality imaging and the tumor was biopsied preoperatively, but the diagnosis remained unclear. An extended right hepatectomy was performed for resection of her tumor, and the tumor was definitively diagnosed based on the surgically resected specimen. As all nine of the previously reported cases also underwent resection, the natural history of this lesion remains unknown. The lack of both recurrence and tumor spread in the previously reported cases indicates that this may be a benign lesion not requiring surgical resection unless symptomatic. CONCLUSION Multicystic biliary hamartoma is an extremely rare tumor. Increased awareness of the radiologic and pathologic features will likely lead to the diagnoses of further cases in both Western and Eastern populations and could potentially assist with preoperative diagnosis. The natural history and optimal management of this tumor remain uncertain.
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Affiliation(s)
- Rachel E Beard
- Department of Surgery, Beth Israel Deaconess Medical Center, 110 Francis Street, Boston, MA 02215, United States.
| | - Eric U Yee
- Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States
| | - Koenraad J Mortele
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States
| | - Khalid Khwaja
- Department of Surgery, Beth Israel Deaconess Medical Center, 110 Francis Street, Boston, MA 02215, United States
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12
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Intrahepatic multicystic biliary hamartoma: Presentation of a case report. Cir Esp 2014; 93:e103-5. [PMID: 25066568 DOI: 10.1016/j.ciresp.2014.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 02/28/2014] [Indexed: 11/24/2022]
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13
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Yoh T, Okamura R, Nakayama H, Lin X, Nakamura Y, Kato T. Multicystic biliary hamartoma mimicking intrahepatic cholangiocarcinoma: report of a case. Clin J Gastroenterol 2014; 7:418-21. [PMID: 26184022 DOI: 10.1007/s12328-014-0513-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 06/29/2014] [Indexed: 12/23/2022]
Abstract
Multicystic biliary hamartoma (MCBH) is a rare cystic disease of the liver. A 69-year-old man was referred to our hospital with radiographic abnormality. Physical examination of the patient was unremarkable, and he denied any previous medical, travel, or surgical history. An abdominal computed tomography (CT) scan demonstrated a 3-cm low-density lesion in segment 3 of the liver, with dilation of the intrahepatic bile duct. The peripheral site of this lesion was slightly enhanced in the arterial phase. In the portal phase, the peripheral site was enhanced more clearly and showed a honeycomb-like dilated bile duct. Ultrasonography also revealed that the lesion was an irregularly shaped mass. On magnetic resonance imaging (MRI), T1-weighted images revealed a low-density mass and T2-weighted images revealed a dappled-density mass with honeycomb-like dilated bile duct and dilation of major intrahepatic bile duct. The patient was diagnosed with intrahepatic cholangiocarcinoma (ICC) and underwent left hepatectomy. However, pathological findings revealed that the lesion was MCBH. Our case highlights the potential difficulties in differentiating between MCBH and ICC under such circumstances.
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Affiliation(s)
- Tomoaki Yoh
- Department of Surgery, Yamatotakada Municipal Hospital, Yamatotakada, Nara, Japan,
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14
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Shah AA, Karass M, Page AJ, Shehata BM, Durham MM. Extra-hepatic bile duct hamartoma in a 10-month-old with a morgagni hernia and multiple anatomical anomalies: a rare and incidental finding. Pediatr Surg Int 2013; 29:745-8. [PMID: 23456283 DOI: 10.1007/s00383-013-3271-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2013] [Indexed: 10/27/2022]
Abstract
Von Meyenburg complexes (VMCs), also known as bile duct hamartomas, are a part of a group of ductal plate malformations. They are typically present intrahepatically. In this case, we present to our knowledge the first report of an extra-hepatic VMC in the pediatric population. The patient presented as a 10-month-old infant with a weeklong history of progressive breathing difficulty. A chest radiograph was obtained, showing intestinal loops in the thoracic cavity consistent with a Morgagni's hernia, unrelated to his breathing difficulty. The patient then underwent an elective repair of his congenital diaphragmatic defect. During the operation, the bile duct hamartoma was found adherent to the accessory lobe of the liver, present to the left of the ligamentum teres.
