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Frenette C, Mendiratta-Lala M, Salgia R, Wong RJ, Sauer BG, Pillai A. ACG Clinical Guideline: Focal Liver Lesions. Am J Gastroenterol 2024; 119:1235-1271. [PMID: 38958301 DOI: 10.14309/ajg.0000000000002857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 04/25/2024] [Indexed: 07/04/2024]
Abstract
Focal liver lesions (FLLs) have become an increasingly common finding on abdominal imaging, especially asymptomatic and incidental liver lesions. Gastroenterologists and hepatologists often see these patients in consultation and make recommendations for management of multiple types of liver lesions, including hepatocellular adenoma, focal nodular hyperplasia, hemangioma, and hepatic cystic lesions including polycystic liver disease. Malignancy is important to consider in the differential diagnosis of FLLs, and healthcare providers must be familiar with the diagnosis and management of FLLs. This American College of Gastroenterology practice guideline uses the best evidence available to make diagnosis and management recommendations for the most common FLLs.
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Affiliation(s)
| | | | - Reena Salgia
- Department of Gastroenterology/Hepatology, Henry Ford Health, Detroit, Michigan, USA
| | - Robert J Wong
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System and Stanford University School of Medicine, Palo Alto, California, USA
| | - Bryan G Sauer
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA
| | - Anjana Pillai
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Chicago Medical Center, University of Chicago, Chicago, Illinois, USA
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2
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Jain D, Khandakar B, Ni P, Kenney B, Qin L, Deshpande V, Fiel MI. von Meyenburg complexes are more frequently associated with cholangiocarcinoma. J Clin Pathol 2024:jcp-2024-209572. [PMID: 38729770 DOI: 10.1136/jcp-2024-209572] [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: 04/06/2024] [Accepted: 04/21/2024] [Indexed: 05/12/2024]
Abstract
AIM There is some evidence that von Meyenburg complexes (VMCs) can progress to cholangiocarcinoma (CC). This study aimed to evaluate the prevalence of VMCs in CC cases. METHODS All hepatic resections and explants with intra-hepatic CC (I-CC) and hilar-CC (H-CC) from 1985 to 2020 were studied. Hepatic resections (n=68) for benign lesions or metastatic colonic carcinoma and 15 cases with cirrhosis without any cancer were used as controls. RESULTS A total of 118 cases of CC (88 I-CC, 30 H-CC) were identified. Of these, 61 (52%) patients had no known background liver disease, and 20 (17%) had cirrhosis. Associated liver disorders included metabolic dysfunction-associated steatohepatitis (23), chronic viral hepatitis B or C (13), biliary disease (primary or secondary sclerosing cholangitis) (8), polycystic kidney disease (6), cryptogenic cirrhosis (5) and others miscellaneous disorders (7). VMCs were present in 34 (39%) of 88 I-CC cases and 7 (23%) of 30 H-CC cases. VMCs were present within the tumour (20 cases), outside the cancer (21 cases) or at both locations (10 cases). VMCs with dysplasia/carcinoma in situ were seen in 19 of 41 (46%) cases with CC and VMCs. In addition, bile duct adenomas were identified in 6 (5%) of CC. 7% of controls showed the presence of VMCs compared with 35% of CC cases (p<0.05). CONCLUSIONS VMCs are seen far more frequently in patients with CC than in the control group. The findings support the hypothesis that VMCs could represent a precursor of CC or a marker for a higher risk of developing CC.
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Affiliation(s)
- Dhanpat Jain
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Binny Khandakar
- Department of Pathology and Laboratory Medicine, Donald Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Pu Ni
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Barton Kenney
- Department of Pathology, Middlesex Health, Middletown, Connecticut, USA
| | - Lihui Qin
- Department of Pathology, Weill Cornell Medical College, New York City, New York, USA
| | - Vikram Deshpande
- Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA
| | - Maria Isabel Fiel
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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3
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Hirayama AB, Mello ESD, Alves VAF. INTRAHEPATIC BILIARY PROLIFERATIONS: HISTOPATHOLOGY AND POTENTIAL IMMUNOHISTOCHEMICAL MARKERS. ARQUIVOS DE GASTROENTEROLOGIA 2023; 60:393-403. [PMID: 37792770 DOI: 10.1590/s0004-2803.23032023-107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 10/06/2023]
Abstract
•Intrahepatic biliary proliferations represent a spectrum varying from reactive to malignant entities. •Clinical and imaging patterns may be similar, requiring histopathological and immunohistochemistry for precise diagnosis. Intrahepatic biliary proliferations represent a spectrum from reactive (ductular reaction, some with atypical architecture), hamartomatous (von Meyenburg complex), benign (bile duct adenoma) and precursor/borderline entities (biliary intraepithelial neoplasia, intraductal papillary neoplasm of the bile duct) to fully malignant (cholangiocarcinoma) neoplasms. Clinical pictures and even imaging patterns may be similar, requiring refined studies aiming at histopathological and immunohistochemistry for more precise diagnosis, essential for correct patient management. This article discusses updated concepts and definitions of most relevant entities aiming more specifically at the differential diagnosis in practice, focusing on morphology and immunohistochemistry, with a discussion of potential markers to help distinguishing between benign and malignant lesions.
