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Unilocular extrahepatic biliary cystadenoma mimicking choledochal cyst: a case report.

Park JH, Lee DH, Kim HJ, Ko YT, Lim JW, Yang MH - Korean J Radiol (2004 Oct-Dec)

Bottom Line: Ultrasonography and CT showed a cystic dilatation of the common hepatic duct and also marked dilatation of the intrahepatic duct.Direct cholangiography demonstrated a large filling defect between the left hepatic duct and the common hepatic duct; dilatation of the intrahepatic duct was also demonstrated.Following excision of the cystic mass, it was pathologically confirmed as a unilocular biliary mucinous cystadenoma arising from the common hepatic duct.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Kyung Hee University Hospital, Dongdaemun-gu, Seoul, Korea.

ABSTRACT
We report here on a case of extrahepatic biliary cystadenoma arising from the common hepatic duct. A 42-year-old woman was evaluated by us to find the cause of her jaundice. Ultrasonography and CT showed a cystic dilatation of the common hepatic duct and also marked dilatation of the intrahepatic duct. Direct cholangiography demonstrated a large filling defect between the left hepatic duct and the common hepatic duct; dilatation of the intrahepatic duct was also demonstrated. Following excision of the cystic mass, it was pathologically confirmed as a unilocular biliary mucinous cystadenoma arising from the common hepatic duct.

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Unilocular extrahepatic biliary cystadenoma in a 42-year-old woman.A, B. Abdominal CT scans show marked dilatation of the intrahepatic duct and the cystic dilatation of the common bile duct (arrow).C. Ultrasonography also shows cystic dilatation of the extrahepatic duct. On retrospective review, the thin partial septum like structure (arrow) is seen at the upper aspect of the cystic dilatation of the extrahepatic duct.D. Endoscopic retrograde cholangiopancreatography shows a well-demarcated large filling defect (arrow) in the common hepatic duct with dilatation of the intrahepatic duct. It does not communicate with the bile duct. The PTBD tube, which is not filled with contrast material, is also seen in the left hepatic duct.E. Magnetic resonance cholangiopancreatography clearly shows the thin wall (arrow) of the cystic lesion in the common hepatic duct. It also shows a bile duct variation; the right posterior segmental duct drained into the left hepatic duct.F. The surgical specimen shows a unilocular cystic mass arising from the common hepatic duct (incised). GB; gallbladderG. Microscopically (H & E staining, ×200), the cyst wall is lined by a single layer of columnar mucin-secreting cells (arrows). The epithelium is supported by ovarian-like stroma.
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Figure 1: Unilocular extrahepatic biliary cystadenoma in a 42-year-old woman.A, B. Abdominal CT scans show marked dilatation of the intrahepatic duct and the cystic dilatation of the common bile duct (arrow).C. Ultrasonography also shows cystic dilatation of the extrahepatic duct. On retrospective review, the thin partial septum like structure (arrow) is seen at the upper aspect of the cystic dilatation of the extrahepatic duct.D. Endoscopic retrograde cholangiopancreatography shows a well-demarcated large filling defect (arrow) in the common hepatic duct with dilatation of the intrahepatic duct. It does not communicate with the bile duct. The PTBD tube, which is not filled with contrast material, is also seen in the left hepatic duct.E. Magnetic resonance cholangiopancreatography clearly shows the thin wall (arrow) of the cystic lesion in the common hepatic duct. It also shows a bile duct variation; the right posterior segmental duct drained into the left hepatic duct.F. The surgical specimen shows a unilocular cystic mass arising from the common hepatic duct (incised). GB; gallbladderG. Microscopically (H & E staining, ×200), the cyst wall is lined by a single layer of columnar mucin-secreting cells (arrows). The epithelium is supported by ovarian-like stroma.

