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C A D, Thejeswi P, Prabhu S, Kini J. A rare encounter - Unveiling the mysteries of biliary hamartoma: A case report. Int J Surg Case Rep 2024; 122:110119. [PMID: 39116666 PMCID: PMC11363819 DOI: 10.1016/j.ijscr.2024.110119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/29/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024] Open
Abstract
INTRODUCTION Biliary hamartomas are rare congenital development anomaly of bile ducts, which are detected incidentally. They often present as multiple lesions on liver surface which resembles metastatic lesions. We report a case of acute calculous cholecystitis ultimately diagnosed to have asymptomatic multiple biliary hamartomas. CASE DESCRIPTION A 42-year-old male with no co-morbidities presented with pain in upper abdomen associated with fever and vomiting. Contrast enhanced computed tomography (CECT) of abdomen showed acute calculous cholecystitis, hepatomegaly with fatty changes in liver. On laparoscopy the liver was found to have grey-white nodular lesions of about 0.5 cm in diameter scattered on the surface of both the lobes. One of the lesion was biopsied along with cholecystectomy. DISCUSSION Biliary hamartoma commonly referred to as "von Meyenburg complexes" are uncommon lesions found in the liver which are usually asymptomatic. In this case the patient presented with symptoms of acute cholecystitis but the biopsy report from liver lesions proved to be benign biliary hamartoma which on initial impression looked like multiple liver secondaries. CONCLUSION We have described a case of an adult with multiple biliary hamartoma which was an incidental finding. Biliary hamartoma is a rare entity which can sometime mimic metastasis in the liver. Thus, histopathological confirmation is essential before planning any further treatment.
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Affiliation(s)
- Deepika C A
- Department of General Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Poornachandra Thejeswi
- Department of General Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Shivananda Prabhu
- Department of General Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Jyothi Kini
- Department of Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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2
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Urzay Gutiérrez M, Vieiro Medina MV, Jiménez de Los Galanes Marchán S. Von Meyenburg complexes mimicking liver metastases of cholangiocarcinoma. J Gastrointest Surg 2024; 28:191-192. [PMID: 38445944 DOI: 10.1016/j.gassur.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 03/07/2024]
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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: 21] [Impact Index Per Article: 10.5] [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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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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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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Sarcognato S, Sacchi D, Fassan M, Fabris L, Cadamuro M, Zanus G, Cataldo I, Covelli C, Capelli P, Furlanetto A, Guido M. Benign biliary neoplasms and biliary tumor precursors. Pathologica 2021; 113:147-157. [PMID: 34294933 PMCID: PMC8299320 DOI: 10.32074/1591-951x-251] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 12/21/2022] Open
Abstract
Benign biliary tumor are common lesions that are often an incidental finding in subjects who undergo medical imaging tests for other conditions. Most are true neoplasms while few result from reactive or malformative proliferation. Benign tumors have no clinical consequences, although the premalignant nature or potential for malignant transformation is of concern in some cases. The main practical problem for pathologists is the need to differentiate them from malignant biliary tumours, which is not always straightforward. Premalignant lesions of the bile duct have been described, although their incidence has been poorly characterized. These lesions include biliary mucinous cystic neoplasms, intraductal papillary neoplasms of the bile duct, and biliary intraepithelial neoplasia. In this article, histopathology of benign biliary tumors and biliary tumor precursors is discussed, with a focus on the main diagnostic criteria.