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Affiliation(s)
- André Bubna Hirayama
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
- CICAP - Anatomia Patológica, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
| | - Evandro Sobroza de Mello
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
- CICAP - Anatomia Patológica, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
| | - Venâncio Avancini Ferreira Alves
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
- CICAP - Anatomia Patológica, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
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4
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Drenth J, Barten T, Hartog H, Nevens F, Taubert R, Torra Balcells R, Vilgrain V, Böttler T. EASL Clinical Practice Guidelines on the management of cystic liver diseases. J Hepatol 2022; 77:1083-1108. [PMID: 35728731 DOI: 10.1016/j.jhep.2022.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 02/07/2023]
Abstract
The advent of enhanced radiological imaging techniques has facilitated the diagnosis of cystic liver lesions. Concomitantly, the evidence base supporting the management of these diseases has matured over the last decades. As a result, comprehensive clinical guidance on the subject matter is warranted. These Clinical Practice Guidelines cover the diagnosis and management of hepatic cysts, mucinous cystic neoplasms of the liver, biliary hamartomas, polycystic liver disease, Caroli disease, Caroli syndrome, biliary hamartomas and peribiliary cysts. On the basis of in-depth review of the relevant literature we provide recommendations to navigate clinical dilemmas followed by supporting text. The recommendations are graded according to the Oxford Centre for Evidence-Based Medicine system and categorised as 'weak' or 'strong'. We aim to provide the best available evidence to aid the clinical decision-making process in the management of patients with cystic liver disease.
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Sharbidre K, Zahid M, Venkatesh SK, Bhati C, Lalwani N. Imaging of fibropolycystic liver disease. Abdom Radiol (NY) 2022; 47:2356-2370. [PMID: 35670875 DOI: 10.1007/s00261-022-03565-7] [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: 03/22/2022] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 11/01/2022]
Abstract
Fibropolycystic liver diseases (FLDs) make up a rare spectrum of heritable hepatobiliary diseases resulting from congenital ductal plate malformations (DPMs) due to the dysfunction of proteins expressed on the primary cilia of cholangiocytes. The embryonic development of the ductal plate is key to understanding this spectrum of diseases. In particular, DPMs can result in various degrees of intrahepatic duct involvement and a wide spectrum of cholangiopathies, including congenital hepatic fibrosis, Caroli disease, polycystic liver disease, and Von Meyenberg complexes. The most common clinical manifestations of FLDs are portal hypertension, cholestasis, cholangitis, and (in rare cases) cholangiocarcinoma. This article reviews recent updates in the pathophysiology, imaging, and clinical management of FLDs.
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Affiliation(s)
- Kedar Sharbidre
- Department of Abdominal Imaging, University of Alabama at Birmingham, Birmingham, AB, USA.
| | - Mohd Zahid
- Department of Abdominal Imaging, University of Alabama at Birmingham, Birmingham, AB, USA
| | | | - Chandra Bhati
- Department of Transplant Surgery, University of Maryland Medical Center, Baltimore, ML, USA
| | - Neeraj Lalwani
- Department of Abdominal Imaging, Virginia Commonwealth University, Richmond, VA, USA
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Kinoshita IHB, Torres US, Zanini LAP, Pinto MF, Veloso JDCV, de Siqueira GRS, D'Ippolito G. The Ductal Plate From the Inside Out: An Illustrated Review of Fibropolycystic Liver Disease. Semin Ultrasound CT MR 2022; 43:510-516. [DOI: 10.1053/j.sult.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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7
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Yuan Y, Fu G, Wan F, Chen XL, Feng J. Imaging analysis of the malignant transformation of bile duct hamartomas in the liver: A case report and literature review. Exp Ther Med 2022; 23:431. [PMID: 35607375 PMCID: PMC9121201 DOI: 10.3892/etm.2022.11358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/21/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yuan Yuan
- Department of Ultrasound, The Second Hospital of Wuxi Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214002, P.R. China
| | - Gang Fu
- Department of Ultrasound, The Second Hospital of Wuxi Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214002, P.R. China
| | - Feng Wan
- Department of Ultrasound, The Second Hospital of Wuxi Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214002, P.R. China
| | - Xu-Lei Chen
- Department of Pathology, The Second Hospital of Wuxi Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214002, P.R. China
| | - Jun Feng
- Department of Ultrasound, The Second Hospital of Wuxi Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214002, P.R. China
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8
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Sheikh AAE, Nguyen AP, Leyba K, Javed N, Shah S, Deradke A, Cormier C, Shekhar R, Sheikh AB. Biliary Duct Hamartomas: A Systematic Review. Cureus 2022; 14:e25361. [PMID: 35774682 PMCID: PMC9236677 DOI: 10.7759/cureus.25361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 11/09/2022] Open
Abstract
Biliary duct hamartomas are benign intrahepatic bile duct lesions. Despite being primarily incidental findings on imaging, these lesions can provide a diagnostic conundrum due to their shared characteristics with malignant tumors. The goal of this systematic review is to offer a thorough clinical profile of biliary duct hamartomas. There were 139 cases of biliary duct hamartomas identified in a structured systematic review of the literature. Patient demographics, clinical presentation, significant laboratory and imaging data, diagnostic modalities, treatment choices, and outcomes were all studied and reported. Biliary duct hamartomas present with mild symptoms and laboratory abnormalities, and while being visible on imaging, the results are non-specific and may require biopsy in case of red flag signs such as weight loss and a progressive increase in the size of the lesion. Furthermore, there are currently no published guidelines for the treatment of biliary duct hamartomas, and many people have had surgery despite the clinically benign nature of these abnormalities. As per the findings of the study, individuals who exhibit signs of malignancy should be investigated further. Eyeballing for red flag symptoms, followed by a specialized imaging scan and invasive treatment, is the three-step approach to biliary duct hamartomas. Since our recommendations include a shift in strategy and do not contradict existing rules, there are likely to be few roadblocks to improvement; the key barriers being technological equipment and image quality. In this study, we intended to pave the way for future research in the field. In our opinion, the next decade will bring a better understanding of the characteristics of biliary hamartomas, disease symptoms, and better recognition of any suspicious features. These indications will aid in reducing the number of unneeded surgical or invasive operations. Finally, the findings of these future studies will allow the medical community to improve and provide the best care possible.
