Pancreatic heterotropia in wall of extra-hepatic choledochal cysts: A retrospective analysis of thirteen of such cases from north India

Type 1 Choledochal Cyst with Ectopic Pancreas and Septate Gallbladder

Background Choledochal cysts (CCs), congenital cystic dilatation of the biliary tract, are more commonly identified in females and have been associated with a myriad of other developmental abnormalities. Case Report: We present a male infant who was diagnosed with type I CC prenatally. He subsequently underwent cyst and gallbladder resection with hepaticoduodenostomy reconstruction at the age of 6 months. Pathologic examination confirmed type I CC with co-existing septate gallbladder and ectopic pancreas (Heinrich type 1). Conclusions: Although the clinical significance is unclear, this second case of CC with septate gallbladder and ectopic pancreas highlights the embryologic association of these abnormalities.

Smooth Muscle Distribution Patterns of Choledochal Cysts and Their Implications for Pathogenesis and Postoperative Complications

OBJECTIVES

Histopathologic characteristics of choledochal cysts and their clinical implications have not been previously comprehensively studied.

METHODS

Smooth muscle distribution patterns and other histologic findings (inflammation, metaplasia, dysplasia, and heterotopia) in 233 surgically resected choledochal cysts were evaluated.

RESULTS

Mean patient age was 23.3 ± 19.8 years, with male:female ratio of 0.3. Most cases were Todani type I (175 cases, 75.1%) or IVa (56 cases, 24.1%). Choledochal cysts with thin scattered/no muscle fiber (175 cases, 75.1%) were the predominant pattern and were associated with more frequent postoperative biliary stricture (P = .031), less frequent pyloric metaplasia (P = .016), and mucosal smooth muscle aggregates (P < .001) compared to cysts with thick muscle bundles. Severe chronic cholangitis (P = .049), pyloric metaplasia (P = .019), mucosal smooth muscle aggregates (P < .001), biliary intraepithelial neoplasia (P = .021), and associated bile duct (P = .021) and gallbladder carcinomas (P = .03) were more common in adults (age >20 years vs ≤20 years), suggesting that chronic irritation in association with developmental anomalies involves tumorigenesis from choledochal cysts.

CONCLUSION

Smooth muscle distribution pattern of choledochal cyst may predict postoperative complication, raising clinical implications of smooth muscle patterns in postoperative management of choledochal cysts.