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Affiliation(s)
- Adil A Shah
- Medical College, Aga Khan University, Karachi, Pakistan
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15
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Song JS, Noh SJ, Cho BH, Moon WS. Multicystic biliary hamartoma of the liver. KOREAN JOURNAL OF PATHOLOGY 2013; 47:275-8. [PMID: 23837021 PMCID: PMC3701824 DOI: 10.4132/koreanjpathol.2013.47.3.275] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 06/11/2012] [Accepted: 06/12/2012] [Indexed: 12/23/2022]
Abstract
Multicystic biliary hamartoma (MCBH) is a very rare hamartomatous cystic nodule of the liver, which has recently been described as a new entity of a hepatic nodular lesion. We report a unique case of MCBH with a review of the literatures. A hepatic multicystic mass of segment 3 was detected in a 52-year-old male by abdominal computed tomography, and resection of this lesion was performed. Macroscopic examination revealed a 2.7×2.0 cm nodular mass with a multicystic honeycomb cut surface. Histologically, this lesion consisted of multiple dilated cystic ducts lined by biliary type epithelial cells, periductal glands and connective tissue, which included small amounts of hepatic parenchyma and blood vessels. Recognition of this unusual lesion is essential to avoid confusion with other cystic tumors of the liver, and to learn more about its natural history and response to treatment.
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Affiliation(s)
- Ji Soo Song
- Department of Radiology, Research Institute of Clinical Medicine and Research Institute for Endocrine Sciences, Chonbuk National University Medical School, Jeonju, Korea
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Kai K, Yakabe T, Kohya N, Miyoshi A, Iwane S, Mizuta T, Miyazaki K, Tokunaga O. A case of unclassified multicystic biliary tumor with biliary adenofibroma features. Pathol Int 2012; 62:506-10. [PMID: 22726072 DOI: 10.1111/j.1440-1827.2012.02830.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A 40-year-old Japanese man was admitted to our hospital for evaluation of upper abdominal pain. Abdominal computed tomography (CT) revealed a well-circumscribed multicystic mass measuring approximately 7 × 6 cm. The mass contained a solid lesion measuring 3 × 2 cm. Biopsy of a swollen cervical lymph node led to a diagnosis of diffuse large B-cell lymphoma. After initial chemotherapy for lymphoma, the multicystic mass was surgically resected. The tumor was composed of a multicystic lesion and a solid lesion. Histopathologic examination of the multicystic lesion revealed that the locules were lined by biliary epithelium, demonstrating various degrees of cytological atypia. The stroma was fibrous, and the tumor showed marked apocrine snouts. Part of the tumor showed papillary growth with strong cytological atypia. The solid lesion showed tubulocystic proliferation of tumor cells, with prominent apocrine snouts, embedded in dense and partially hyalinized fibrous stroma. The morphology of the solid part was quite similar to that of reported biliary adenofibroma. Despite lengthy discussion, an appropriate pathological diagnosis could not be found among the current classifications of biliary tumor. The tumor was finally diagnosed as unclassified multicystic biliary tumor with adenofibroma features.
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Affiliation(s)
- Keita Kai
- Department of Pathology & Microbiology, Saga University Faculty of Medicine, Saga, Japan.