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Affiliation(s)
- Abdul Ahad E Sheikh
- Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Anthony P Nguyen
- Internal Medicine, University of New Mexico School of Medicine, Albuquerque, USA
| | - Katarina Leyba
- Internal Medicine, University of New Mexico School of Medicine, Albuquerque, USA
| | - Nismat Javed
- Internal Medicine, Shifa International Hospital, Islamabad, PAK
| | - Sana Shah
- Medicine, Aga Khan University, Karachi, PAK
| | - Alexander Deradke
- Internal Medicine, University of New Mexico School of Medicine, Albuquerque, USA
| | | | - Rahul Shekhar
- Internal Medicine, University of New Mexico School of Medicine, Albuquerque, USA
| | - Abu Baker Sheikh
- Internal Medicine, University of New Mexico School of Medicine, Albuquerque, USA
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Wang Q, Xu Y, Wang SM, Hu AY, Pan YC, Zhang SH. Histopathological evidence of intrahepatic cholangiocarcinoma occurring in ductal plate malformation: A clinicopathologic study of 5 cases. Ann Diagn Pathol 2021; 55:151828. [PMID: 34571341 DOI: 10.1016/j.anndiagpath.2021.151828] [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: 06/15/2021] [Revised: 07/06/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
Ductal plate malformations (DPM) arise from abnormal remodeling of the embryologic ductal plate of the liver. Malignant transformation of DPMs to intrahepatic cholangiocarcinoma (iCCA) has been reported in very rare instances but is viewed with some skepticism. We report the clinicopathological findings in five cases of iCCA, occurring in liver with DPM-like features. All tumors were less than 5 cm, often presented as stage T1a tumors. Histologically, a typical tumor showed a vague multinodular architecture with larger, irregular, tortuous glandular structures with microcystic dilation, intraluminal fibroepithelial projection, and bridge/island formation. The tumor cells were relatively small, bland, and without obvious pleomorphism. Interestingly, DPM presented as a histopathological transition sequence of definitively benign to biliary intraepithelial neoplasia (bilIN), then finally to iCCA. A complete pushing border, with entrapped portal tracts at the edge of the main tumor, suggested a replacing growth pattern. There was gradually increased expression of Ki-67 and p53 in these transition phases from benign to bilIN then to iCCA with DPM-like features. The neoplastic epithelium exhibited immunoreactivity in EpCAM, MUC1, NCAM, and CK19. KRAS mutation was found in 2 of the 5 iCCA cases with DPM-like features. Multifocal DPMs or VMCs with bilIN were dispersed in the non-tumor liver parenchyma in 3 of the 5 cases. The neoplasm was interpreted as iCCA arising in DPM, which may have originated from small bile duct or hepatic precursor cells. More studies are needed to verify this scarce entity and its premalignant properties.
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Affiliation(s)
- Qian Wang
- Department of Pathology, Yueyang Integrated Traditional Chinese and Western Medicine Hospital, Shanghai University of traditional Chinese Medicine, Shanghai, China
| | - Yi Xu
- Department of Pathology, Yueyang Integrated Traditional Chinese and Western Medicine Hospital, Shanghai University of traditional Chinese Medicine, Shanghai, China
| | - Shou-Mei Wang
- Department of Pathology, Yueyang Integrated Traditional Chinese and Western Medicine Hospital, Shanghai University of traditional Chinese Medicine, Shanghai, China
| | - Ai-Yan Hu
- Department of Pathology, Yueyang Integrated Traditional Chinese and Western Medicine Hospital, Shanghai University of traditional Chinese Medicine, Shanghai, China
| | - Yun-Cui Pan
- Department of Pathology, Yueyang Integrated Traditional Chinese and Western Medicine Hospital, Shanghai University of traditional Chinese Medicine, Shanghai, China
| | - Shu-Hui Zhang
- Department of Pathology, Yueyang Integrated Traditional Chinese and Western Medicine Hospital, Shanghai University of traditional Chinese Medicine, Shanghai, China.
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10
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Heterogeneous liver. Rev Med Interne 2021; 43:187-188. [PMID: 34563394 DOI: 10.1016/j.revmed.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/28/2021] [Indexed: 11/22/2022]
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11
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Shirazi N, Chauhan NV, Chandra S, Kumar SS. Von Meyenburg complex clinically presenting as metastatic liver nodule: A rare finding in an elderly male. J Lab Physicians 2020; 11:385-387. [PMID: 31929709 PMCID: PMC6943869 DOI: 10.4103/jlp.jlp_55_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Von Meyenburg complex is a benign biliary hamartoma observed in approximately 3% of the autopsies conducted. These hamartomas are small, multiple and can be seen anywhere in the liver. There is usually no abnormality in liver function tests, and the patient is mostly asymptomatic. They serve as a diagnostic dilemma, particularly during metastatic workup in suspected cancer patients. Imaging studies are usually noncontributory, and biopsy is necessary for a definite diagnosis. We present here a middle-aged North Indian male who underwent liver biopsy to rule out metastasis.
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Affiliation(s)
- Nadia Shirazi
- Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Neena V Chauhan
- Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Smita Chandra
- Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Sunil Saini Kumar
- Department of Surgery, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
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12
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Shear wave elastography for differentiating biliary hamartoma from liver cirrhosis: A case series study and literature review. ADVANCES IN DIGESTIVE MEDICINE 2019. [DOI: 10.1002/aid2.13132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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13
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Mamone G, Carollo V, Cortis K, Aquilina S, Liotta R, Miraglia R. Magnetic resonance imaging of fibropolycystic liver disease: the spectrum of ductal plate malformations. Abdom Radiol (NY) 2019; 44:2156-2171. [PMID: 30852632 DOI: 10.1007/s00261-019-01966-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Fibropolycystic liver diseases, also known as ductal plate malformations, are a group of associated congenital disorders resulting from abnormal development of the biliary ductal system. These disorders include congenital hepatic fibrosis, biliary hamartomas, polycystic liver disease, choledochal cysts and Caroli disease. Recently, it has been thought to include biliary atresia in this group of diseases, because ductal plate malformations could be implicated in the pathogenesis of this disease. Concomitant associated renal anomalies can also be present, such as autosomal recessive polycystic kidney disease (ARPKD), medullary sponge kidney and nephronophthisis. These disorders can be clinically silent or can cause abnormalities such as cholangitis, portal hypertension, gastrointestinal bleeding and infections. The different types of ductal plate malformations show typical findings at magnetic resonance (MR) imaging. A clear knowledge of the embryology and pathogenesis of the ductal plate plays a pivotal role to understand the characteristic imaging appearances of these complex diseases. Awareness of these MR imaging findings is central to the detecting and differentiating between various fibropolycystic liver diseases and is important to direct appropriate clinical management and prevent misdiagnosis.