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Affiliation(s)
| | - Diana Sacchi
- Department of Pathology, Azienda ULSS2 Marca Trevigiana, Treviso, Italy
| | - Matteo Fassan
- Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Luca Fabris
- Department of Molecular Medicine - DMM, University of Padova, Padova, Italy
| | | | - Giacomo Zanus
- 4 Surgery Unit, Azienda ULSS2 Marca Trevigiana, Treviso, Italy
- Department of Surgery, Oncology and Gastroenterology - DISCOG, University of Padova, Padova, Italy
| | - Ivana Cataldo
- Department of Pathology, Azienda ULSS2 Marca Trevigiana, Treviso, Italy
| | - Claudia Covelli
- Pathology Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, San GiovanniRotondo, Italy
| | - Paola Capelli
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy
| | | | - Maria Guido
- Department of Pathology, Azienda ULSS2 Marca Trevigiana, Treviso, Italy
- Department of Medicine - DIMED, University of Padova, Padova, Italy
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8
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Patania OM, Troan BV, Cullen JM. Ductal Plate Malformations in Captive Snakes. Vet Pathol 2021; 58:736-742. [PMID: 33938322 DOI: 10.1177/03009858211011941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ductal plate malformations are abnormalities in the liver that arise from inappropriate or incomplete remodeling of the embryologic ductal plate. Various types of ductal plate malformations are reported in the human and veterinary literature, most commonly affecting domestic mammalian species but also fish. We investigated the occurrence and described the histopathologic features of ductal plate malformations in captive snakes. Malformations were identified in 18 snakes: 10 colubrids, 6 vipers, and 2 boids. There was no sex predilection, and the mean age was 17 years. The majority of lesions were incidental with most snakes having one or more comorbidities, most commonly neoplasia or systemic inflammation, that resulted in natural death or euthanasia. Ductal plate malformations in all livers were broadly characterized by a well-demarcated nodule of irregular bile ducts embedded within a varying amount of fibrous stroma. Malformations were further categorized based on the amount of fibrous stroma and dilation of the bile ducts as von Meyenburg complexes, cystic liver disease, and/or an intermediate hybrid subtype representative of cysts arising within von Meyenburg complexes. Histochemical and immunohistochemical staining, including Gomori's trichome and pan-cytokeratin, respectively, were applied on select cases to confirm histologic features. Malignant transformation was not identified within this population.
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Affiliation(s)
| | - Brigid V Troan
- 6798North Carolina State University, Raleigh, NC, USA
- North Carolina Zoo, Asheboro, NC, USA
| | - John M Cullen
- 6798North Carolina State University, Raleigh, NC, USA
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9
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Kumar K, Almanea H, Broering D, Shagrani M. Early Hepatocellular Carcinoma Associated With Fibrocystic Liver Disease in a 10-Year-Old Child: A Case Report. Transplant Proc 2019; 51:3147-3149. [PMID: 31371215 DOI: 10.1016/j.transproceed.2019.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/26/2019] [Accepted: 03/13/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Fibrocystic liver-kidney disease is caused by a group of rare and genetically diverse disorders that are associated with kidney cysts or dysplasia and ductal plate malformation in the liver. There have been several reports of liver neoplasias arising in hepatobiliary fibrocystic diseases. However, most were cholangiocarcinoma; cases involving hepatocellular carcinoma (HCC) are rare, and all the reported cases are related with adults. CASE REPORT A 10-year-old girl with a history of repeated gastrointestinal bleeding underwent banding and sclerotherapy multiple times and had a history of a Portosystemic shunt without any significant benefit. She was referred to us as a case of fibrocystic liver disease with decompensated liver disease for liver transplantation. The patient underwent living donor liver transplantation, and the explanted liver histopathology report is documented. The explant liver weighed 838 g and measured 21 × 13 × 8.5 cm with the attached gallbladder measuring 7 × 3 × 0.2 cm (in wall thickness). The external surface was covered with multiple white nodules ranging in size from 0.4 to 1 cm. Serial slicing revealed an ill-defined, yellow, soft lesion (4 × 2.5 × 2.5 cm) localized in the subcapsular area of the left lobe (segment 4). The rest of the cut surface was green and nodular (cirrhotic). Microscopy from largest nodule was consistent with early hepatocellular carcinoma.The rest of the liver was cirrhotic, and the morphology was consistent with fibrocystic disease of liver. CONCLUSION We report a rare case of HCC associated with fibrocystic liver disease. When diagnosing fibrocystic liver disease without known risk factors, the presence of HCC must be considered, and vice versa. To our knowledge, this is the first reported case of HCC associated with fibrocystic liver disease in a 10-year-old child.