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17
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Zen Y, Pedica F, Patcha VR, Capelli P, Zamboni G, Casaril A, Quaglia A, Nakanuma Y, Heaton N, Portmann B. Mucinous cystic neoplasms of the liver: a clinicopathological study and comparison with intraductal papillary neoplasms of the bile duct. Mod Pathol 2011; 24:1079-89. [PMID: 21516077 DOI: 10.1038/modpathol.2011.71] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Mucinous cystic neoplasm of the liver has been a controversial entity, in particular, regarding differentiation from intraductal papillary neoplasm of the bile duct. In this study, we compared the characteristics of hepatic mucinous cystic neoplasms with ovarian-like stroma (n=29) to those of cyst-forming intraductal papillary neoplasms of the bile duct (n=12). Radiological or macroscopic appearance, histological grade of malignancy, and postoperative clinical course were recorded. Immunohistochemistry for biliary or gastrointestinal markers was performed to characterize cell phenotypes. The patients with hepatic mucinous cystic neoplasm were all female and ranged in age from 21 to 67 years, which was significantly younger than that in the patients with biliary intraductal papillary neoplasm. Eighteen mucinous cystic neoplasms (76%) were located in the left lobe, with 13 (54%) in segment IV. Mucinous cystic neoplasms were significantly larger than intraductal papillary neoplasms (median diameter: 110 vs 50 mm, P=0.008). In contrast to intraductal papillary neoplasms that were all histologically malignant, 26 mucinous cystic neoplasms (90%) were adenomas, 2 (7%) were borderline malignant, and 1 (3%) was a carcinoma in situ. Benign mucinous cystadenomas had the pure biliary immunophenotype, whereas gastrointestinal markers including cytokeratin 20 and mucin core proteins 2, 5AC, and 6 were more frequently expressed in borderline or malignant mucinous cystic neoplasms and biliary intraductal papillary neoplasms. There was no mortality in the patients with mucinous cystic neoplasm, whereas one patient with intraductal papillary neoplasm died of cancer. In conclusion, hepatic mucinous cystic neoplasms and biliary intraductal papillary neoplasms have different clinicopathological characteristics as evidenced by differences in the age and gender of patients, macroscopic appearance, immunophenotypes, and grades of malignancy.
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Affiliation(s)
- Yoh Zen
- Institute of Liver Studies, King's College Hospital, London, UK.
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18
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Singhal A, Kanagala R, Wright HI, Kohli V. Multiple bile duct hamartomas mimicking diffuse hepatic metastasis: GI image. J Gastrointest Surg 2010; 14:1629-31. [PMID: 20480252 DOI: 10.1007/s11605-010-1224-9] [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] [Received: 04/08/2010] [Accepted: 04/28/2010] [Indexed: 01/31/2023]
Abstract
Bile duct hamartomas (von Meyenburg complex) are the rare benign neoplasm of the liver due to dysembryogenesis; constituted historically, cystic dilatations of the bile duct encompassed by fibrous stroma. Usually, they are asymptomatic and are not detected on routine radiological examinations including ultrasound or CT scan. Magnetic resonance cholangiography has been suggested as the best investigation for their imaging diagnosis. Their presence can cause diagnostics confusion and complicate the patient's management. We report a 45-year-old female with symptomatic cholelithiasis, whose liver on laparoscopy mimicked multiple hepatic metastases.
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Affiliation(s)
- Ashish Singhal
- Nazih Zuhdi Transplant Institute, INTEGRIS Baptist Medical Center, 3300 NW Expressway, Oklahoma City, OK 73112, USA
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19
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20
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Ryu Y, Matsui O, Zen Y, Ueda K, Abo H, Nakanuma Y, Gabata T. Multicystic biliary hamartoma: imaging findings in four cases. ACTA ACUST UNITED AC 2009; 35:543-7. [DOI: 10.1007/s00261-009-9566-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 07/30/2009] [Indexed: 12/23/2022]
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21
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Nakanuma Y, Zen Y, Harada K, Ikeda H, Sato Y, Uehara T, Sasaki M. Tumorigenesis and phenotypic characteristics of mucin-producing bile duct tumors: an immunohistochemical approach. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2009; 17:211-22. [PMID: 19680592 DOI: 10.1007/s00534-009-0158-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Accepted: 04/30/2009] [Indexed: 12/13/2022]
Abstract
Intraductal papillary neoplasm of the bile duct (IPNB) is characterized by exophytic proliferation of neoplastic epithelial cells with fibrovascular stalks in bile duct lumen, mucin hypersecretion, and considerable dilatation or multilocular changes of the affected bile ducts. A mucin-producing bile duct tumor is an IPNB with excessive mucin production and clinical symptoms. Herein, the phenotypes as well as the tumorigenesis and progression of IPNB are reviewed with immunohistochemical assistance. The tumors are subdivided into three phenotypes: pancreatobiliary, intestinal, and gastric. About half of IPNB cases are of the pancreatobiliary type, and the remaining half are of the intestinal type. Aberrant expression of CDX2 with MUC2 and CK20 is related to the development of intestinal metaplasia. Inactivation of P16INK4a and nuclear expression of beta-catenin are related to the development of IPNB. Decreased expression of membranous beta-catenin and E-cadherin and aberrant expression of MMP-7 and -9 and of MUC1 are related to invasion of IPNB with tubular adenocarcinoma, whereas MUC2 is involved in the invasion of IPNB with mucinous carcinoma. IPNB can be regarded as a counterpart of intraductal papillary mucinous neoplasm (IPMN) of the pancreas, particularly the main duct type. More comparative studies between IPNB and pancreatic IPMN are recommended for further analysis of these papillary neoplasms.