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Affiliation(s)
- Giuseppe Mamone
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127, Palermo, Italy.
| | - Vincenzo Carollo
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127, Palermo, Italy
| | - Kelvin Cortis
- Department of Medical Imaging, Mater Dei Hospital, Msida, MSD 2090, Malta
| | - Sarah Aquilina
- Department of Medical Imaging, Mater Dei Hospital, Msida, MSD 2090, Malta
| | - Rosa Liotta
- Pathology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127, Palermo, Italy
| | - Roberto Miraglia
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127, Palermo, Italy
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Jáquez-Quintana JO, Reyes-Cabello EA, Bosques-Padilla FJ. Multiple Biliary Hamartomas, The ''Von Meyenburg Complexes''. Ann Hepatol 2018; 16:812-813. [PMID: 28809728 DOI: 10.5604/01.3001.0010.2822] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Joel O Jáquez-Quintana
- Universidad Autónoma de Nuevo León, Monterrey, Mexico Gastroenterology Division, Hospital Universitario "Dr. José Eleuterio González"
| | - Erick A Reyes-Cabello
- Universidad Autónoma de Nuevo León, Monterrey, Mexico Gastroenterology Division, Hospital Universitario "Dr. José Eleuterio González"
| | - Francisco J Bosques-Padilla
- Universidad Autónoma de Nuevo León, Monterrey, Mexico Gastroenterology Division, Hospital Universitario "Dr. José Eleuterio González"
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15
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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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16
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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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Yang XY, Zhang HB, Wu B, Li AJ, Fu XH. Surgery is the preferred treatment for bile duct hamartomas. Mol Clin Oncol 2017; 7:649-653. [PMID: 28855998 DOI: 10.3892/mco.2017.1354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 07/22/2017] [Indexed: 12/19/2022] Open
Abstract
Bile duct hamartoma (BDH) is a rare liver disease with a rising incidence in recent years. A retrospective study on BDH patients between June 2007 and December 2015 was conducted. All the medical records, including clinical, imaging and pathological characteristics, were retrieved. Follow-up data were obtained by telephone communication. The majority of the patients had no symptoms and the laboratory tests were normal. The appearance on ultrasound examination was variable. The lesion exhibited low density on plain computed tomography and no enhancement in 4 cases, and inhomogeneous enhancement in 1 case. Magnetic resonance imaging examination revealed hypointensity on T1-weighted imaging (WI), hyperintensity on T2WI, no enhancement in 1 case, and enhancement in 4 cases. Two patients underwent magnetic resonance cholangiopancreatography due to jaundice and intrahepatic bile duct dilation. The preoperative diagnosis was liver cancer in 4 cases, hepatic hilar biliary obstruction in 1, chronic calculous cholecystitis in 1, suspected hepatic abscess in 1, and benign liver tumor in 2 cases. All the patients underwent surgery. Nest-like cell arrangements were observed in 2 patients, and in 1 patient the lesion transformed to intrahepatic cholangiocarcinoma, resulting in the patient's death 25 months after surgery. Thus, BDH may transform into a life-threatening cholangiocarcinoma and it should be surgically removed. Furthermore, the mechanism underlying carcinogenesis in BDH requires further investigation.
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Affiliation(s)
- Xiao-Yu Yang
- Division of Special Treatment II, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, P.R. China
| | - Hai-Bo Zhang
- The First Department of General Surgery, Cixian People's Hospital, Handan, Hebei 056500, P.R. China
| | - Bin Wu
- Division of Special Treatment II, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, P.R. China
| | - Ai-Jun Li
- Division of Special Treatment II, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, P.R. China
| | - Xiao-Hui Fu
- Division of Special Treatment II, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, P.R. China
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Singh Y, Cawich SO, Ramjit C, Naraynsingh V. Rare liver tumor: symptomatic giant von Meyenburg complex. J Surg Case Rep 2017; 2016:rjw195. [PMID: 28068648 PMCID: PMC5221604 DOI: 10.1093/jscr/rjw195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
von Meyenburg complexes are hamartomas that arise from intra-hepatic bile ducts. Symptomatic lesions are uncommon and giant lesions are exceedingly rare. When encountered, they should be excised because there are reports of malignant change in large, symptomatic lesions. We report a case of a symptomatic giant von Meyenburg complex.
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Affiliation(s)
- Yardesh Singh
- Department of Clinical Surgical Sciences, Faculty of Medicine, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad & Tobago
| | - Shamir O Cawich
- Department of Clinical Surgical Sciences, Faculty of Medicine, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad & Tobago
| | - Chunilal Ramjit
- Department of Clinical Surgical Sciences, Faculty of Medicine, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad & Tobago
| | - Vijay Naraynsingh
- Department of Clinical Surgical Sciences, Faculty of Medicine, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad & Tobago
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19
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Koay DSC, Leow WQ, Tan TT, Slapak G. Recurrent hepatobiliary sepsis in a patient with von Meyenburg complexes: a case report and review of the literature. PROCEEDINGS OF SINGAPORE HEALTHCARE 2016. [DOI: 10.1177/2010105816670413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The von Meyenburg complex (VMC) is a rare, congenital malformation of the ductal plate. It is typically asymptomatic and usually discovered incidentally. We report a unique case of recurrent life-threatening hepatobiliary sepsis caused by VMC and a review of the literature. A 62-year-old man presented with recurrent episodes of life-threatening hepatobiliary sepsis. Extensive investigations only showed that he has VMCs without any other source of sepsis or underlying immunodeficiency states. Despite prolonged courses of antibiotics which resolved each episode of sepsis, he suffers repeated recurrences of hepatobiliary sepsis. Liver transplantation is now being considered in view of his refractoriness to medical therapy. As VMC can present with severe hepatobiliary sepsis, it is therefore essential to recognise its presence. This case adds to the literature the atypical but life-threatening clinical presentation of VMC.