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Affiliation(s)
- Kishwer Kumar
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
| | - Hadeel Almanea
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Dieter Broering
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammad Shagrani
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; Alfaisal University, Riyadh, Saudi Arabia
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Kendall T, Verheij J, Gaudio E, Evert M, Guido M, Goeppert B, Carpino G. Anatomical, histomorphological and molecular classification of cholangiocarcinoma. Liver Int 2019; 39 Suppl 1:7-18. [PMID: 30882996 DOI: 10.1111/liv.14093] [Citation(s) in RCA: 195] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 02/06/2023]
Abstract
Cholangiocarcinoma constitutes a heterogeneous group of malignancies that can emerge at any point of the biliary tree. Cholangiocarcinoma is classified into intrahepatic, perihilar and distal based on its anatomical location. Histologically, conventional perihilar/distal cholangiocarcinomas are mucin-producing adenocarcinomas or papillary tumours; intrahepatic cholangiocarcinomas are more heterogeneous and can be sub-classified according to the level or size of the displayed bile duct. Cholangiocarcinoma develops through multistep carcinogenesis and is preceded by dysplastic and in situ lesions. Definition and clinical significance of precursor lesions, including biliary intraepithelial neoplasia, intraductal papillary neoplasms of the bile duct, intraductal tubulopapillary neoplasms and mucinous cystic neoplasm, are discussed in this review. A main challenge in diagnosing cholangiocarcinoma is the fact that tumour tissue for histological examination is difficult to obtain. Thus, a major clinical obstacle is the establishment of the correct diagnosis at a tumour stage that is amenable to surgery which still represents the only curable therapeutic option. Current standards, methodology and criteria for diagnosis are discussed. Cholangiocarcinoma represents a heterogeneous tumour with regard to molecular alterations. In intrahepatic subtype, mainly two distinctive morpho-molecular groups can currently be discriminated. Large-duct type intrahepatic cholangiocarcinoma shows a high mutation frequency of oncogenes and tumour suppressor genes, such as KRAS and TP53 while Isocitrate Dehydrogenase 1/2 mutations and Fibroblast Growth Factor Receptor 2-fusions are typically seen in small-duct type tumours. It is most important to ensure the separation of the given anatomical subtypes and to search for distinct subgroups within the subtypes on a molecular and morphological basis.
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Affiliation(s)
- Timothy Kendall
- Division of Pathology, University of Edinburgh, Edinburgh, UK
| | - Joanne Verheij
- Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Eugenio Gaudio
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy
| | - Matthias Evert
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Maria Guido
- Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Benjamin Goeppert
- Department of Pathology, University Hospital Heidelberg and Liver Cancer Center Heidelberg (LCCH), Heidelberg, Germany
| | - Guido Carpino
- Department of Movement, Human and Health Sciences, Division of Health Sciences, University of Rome "Foro Italico", Rome, Italy
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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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12
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Histopathological evidence of neoplastic progression of von Meyenburg complex to intrahepatic cholangiocarcinoma. Hum Pathol 2017; 67:217-224. [PMID: 28823571 DOI: 10.1016/j.humpath.2017.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/04/2017] [Accepted: 08/10/2017] [Indexed: 12/15/2022]
Abstract
Von Meyenburg complex (VMC) is generally thought to be benign, although its preneoplastic potential for intrahepatic cholangiocarcinoma (iCC) has been a subject of contention. We retrospectively reviewed 86 hepatectomy specimens with a diagnosis of iCC. Morphologically, an association between iCC and VMC was appreciated in 35% of cases that illustrated a gradual neoplastic progression from benign VMC to dysplasia and then to iCC. Among them, 24 cases had VMC lined by epithelial cells with low-grade biliary dysplasia and 13 with high-grade biliary dysplasia. VMC-associated iCCs were smaller in size and well to moderately differentiated, with features of anastomosing glandular architecture, ductal carcinoma in situ-like growth pattern, peritumoral lymphocytic infiltrate, central fibrous scar, and complete pushing border. They often presented as T1 tumors. In contrast, non-VMC-associated iCCs were moderately to poorly differentiated with solid, cribriform or papillary growth patterns. They likely exhibited necrosis, perineural invasion, positive surgical margin, lymphovascular invasion, and high T stage. Additionally, Ki67 and p53 immunostains support the continuing neoplastic evolution from benign VMC to dysplasia and then to iCC. VMC could become neoplastic, serving as an in situ carcinoma lesion to transform to iCC. The underlying molecular alteration and clinical implication of this neoplastic transformation deserves further investigation.