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Affiliation(s)
- Yasuni Nakanuma
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, 920-8640, Japan.
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22
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Kai K, Takahashi T, Miyoshi A, Yasui T, Tokunaga O, Miyazaki K. Intrahepatic multicystic biliary hamartoma: report of a case. Hepatol Res 2008; 38:629-34. [PMID: 18179562 DOI: 10.1111/j.1872-034x.2007.00314.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Multicystic biliary hamartoma is a very rare hamartomatous nodule in the liver, which has recently been described as a new category of hepatic nodular lesion. We herein report the case of a 55-year-old man histopathologically diagnosed with this entity following surgery. A solitary multilocular lesion in the liver was pointed out by ultrasonography during a systemic examination for a positive HBs antigen. This nodule could not be definitively diagnosed by radiologic modalities, including computed tomography, magnetic resonance imaging and arteriography. The patient underwent a partial resection of the posterior segment of the liver. The nodule was a localized lesion which measured 5 x 3 cm at the widest point and displayed a honeycomb appearance. Histologically, it consisted of ductal structures, periductal glands, fibrous connective tissues containing blood vessels, and bile-like materials and xanthogranulomatous inflammation within some ducts. Liver parenchyma was not present in the nodule and the bile ducts were not dilated in the background liver. The ductal epithelium expressed biliary type cytokeratins (CK7 and 19) in immunohistochemical studies. These histopathological features were consistent with multicystic biliary hamartoma, and we discuss this rare case in detail in this report.
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Affiliation(s)
- Keita Kai
- Department of Surgery and Department of Pathology and Biodefense, Saga University Faculty of Medicine, Saga, Japan
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23
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Guarrera JV, Alkofer BJ, Feirt N, Sandoval R, Samstein B, Smith ET, Marshman D, Cogswell C, Vannatta J, Brown RS, Emond JC, Renz JF. Discovery of diffuse biliary microhamartomas during liver procurement. Liver Transpl 2007; 13:1470-1. [PMID: 17902135 DOI: 10.1002/lt.21194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- James V Guarrera
- Center for Liver Disease and Transplantation, Department of Pathology, Columbia University Medical Center, New York, NY 10032, and Carilion Roanoke Memorial Hospital, VA, USA.
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Abstract
PURPOSE OF REVIEW Recent papers on disorders of the liver and biliary tract which clarify their pathogenesis and attendant morphologic changes are highlighted. RECENT FINDINGS The concept of 'bystander hepatitis' was cited in studies showing hepatic infiltration of CD8-positive T cells in the setting of extrahepatic infections such as influenza virus and severe acute respiratory syndrome. Diabetic liver lesions include glycogenic hepatopathy (in which poor diabetic control leads to swollen, glycogen-filled hepatocytes without fat, steatohepatitis or fibrosis) and diabetic hepatosclerosis in which there is diffuse perisinusoidal fibrosis (type IV collagen) without zonal predilection. Ground-glass hepatocellular inclusions (positive with periodic acid-Schiff stain for glycogen) were reported in three separate series of patients who were hepatitis B virus-negative, often transplant recipients, immunosuppressed and on multiple medications. A Banff consensus paper expertly compared and contrasted the histologic features which characterize the various causes of late liver allograft dysfunction. SUMMARY Informative papers emerged this past year concerning collateral damage to the liver in extrahepatic infections, diabetic lesions and causes of liver dysfunction after transplantation, among other topics.
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Affiliation(s)
- Jay H Lefkowitch
- Department of Pathology, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
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