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Affiliation(s)
| | - Wei Qiang Leow
- Department of Pathology, Singapore General Hospital, Singapore
| | - Thuan Tong Tan
- Department of Infectious Disease, Singapore General Hospital, Singapore
| | - Gabrielle Slapak
- Department of Gastroenterology, Barking, Havering and Redbridge NHS Trust, UK
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Malignant Transformation in Von-Meyenburg Complexes: Histologic and Immunohistochemical Clues With Illustrative Cases. Appl Immunohistochem Mol Morphol 2016; 23:607-14. [PMID: 25789533 DOI: 10.1097/pai.0000000000000132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Benign developmental defects known as Von-Meyenburg complexes (VMCs) have been postulated to progress to cholangiocarcinoma (CC) in rare instances. Although a gradual, sequential histologic transition from VMCs to CC has been described in some of these cases, the underlying genetic mechanism is yet to be elucidated. Here, we review the literature to put together a report on the clinicopathologic features and immunohistochemical changes associated with such transformation. We also review the documented association between CC and p16 inactivation, and discuss a possible role for this mechanism to contribute in VMCs to CC progression. In addition, using 2 illustrative cases encountered at our institute, we provide morphologic and immunohistochemical clues that can be used to detect such progression from hamartoma to malignancy. These cases and the accompanying review of literature further solidify the association between VMCs and CC.
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Thai E, Dalla Valle R, Evaristi F, Silini EM. A case of biliary adenofibroma with malignant transformation. Pathol Res Pract 2015; 212:468-70. [PMID: 26778388 DOI: 10.1016/j.prp.2015.12.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/23/2015] [Accepted: 12/22/2015] [Indexed: 12/21/2022]
Abstract
Identifying precursor lesions of cholangiocarcinoma (CC) is relevant for early diagnosis and management. While for distal, perihilar and large duct cholangiocarcinoma, premalignant lesions are being recognized and studied actively, precursors of peripheral CC are still poorly described. Biliary adenofibroma is a rare benign tumor that has been proposed as a possible precursor lesion of peripheral CC. In the present report, we describe a unique case of a peripheral ICC that originated from a benign biliary adenofibroma with areas of atypical papillary proliferation, which is an expression of a multistep process of carcinogenesis.
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Affiliation(s)
- Elena Thai
- Surgical Pathology Unit, University Hospital of Parma, Parma, Italy.
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Ettel M, Eze O, Xu R. Clinical and biological significance of precursor lesions of intrahepatic cholangiocarcinoma. World J Hepatol 2015; 7:2563-2570. [PMID: 26557948 PMCID: PMC4635141 DOI: 10.4254/wjh.v7.i25.2563] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/10/2015] [Accepted: 10/19/2015] [Indexed: 02/06/2023] Open
Abstract
Cholangiocarcinoma (CC) is primarily a malignant tumor of older adults most prevalent in Southeast Asia, where liver fluke infestation is high. However the etiology in western countries is unknown. Although the incidence of extrahepatic cholangiocarcinoma has remained constant, incidence of intrahepatic CC (ICC) which differs in morphology, pathogenesis, risk factors, treatment and prognosis is increasing. While this increase is associated with hepatitis C virus infection, chronic nonalcoholic liver disease, obesity, and smoking, the pathogenesis of ICC and molecular alterations underlying the carcinogenesis are not completely elucidated. Benign biliary lesions such as biliary intraepithelial neoplasia, intraductal papillary neoplasm of the bile duct, von Meyenburg complex or bile duct hamartoma, and bile duct adenoma have been associated with ICC. For each of these entities, evidence suggests or supports a role as premalignant lesions. This article summarized the important biological significance of the precursor lesions of ICC and the molecular mechanisms that may be involved in intrahepatic cholangiocarcinogenesis.
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Imaging of Von Meyenburg complexes. Diagn Interv Imaging 2015; 97:401-9. [PMID: 26522945 DOI: 10.1016/j.diii.2015.05.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/18/2015] [Accepted: 05/18/2015] [Indexed: 12/18/2022]
Abstract
Von Meyenburg complexes, or biliary hamartomas, are frequently incidentally detected. They are usually easy to characterize with magnetic resonance imaging. However, in some occasions they are difficult to differentiate from other liver lesions, in particular from small liver metastases. Von Meyenburg complexes are developmental malformations of the ductal plate. They can be found in association with Caroli disease and Caroli syndrome. Like other ductal plate malformations, Von Meyenburg complexes associated with cholangiocarcinoma have been described and their relationship has been established. This review provides an update on the etiopathogenesis of Von Meyenburg complexes, illustrates the imaging features on ultrasound, CT and MRI of this condition and discusses the most common diagnostic pitfalls. The relationships between Von Meyenburg complexes and the various ductal plate malformations and the most recent literature data regarding the relationships between Von Meyenburg complexes and cholangiocarcinoma are presented.