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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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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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15
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16
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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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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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Epidemiological aspects of biliary tree tumors in a region of northern Italy: emerging trends and sex-based differences. Eur J Gastroenterol Hepatol 2013; 25:1347-51. [PMID: 24081106 DOI: 10.1097/meg.0b013e3283636cfb] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cholangiocarcinoma (CCA) and gallbladder cancer are the second cause of liver malignancy after hepatocellular carcinoma. Epidemiological data point to an increase in the incidence of CCA in both western and eastern countries; however, data on more recent years are lacking. AIMS The aim of this study was to elucidate the more recent epidemiology of CCA and gallbladder carcinoma in north-east Italy using automatically collected regional data on hospital admissions over a 10-year period. MATERIALS AND METHODS We performed a retrospective analysis of the Veneto region (north-east Italy) database of patients' hospital discharge records, identifying cases with the following codes: intrahepatic cholangiocarcinoma (155.1), primary gallbladder cancer (156.0), and primary extrahepatic biliary tract cancer (156.1). Hospitalizations were recorded according to the surgical or medical procedures involved (based on International Classification of Diseases-9 procedure codes), and only the first hospitalization was considered for the 2005-2009 period. RESULTS The number of hospitalizations for biliary tumors as a whole has remained stable over the past 10 years. The hospitalization rate of intrahepatic CCA is increasing; this cancer is more frequent in males than in females. The hospitalization rate for gallbladder cancer is increasing with age. However, the figures for extrahepatic CCA have remained stable over the past 10 years. The duration of survival was significantly longer for patients who underwent radical surgery than for those who did not. CONCLUSION Efforts are needed to prevent CCA, bearing in mind the emerging conditions associated with its onset. Secondary prevention of these tumors will substantially improve the duration of survival.
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19
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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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20
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Ramia JM, de La Plaza R, Figueras J, García-Parreño J. [Benign non-parasitic hepatic cystic tumours]. Cir Esp 2011; 89:565-73. [PMID: 21723544 DOI: 10.1016/j.ciresp.2011.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 05/03/2011] [Accepted: 05/03/2011] [Indexed: 02/07/2023]
Abstract
Hepatic cystic tumours are a heterogeneous group of diseases with different aetiology and incidence, and with similar clinical signs and symptoms. They are classified as congenital, traumatic, parasitic, or neoplastic cysts. The congenital cystic tumours are the most prevalent, and include the simple cyst and polycystic hepatic disease. Other less common lesions are, hepatic cystadenoma, ciliated embryonic cyst, and a miscellaneous group. We have carried out a review of all benign non-parasitic hepatic cystic tumours, placing special emphasis on therapeutic strategies.
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Affiliation(s)
- José Manuel Ramia
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, Spain.
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21
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Kinugasa H, Nouso K, Kobayashi Y, Yasunaka T, Onishi H, Nakamura SI, Shiraha H, Takayama H, Toshimori J, Kuwaki K, Hagihara H, Miyake Y, Ikeda F, Takaki A, Kobashi H, Yamamoto K. Hepatocellular carcinoma occurring in hepatobiliary fibropolycystic disease. Hepatol Res 2011; 41:277-81. [PMID: 21338456 DOI: 10.1111/j.1872-034x.2010.00761.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Congenital hepatic fibrosis (CHF) and bile duct hamartomas (von Meyenburg complexes) are hepatobiliary fibropolycystic diseases. There have been several reports of liver neoplasias arising in hepatobiliary fibropolycystic diseases. However, most of them were cholangiocarcinomas and cases involving hepatocellular carcinoma (HCC) are rare. A 51-year-old woman was found to have multiple hepatic tumors by ultrasonography and enhanced computed tomography (CT) during a regular work-up for the recurrence of lung cancer and thyroid cancer, which had been surgically removed 4 and 3 years ago, respectively. Nodules were observed at S3, S5, and S6 (2 cm in diameter). All of the nodules were hyperattenuated at the early arterial phase, and the main tumor at S5 showed hypoattenuation at the delayed phase on dynamic CT and magnetic resonance imaging (MRI). HCC was suspected from these findings. She also suffered from multiple small cystic lesions in the liver. The surgically removed liver showed HCC arising in CHF, which is a rare histological finding.