Mentions: A 42-year-old woman had presented to the local clinic with jaundice of two months duration and she was suspected of having periampullary cancer; she was then referred to us and admitted to our hospital for further evaluation. The physical examination revealed no abnormality. The serum total bilirubin level was 3.1 mg/dl and the aspartate aminotransferase/alanine aminotransferase levels were 80/180 U/L. Abdominal CT showed a cystic dilatation of the common hepatic duct and a marked dilatation of the intrahepatic bile duct (Figs. 1A, B). Abdominal ultrasonography also revealed these lesions, but there was a partial thin septum-like structure within the upper aspect of the cystic dilated common hepatic duct (Fig. 1C). However, neither definite septation nor an enhancing portion within the dilated duct was noted, and so this was considered to be a choledochal cyst. Percutaneous transhepatic biliary drainage (PTBD) was done through the left hepatic duct, and the subsequent tubogram showed obstruction of the left hepatic duct by a large filling defect. On endoscopic retrograde cholangiopancreatography (ERCP), a well-demarcated filling defect was seen in the common hepatic duct and this did not communicate with the bile duct. The distal portion of the common hepatic duct showed a beaking appearance near this mass and the left hepatic duct was not opacified (Fig. 1D). Any anomalous pancreaticobiliary ductal union was not found. Before surgery, magnetic resonance cholangiopancreatography (MRCP) was performed, and it showed a well-defined cystic mass extending from the left hepatic duct to the common hepatic duct with a definite thin wall displaying a dark signal intensity. Magnetic resonance cholangiopancreatography also showed a bile duct variation; the right posterior segmental duct drained into the left hepatic duct (Fig. 1E). The patient underwent resection of the extrahepatic biliary tract including the cystic mass, and hepaticojejunostomy was next performed. During surgery, the cystic mass was noted to arise from the common hepatic duct, yet it had no communication with this duct. Pathologically, this unilocular cystic mass arose from the serosal surface of the common hepatic duct, which was bulging into the common hepatic duct (Fig. 1F). It was lined by a single layer of tall columnar mucin-secreting cells with focal evidence of mucinous secretion (Fig. 1G). Our case was diagnosed as a biliary mucinous cystadenoma in the common hepatic duct. The patient has been alive with no tumor recurrence for one year after surgery.


Unilocular extrahepatic biliary cystadenoma mimicking choledochal cyst: a case report.

Park JH, Lee DH, Kim HJ, Ko YT, Lim JW, Yang MH - Korean J Radiol (2004 Oct-Dec)

Unilocular extrahepatic biliary cystadenoma in a 42-year-old woman.A, B. Abdominal CT scans show marked dilatation of the intrahepatic duct and the cystic dilatation of the common bile duct (arrow).C. Ultrasonography also shows cystic dilatation of the extrahepatic duct. On retrospective review, the thin partial septum like structure (arrow) is seen at the upper aspect of the cystic dilatation of the extrahepatic duct.D. Endoscopic retrograde cholangiopancreatography shows a well-demarcated large filling defect (arrow) in the common hepatic duct with dilatation of the intrahepatic duct. It does not communicate with the bile duct. The PTBD tube, which is not filled with contrast material, is also seen in the left hepatic duct.E. Magnetic resonance cholangiopancreatography clearly shows the thin wall (arrow) of the cystic lesion in the common hepatic duct. It also shows a bile duct variation; the right posterior segmental duct drained into the left hepatic duct.F. The surgical specimen shows a unilocular cystic mass arising from the common hepatic duct (incised). GB; gallbladderG. Microscopically (H & E staining, ×200), the cyst wall is lined by a single layer of columnar mucin-secreting cells (arrows). The epithelium is supported by ovarian-like stroma.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2698174&req=5