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Kwon AY, Lee HJ, An HJ, Kang H, Heo JH, Kim G. Intrahepatic Cholangiocarcinoma with Ductal Plate Malformation-like Feature Associated with Bile Duct Adenoma. J Pathol Transl Med 2015; 49:531-4. [PMID: 26265688 PMCID: PMC4696523 DOI: 10.4132/jptm.2015.06.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/10/2015] [Accepted: 06/19/2015] [Indexed: 12/04/2022] Open
Affiliation(s)
- Ah-Young Kwon
- Department of Pathology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Hye Jin Lee
- Department of Pathology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Hee Jung An
- Department of Pathology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Haeyoun Kang
- Department of Pathology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jin-Hyung Heo
- Department of Pathology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Gwangil Kim
- Department of Pathology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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26
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Pujals A, Bioulac-Sage P, Castain C, Charpy C, Zafrani ES, Calderaro J. BRAF V600E mutational status in bile duct adenomas and hamartomas. Histopathology 2015; 67:562-7. [PMID: 25704541 DOI: 10.1111/his.12674] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 02/13/2015] [Indexed: 12/12/2022]
Abstract
AIMS Bile duct adenomas (BDA) and bile duct hamartomas (BDH) are benign bile duct lesions considered neoplastic or secondary to ductal plate malformation, respectively. We have reported previously a high prevalence of BRAF V600E mutations detected by allele-specific polymerase chain reaction assay in BDA, and suggested that BDA may be precursors to a subset of intrahepatic cholangiocarcinomas harbouring V600E mutations. The aim of the present study was to assess the existence of BRAF V600E mutations, using immunohistochemical methods, in additional BDA as well as in BDH. METHODS AND RESULTS Fifteen BDA and 35 BDH were retrieved from the archives of the pathology departments of two French university hospitals. All cases were reviewed by two pathologists specialized in liver diseases. BRAF V600E mutational status was investigated by immunohistochemistry. Mutated BRAF mutant protein was detected in 53% of the BDA and in none of the cases of BDH. CONCLUSION Our findings suggest that BDA and BDH are different processes, and that BDA represent true benign neoplasms. They also support the hypothesis that mutated BDA might precede the development of the subset of intrahepatic cholangiocarcinomas harbouring BRAF V600E mutations.
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Affiliation(s)
- Anaïs Pujals
- Department of Pathology, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Créteil, France.,Faculté de Médecine, Université Paris-Est Créteil, Créteil, France.,Inserm U955, Equipe 9, Institut Mondor de Recherche Biomédicale, Créteil, France
| | - Paulette Bioulac-Sage
- Department of Pathology, CHU de Bordeaux, Pellegrin Hospital, Bordeaux, France.,Inserm, UMR-1053, Université de Bordeaux, Bordeaux, France
| | - Claire Castain
- Department of Pathology, CHU de Bordeaux, Pellegrin Hospital, Bordeaux, France.,Inserm, UMR-1053, Université de Bordeaux, Bordeaux, France
| | - Cécile Charpy
- Department of Pathology, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Créteil, France
| | - Elie Serge Zafrani
- Department of Pathology, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Créteil, France.,Faculté de Médecine, Université Paris-Est Créteil, Créteil, France
| | - Julien Calderaro
- Department of Pathology, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Créteil, France.,Faculté de Médecine, Université Paris-Est Créteil, Créteil, France.,Inserm U955 Equipe 18, Institut Mondor de Recherche Biomédicale, Créteil, France
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27
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Aishima S, Tanaka Y, Kubo Y, Shirabe K, Maehara Y, Oda Y. Bile duct adenoma and von Meyenburg complex-like duct arising in hepatitis and cirrhosis: pathogenesis and histological characteristics. Pathol Int 2014; 64:551-9. [PMID: 25329860 DOI: 10.1111/pin.12209] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 09/02/2014] [Indexed: 12/15/2022]
Abstract
Morphologic features and neoplastic potentials of bile duct adenoma (BDA) and von Meyenburg complex (VMC)-like duct arising in chronic liver disease were unknown. Thirty-five BDAs and 12 VMC-like duct lesions were observed in 39 cases with chronic liver disease. BDAs were divided into the EMA-cytoplasmic type (n = 14) and EMA-luminal type (n = 21). EMA-cytoplasmic BDA composed of a proliferation of cuboidal to low-columnar cells forming an open lumen with NCAM(+)/MUC6(-), resembling an interlobular bile duct. EMA-luminal BDA showed uniform cuboidal cells with narrow lumen, and NCAM(++)/MUC6(++), resembling a ductular reaction. VMC-like duct showed positive MUC1 expression and negative MUC6. The expression of S100P, glucose transporter-1 (GLUT-1) and insulin-like growth factor II mRNA-binding protein 3 (IMP-3) were not detected in three lesions. p16 expression was higher than those of the ductular reaction, and the Ki67 and p53 indexes were very low (<1.0%). Large-sized EMA-luminal BDA shows sclerotic stroma. We classified small nodular lesions of ductal or ductular cells in chronic hepatitis and cirrhosis into the following groups: BDA, interlobular bile duct type; BDA, ductular/peribiliary gland type; and VMC-like duct. They may be reactive proliferation rather than neoplastic lesions.
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Affiliation(s)
- Shinichi Aishima
- Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga, Japan
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28
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What are the precursor and early lesions of peripheral intrahepatic cholangiocarcinoma? Int J Hepatol 2014; 2014:805973. [PMID: 24860673 PMCID: PMC4016917 DOI: 10.1155/2014/805973] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 03/31/2014] [Indexed: 12/12/2022] Open
Abstract
Cholangiocarcinoma (CC) is divided into distal, perihilar, and intrahepatic CCs (ICCS), and are further subdivided into large bile duct ICC and peripheral ICC. In distal and perihilar CC and large duct ICC, biliary intraepithelial neoplasm (BilIN) and intraductal papillary neoplasm (IPN) have been proposed as precursor lesions. Peripheral ICC, bile duct adenoma (BDA), biliary adenofibroma (BAF), and von Meyenburg complexes (VMCs) are reportedly followed by development of ICCs. Herein, we surveyed these candidate precursor lesions in the background liver of 37 cases of peripheral ICC and controls (perihilar CC, 34 cases; hepatocellular carcinoma, 34 cases and combined hepatocellular cholangiocarcinoma, 25 cases). In the background liver of peripheral ICC, BDA and BAF were not found, but there were not infrequently foci of BDA-like lesions and atypical bile duct lesions involving small bile ducts (32.4% and 10.8%, resp.). VMCs were equally found in peripheral CCs and also control CCs. In conclusion, BDA, BAF, and VMCs are a possible precursor lesion of a minority of peripheral CCs, and BDA-like lesions and atypical bile duct lesions involving small bile ducts may also be related to the development of peripheral ICC. Further pathologic studies on these lesions are warranted for analysis of development of peripheral ICCs.