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Affiliation(s)
- Hideaki Kinugasa
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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22
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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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23
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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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24
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Reynaert H, Dujardin M, Urbain D. A star-spangled liver. Liver Int 2010; 30:1197. [PMID: 19747190 DOI: 10.1111/j.1478-3231.2009.02118.x] [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: 02/13/2023]
Affiliation(s)
- Hendrik Reynaert
- Department of Gastroenterology-Hepatology, University Hospital UZ Brussel, Brussels, Belgium
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25
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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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26
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27
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Molina-Garrido MJ, Guillén-Ponce C, Mora A, Ascuña E, Carrato A. [Multiple hepatic lesions suggestive of metastases in a patient with colorectal cancer]. Rev Clin Esp 2009; 209:309-10. [PMID: 19635255 DOI: 10.1016/s0014-2565(09)71479-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M J Molina-Garrido
- Servicio de Oncología Médica, Hospital General Universitario de Elche, Elche, Alicante, España
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28
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Intrahepatic cholangiocarcinoma arising in multiple bile duct hamartomas: report of two cases and review of the literature. Eur J Gastroenterol Hepatol 2009; 21:580-4. [PMID: 19282767 DOI: 10.1097/meg.0b013e3282fc73b1] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Multiple bile duct hamartomas (BDHs)/von Meyenburg complexes, are tumor-like lesions of the liver. Malignant transformation in BDHs has been previously reported in very rare instances, and the most common tumor arising in this clinical setting is cholangiocarcinoma. Herein, we report on clinicopathological findings in two cases of cholangiocarcinoma occurring in liver with multiple BDHs. Histopathologically, multiple BDHs showed morphologic transition from clearly benign to dysplasia or carcinoma in situ, then to invasive carcinoma sequence of the biliary epithelium. The neoplastic epithelium showed positivity for cytokeratin 19, CA 19-9, and epithelial membrane antigen. Staining for Hep Par 1, alpha-fetoprotein, cytokeratin 20, and alpha1-antitrypsin was negative. All sections from the non-neoplastic liver in each specimen showed multiple BDHs. Any other clinically detectable primary tumor was not found. These two neoplasms were interpreted as a cholangiocarcinoma arising in BDHs. This suggested BDHs might be a risk factor of development of cholangiocarcinoma.
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29
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Yoshida S, Kurokohchi K, Ueno T, Yoshino M, Shimada M, Masaki T. Hepatic von Meyenburg complex: a trigger of severe portal hypertension. Liver Int 2009; 29:614-5. [PMID: 19018981 PMCID: PMC2711260 DOI: 10.1111/j.1478-3231.2008.01903.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Shuhei Yoshida
- Department of Gastroenterology, Internal Medicine, TMG Asakadai Central General HospitalSaitama, Japan,Division of Gastroenterology and Hepatology, Internal Medicine, Kagawa University School of MedicineKagawa, Japan
| | - Kazutaka Kurokohchi
- Division of Gastroenterology and Hepatology, Internal Medicine, Kagawa University School of MedicineKagawa, Japan
| | - Takuya Ueno
- Critical Care Medicine, Hachioji Medical Center, Tokyo Medical UniversityTokyo, Japan
| | - Morihiko Yoshino
- Department of Gastroenterology, Internal Medicine, TMG Asakadai Central General HospitalSaitama, Japan
| | - Masahiko Shimada
- Department of Gastroenterology, Internal Medicine, TMG Asakadai Central General HospitalSaitama, Japan
| | - Tsutomu Masaki
- Division of Gastroenterology and Hepatology, Internal Medicine, Kagawa University School of MedicineKagawa, Japan
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30
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Cholangiocarcinomes sur syndrome des microhamartomes biliaires multiples. Ann Pathol 2009; 29:24-7. [DOI: 10.1016/j.annpat.2008.09.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2008] [Indexed: 11/23/2022]
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31
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Song JS, Lee YJ, Kim KW, Huh J, Jang SJ, Yu E. Cholangiocarcinoma arising in von Meyenburg complexes: report of four cases. Pathol Int 2008; 58:503-12. [PMID: 18705771 DOI: 10.1111/j.1440-1827.2008.02264.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Although von Meyenburg complexes (VMC) are largely considered to be innocuous, neoplastic transformations have been described. The present report describes four cases of cholangiocarcinoma (CC) occurring on a background of VMC. The patients were all male and aged 69, 59, 68 and 75 years, respectively. While two patients were asymptomatic, the other two had a history of colon cancer. Radiologically the tumors measured 3, 4, 4.5 and 10 cm and were well enhanced from the arterial to delayed portal phase. Microscopically, the tumor consisted of multiple foci of characteristic VMC, and had a gradual transition from VMC to hyperplasia or dysplasia and well- to moderately differentiated adenocarcinomas. One patient had combined hepatocellular carcinoma (HCC) and CC, occurring in the high grade dysplastic nodule and VMC. On immunohistochemistry the epithelial cells of the VMC and CC were immunopositive for cytokeratin (CK) 7 in three patients, with another patient being focally positive only for CK19. The Ki-67 labeling indices increased from the VMC to the dysplastic areas and then to the carcinomas. As a potentially precancerous lesion, VMC should be carefully followed up in terms of any size increases. Thus, biopsies are essential to determine any proliferative epithelial changes including dysplasia and malignant transformation.