Figure 1: Unilocular extrahepatic biliary cystadenoma in a 42-year-old woman.A, B. Abdominal CT scans show marked dilatation of the intrahepatic duct and the cystic dilatation of the common bile duct (arrow).C. Ultrasonography also shows cystic dilatation of the extrahepatic duct. On retrospective review, the thin partial septum like structure (arrow) is seen at the upper aspect of the cystic dilatation of the extrahepatic duct.D. Endoscopic retrograde cholangiopancreatography shows a well-demarcated large filling defect (arrow) in the common hepatic duct with dilatation of the intrahepatic duct. It does not communicate with the bile duct. The PTBD tube, which is not filled with contrast material, is also seen in the left hepatic duct.E. Magnetic resonance cholangiopancreatography clearly shows the thin wall (arrow) of the cystic lesion in the common hepatic duct. It also shows a bile duct variation; the right posterior segmental duct drained into the left hepatic duct.F. The surgical specimen shows a unilocular cystic mass arising from the common hepatic duct (incised). GB; gallbladderG. Microscopically (H & E staining, ×200), the cyst wall is lined by a single layer of columnar mucin-secreting cells (arrows). The epithelium is supported by ovarian-like stroma.
Mentions: A 42-year-old woman had presented to the local clinic with jaundice of two months duration and she was suspected of having periampullary cancer; she was then referred to us and admitted to our hospital for further evaluation. The physical examination revealed no abnormality. The serum total bilirubin level was 3.1 mg/dl and the aspartate aminotransferase/alanine aminotransferase levels were 80/180 U/L. Abdominal CT showed a cystic dilatation of the common hepatic duct and a marked dilatation of the intrahepatic bile duct (Figs. 1A, B). Abdominal ultrasonography also revealed these lesions, but there was a partial thin septum-like structure within the upper aspect of the cystic dilated common hepatic duct (Fig. 1C). However, neither definite septation nor an enhancing portion within the dilated duct was noted, and so this was considered to be a choledochal cyst. Percutaneous transhepatic biliary drainage (PTBD) was done through the left hepatic duct, and the subsequent tubogram showed obstruction of the left hepatic duct by a large filling defect. On endoscopic retrograde cholangiopancreatography (ERCP), a well-demarcated filling defect was seen in the common hepatic duct and this did not communicate with the bile duct. The distal portion of the common hepatic duct showed a beaking appearance near this mass and the left hepatic duct was not opacified (Fig. 1D). Any anomalous pancreaticobiliary ductal union was not found. Before surgery, magnetic resonance cholangiopancreatography (MRCP) was performed, and it showed a well-defined cystic mass extending from the left hepatic duct to the common hepatic duct with a definite thin wall displaying a dark signal intensity. Magnetic resonance cholangiopancreatography also showed a bile duct variation; the right posterior segmental duct drained into the left hepatic duct (Fig. 1E). The patient underwent resection of the extrahepatic biliary tract including the cystic mass, and hepaticojejunostomy was next performed. During surgery, the cystic mass was noted to arise from the common hepatic duct, yet it had no communication with this duct. Pathologically, this unilocular cystic mass arose from the serosal surface of the common hepatic duct, which was bulging into the common hepatic duct (Fig. 1F). It was lined by a single layer of tall columnar mucin-secreting cells with focal evidence of mucinous secretion (Fig. 1G). Our case was diagnosed as a biliary mucinous cystadenoma in the common hepatic duct. The patient has been alive with no tumor recurrence for one year after surgery.

Bottom Line: Ultrasonography and CT showed a cystic dilatation of the common hepatic duct and also marked dilatation of the intrahepatic duct.Direct cholangiography demonstrated a large filling defect between the left hepatic duct and the common hepatic duct; dilatation of the intrahepatic duct was also demonstrated.Following excision of the cystic mass, it was pathologically confirmed as a unilocular biliary mucinous cystadenoma arising from the common hepatic duct.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Kyung Hee University Hospital, Dongdaemun-gu, Seoul, Korea.

ABSTRACT
We report here on a case of extrahepatic biliary cystadenoma arising from the common hepatic duct. A 42-year-old woman was evaluated by us to find the cause of her jaundice. Ultrasonography and CT showed a cystic dilatation of the common hepatic duct and also marked dilatation of the intrahepatic duct. Direct cholangiography demonstrated a large filling defect between the left hepatic duct and the common hepatic duct; dilatation of the intrahepatic duct was also demonstrated. Following excision of the cystic mass, it was pathologically confirmed as a unilocular biliary mucinous cystadenoma arising from the common hepatic duct.

Show MeSH
Related in: MedlinePlus