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Sato S, Watanabe H, Asano T, Saito R, Iwadate H, Kobayashi H, Ohira H. Biliary hamartomas (von Meyenburg complex) complicated with microscopic polyangiitis. Mod Rheumatol 2013. [DOI: 10.3109/s10165-012-0734-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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30
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Sato S, Watanabe H, Asano T, Saito R, Iwadate H, Kobayashi H, Ohira H. Biliary hamartomas (von Meyenburg complex) complicated with microscopic polyangiitis. Mod Rheumatol 2013; 23:611-3. [DOI: 10.1007/s10165-012-0734-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 07/30/2012] [Indexed: 10/28/2022]
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Affiliation(s)
- Yong Moon Shin
- Department of Radiology, University of Ulsan College of Medicine, Seoul, Korea.
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Strazzabosco M, Fabris L. Development of the bile ducts: essentials for the clinical hepatologist. J Hepatol 2012; 56:1159-1170. [PMID: 22245898 PMCID: PMC3328609 DOI: 10.1016/j.jhep.2011.09.022] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 09/08/2011] [Accepted: 09/13/2011] [Indexed: 02/07/2023]
Abstract
Several cholangiopathies result from a perturbation of developmental processes. Most of these cholangiopathies are characterised by the persistence of biliary structures with foetal configuration. Developmental processes are also relevant in acquired liver diseases, as liver repair mechanisms exploit a range of autocrine and paracrine signals transiently expressed in embryonic life. We briefly review the ontogenesis of the intra- and extrahepatic biliary tree, highlighting the morphogens, growth factors, and transcription factors that regulate biliary development, and the relationships between developing bile ducts and other branching biliary structures. Then, we discuss the ontogenetic mechanisms involved in liver repair, and how these mechanisms are recapitulated in ductular reaction, a common reparative response to many forms of biliary and hepatocellular damage. Finally, we discuss the pathogenic aspects of the most important primary cholangiopathies related to altered biliary development, i.e. polycystic and fibropolycystic liver diseases, Alagille syndrome.
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Affiliation(s)
- Mario Strazzabosco
- Section of Digestive Diseases, Yale University, New Haven, CT, USA; Department of Clinical Medicine, University of Milan-Bicocca, Milan, Italy.
| | - Luca Fabris
- Department of Clinical Medicine, University of Milan-Bicocca, Milan, Italy,Department of Surgical and Gastroenterological Sciences, University of Padova, Italy
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O'Dell MR, Huang JL, Whitney-Miller CL, Deshpande V, Rothberg P, Grose V, Rossi RM, Zhu AX, Land H, Bardeesy N, Hezel AF. Kras(G12D) and p53 mutation cause primary intrahepatic cholangiocarcinoma. Cancer Res 2012; 72:1557-67. [PMID: 22266220 DOI: 10.1158/0008-5472.can-11-3596] [Citation(s) in RCA: 157] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Intrahepatic cholangiocarcinoma (IHCC) is a primary cancer of the liver with an increasing incidence and poor prognosis. Preclinical studies of the etiology and treatment of this disease are hampered by the relatively small number of available IHCC cell lines or genetically faithful animal models. Here we report the development of a genetically engineered mouse model of IHCC that incorporates two of the most common mutations in human IHCC, activating mutations of Kras (Kras(G12D)) and deletion of p53. Tissue-specific activation of Kras(G12D) alone resulted in the development of invasive IHCC with low penetrance and long latency. Latency was shortened by combining Kras(G12D) activation with heterozygous or homozygous deletion of p53 (mean survival of 56 weeks vs. 19 weeks, respectively), which also resulted in widespread local and distant metastasis. Serial analysis showed that the murine models closely recapitulated the multistage histopathologic progression of the human disease, including the development of stroma-rich tumors and the premalignant biliary lesions, intraductal papillary biliary neoplasms (IPBN), and Von Meyenburg complexes (VMC; also known as biliary hamartomas). These findings establish a new genetically and histopathologically faithful model of IHCC and lend experimental support to the hypothesis that IPBN and VMC are precursors to invasive cancers.
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Affiliation(s)
- Michael R O'Dell
- James P. Wilmot Cancer Center, University of Rochester School of Medicine, Rochester, New York 14642, USA
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Pinho AC, Melo RB, Oliveira M, Almeida M, Lopes J, Graça L, Costa-Maia J. Adenoma-carcinoma sequence in intrahepatic cholangiocarcinoma. Int J Surg Case Rep 2012; 3:131-3. [PMID: 22326450 DOI: 10.1016/j.ijscr.2012.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Revised: 01/09/2012] [Accepted: 01/11/2012] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Cholangiocarcinoma is a rare tumor but recent data report a worldwide increase in incidence and mortality. There are several risk factors associated with cholangiocarcinoma, and chronic inflammation of billiary tree seems to be implied in the cholangiocarcinogenesis, but little is known about this process. PRESENTATION OF CASE We present a 56-year-old female with a bile duct adenoma incidentally discovered in the follow up of breast cancer that 18 months later progress to intrahepatic cholangiocarcinoma. DISCUSSION This is a rare presentation of intrahepatic cholangiocarcinoma that suggests the classic adenoma-carcinoma sequence in cholangiocarcinogenesis. Furthermore this case gives rise to some questions about the possible common ground on intrahepatic cholangiocarcinoma and breast cancer. CONCLUSION Cholangiocarcinogenesis is a complex multi-step mechanism and further investigations are needed to fully understand this process.