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Affiliation(s)
- Joon Seon Song
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu, Seoul, Korea
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32
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Hepatocellular carcinoma in association with bile duct hamartomas: report on 2 cases and review of the literature. Ann Diagn Pathol 2008; 12:208-11. [DOI: 10.1016/j.anndiagpath.2006.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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33
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Carranza Carranza A, Salinas Martín MV, Sánchez Bernal ML, Fernández Alonso J. [Infected pseudotumoral bile duct hamartomas in polycystic liver]. GASTROENTEROLOGIA Y HEPATOLOGIA 2007; 30:372-3. [PMID: 17662224 DOI: 10.1157/13107578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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34
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Fritz S, Hackert T, Blaker H, Hartwig W, Schneider L, Buchler MW, Werner J. Multiple von Meyenburg complexes mimicking diffuse liver metastases from esophageal squamous cell carcinoma. World J Gastroenterol 2006; 12:4250-2. [PMID: 16830386 PMCID: PMC4087385 DOI: 10.3748/wjg.v12.i26.4250] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Von Meyenburg complexes are benign liver lesions consisting of adenomatous bile duct proliferates. We present two patients suffering from esophageal cancer accompanied by the occurrence of von Meyenburg complexes. Preoperative computerized tomography (CT) of the liver had not shown these lesions. In one of the patients, diffuse nodular manifestation was found in both liver lobes, mimicking diffuse hepatic metastases. Intraoperative frozen section revealed the benign nature of the lesions in both cases. The patients underwent esophageal resection without complications. To the best of our knowledge, the coincidence of von Meyenburg complexes and esophageal cancer has never been reported before. This uncommon entity should be taken into consideration as a differential diagnosis of liver lesions in malignancies. It underlines the importance of intraoperative frozen section for liver lesions of unknown origin.
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Affiliation(s)
- Stefan Fritz
- Department of General Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
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35
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Kobayashi A, Takahashi S, Hasebe T, Konishi M, Nakagohri T, Gotohda N, Kinoshita T. Solitary bile duct hamartoma of the liver. Scand J Gastroenterol 2005; 40:1378-81. [PMID: 16334450 DOI: 10.1080/00365520510023387] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Bile duct hamartomas, also known as von Meyenburg complexes, are benign liver malformations which usually present as multiple small nodules scattered in both lobes of the liver. We report a unique case of bile duct hamartoma. An asymptomatic 30-year-old man who had a solitary cystic lesion underwent partial hepatectomy. Macroscopically, the lesion, measuring 3.6 cm in diameter, was composed of a number of small grayish-white cysts measuring 0.1 to 1.2 cm in diameter. Histologically, the constituent cysts were embedded in a fibrous stroma and were lined by low columnar or cuboidal epithelium. By immunohistochemistry, the MIB-1 index was below 1%, and p53 and carcinoembryonic antigen (CEA) were negative. These findings lead us to conjecture that the lesion was a bile duct hamartoma, although its solitary nature and large size differed from those of typical bile duct hamartoma.
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Affiliation(s)
- Akihiro Kobayashi
- Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa City, Chiba 277-8577, Japan
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