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Affiliation(s)
- André Costa Pinho
- Hepatobiliary-pancreatic Unit, General Surgery Department, Hospital S. João, Alameda Prof. Hernâni Monteiro 4200-319, Portugal; Faculty of Medicine, University of Porto, Hospital S. João, Alameda Prof. Hernâni Monteiro 4200-319, Portugal
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Dilli A, Ayaz UY, Yüksel I, Damar C, Ayaz S, Hekimoglu B. Computed tomography and magnetic resonance imaging findings in a case with biliary microhamartomas. Case Rep Med 2012; 2012:976078. [PMID: 22431945 PMCID: PMC3295846 DOI: 10.1155/2012/976078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Accepted: 10/30/2011] [Indexed: 02/07/2023] Open
Abstract
Biliary microhamartomas, also known as bile duct hamartomas and von Meyenburg complexes, are benign neoplasms containing cystic dilated bile ducts embedded in fibrous stroma. They develop in hepatobiliary system, do not generally give clinical outcomes, and are detected incidentally. However, they can rarely show malignant transformation. Our aim was to report the contribution of computed tomography, routine magnetic resonance imaging, and magnetic resonance cholangiopancreatography in the diagnosis of biliary microhamartomas in a 61-year-old woman.
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Affiliation(s)
- Alper Dilli
- 1Department of Radiology, Ministry of Health, Diskapi Yildirim Beyazit Training and Research Hospital, Altindag, O6110 Ankara, Turkey
- *Alper Dilli:
| | - Umit Yasar Ayaz
- 2Department of Radiology, Ministry of Health, Mersin Women's and Children's Hospital, Halkkent, 33240 Mersin, Turkey
| | - Ilhami Yüksel
- 3Department of Gastroenterology, Ministry of Health, Diskapi Yildirim Beyazit Training and Research Hospital, Altindag, O6110 Ankara, Turkey
| | - Cagrı Damar
- 1Department of Radiology, Ministry of Health, Diskapi Yildirim Beyazit Training and Research Hospital, Altindag, O6110 Ankara, Turkey
| | - Sevin Ayaz
- 4Department of Nuclear Medicine, Mersin State Hospital, Ministry of Health, 33050 Mersin, Turkey
| | - Baki Hekimoglu
- 1Department of Radiology, Ministry of Health, Diskapi Yildirim Beyazit Training and Research Hospital, Altindag, O6110 Ankara, Turkey
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Kim HK, Jin SY. Cholangiocarcinoma arising in von Meyenburg complexes. THE KOREAN JOURNAL OF HEPATOLOGY 2011; 17:161-4. [PMID: 21757989 PMCID: PMC3304640 DOI: 10.3350/kjhep.2011.17.2.161] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Hee Kyung Kim
- Department of Pathology, Soon Chun Hyang University Bucheon Hospital, Soon Chun Hyang University College of Medicine, Bucheon, Korea
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van Vlerken LG, van Leeuwen MS, Schipper MEI, van Erpecum KJ. The "Von Meyenburg complex": an unusual cause of cholangitis? Clin Res Hepatol Gastroenterol 2011; 35:762-4. [PMID: 21852223 DOI: 10.1016/j.clinre.2011.07.004] [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] [Received: 05/09/2011] [Revised: 06/28/2011] [Accepted: 07/11/2011] [Indexed: 02/04/2023]
Abstract
Von Meyenburg complexes are an unusual incidental finding at radiologic or pathologic evaluation of patients with suspected liver disease. We present a case report of a patient with recurrent septic episodes in whom von Meyenburg complexes were eventually diagnosed and discuss available literature on this topic.
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Affiliation(s)
- Lotte G van Vlerken
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
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Virginia Bürgesser M, Calafat P, Diller A. [Focal malignant transformation of a large biliary adenoma]. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 34:127-9. [PMID: 21333389 DOI: 10.1016/j.gastrohep.2010.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 10/03/2010] [Accepted: 10/13/2010] [Indexed: 11/29/2022]
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Vitule LF, Simionato FM, Melo MLD, Yoshitake R. Complexo de von Meyenburg: relato de caso e revisão da literatura. Radiol Bras 2010. [DOI: 10.1590/s0100-39842010000600014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Os hamartomas biliares, conhecidos como complexo de von Meyenburg, são lesões tipicamente benignas que podem mimetizar metástases aos exames de imagem. Neste estudo é relatado um caso de complexo de von Meyenburg e são discutidos o diagnóstico por imagem, a associação com doença policística do adulto, e o potencial maligno atualmente considerado e frequentemente ignorado deste achado, que torna necessário o acompanhamento
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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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Jain D, Nayak NC, Saigal S. Hepatocellular carcinoma arising in association with von-Meyenburg's complexes: an incidental finding or precursor lesions? A clinicopatholigic study of 4 cases. Ann Diagn Pathol 2010; 14:317-20. [PMID: 20850692 DOI: 10.1016/j.anndiagpath.2010.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Accepted: 04/06/2010] [Indexed: 12/22/2022]
Abstract
Biliary hamartomas or von-Meyenburg complexes form part of a spectrum of ductal plate malformation that includes polycystic liver disease, congenital hepatic fibrosis, and Caroli disease. These lesions are known to have neoplastic transformation. Development of intrahepatic cholangiocarcinoma is well described in these complexes. Rarely, hepatocellular carcinomas (HCCs) have been seen in association with bile duct hamartomas, however; it is not clear whether development of HCC is an epiphenomenon unrelated to the precursor lesion or biliary hamartomas may progress to liver cancers. We herein report 4 interesting cases of hepatitis C virus-, alcohol-, and nonalcoholic fatty liver disease-associated end-stage liver disease with coexisting HCC and multiple large von-Meyenburg complexes.
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Affiliation(s)
- Deepali Jain
- Department of Pathology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India.
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Mortelé KJ, Peters HE. Multimodality Imaging of Common and Uncommon Cystic Focal Liver Lesions. Semin Ultrasound CT MR 2009; 30:368-86. [DOI: 10.1053/j.sult.2009.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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