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Hepatolithiasis associated with intrahepatic heterotopic pancreas: a case report and literature review.

Yu ZY, Sun ZQ, Zhang M, Wang B, Lu W, Zheng SS - Diagn Pathol (2015)

Bottom Line: Here, we report a case of a 39-year-old male with intrahepatic heterotopic pancreas associated with primary cholesterol hepatolithiasis.These observations were confirmed by magnetic resonance cholangiopaneretography (MRCP).Postoperative histological examination of the resected specimen showed pancreatic tissues distributed along the wall of the bile duct and composed of acinar cells and duct elements without islets of Langerhans, therefore strongly suggesting that the heterotopic pancreas occurred in response to chronic injury due to the primary cholesterol hepatolithiasis and was derived from the biliary epithelial cells.

View Article: PubMed Central - PubMed

Affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejing University School of Medicine, Hangzhou, 310003, Zhejing Province, China. purprain@163.com.

ABSTRACT

Unlabelled: Intrahepatic heterotopic pancreas is rarely reported in the literature. Here, we report a case of a 39-year-old male with intrahepatic heterotopic pancreas associated with primary cholesterol hepatolithiasis. Computed tomography (CT) scans revealed multiple cholesterol stones in intrahepatic bile ducts of the left lobe concomitant with intrahepatic cholangiectases. These observations were confirmed by magnetic resonance cholangiopaneretography (MRCP). The patient underwent transabdominal left hepatic lobectomy. Postoperative histological examination of the resected specimen showed pancreatic tissues distributed along the wall of the bile duct and composed of acinar cells and duct elements without islets of Langerhans, therefore strongly suggesting that the heterotopic pancreas occurred in response to chronic injury due to the primary cholesterol hepatolithiasis and was derived from the biliary epithelial cells.

Virtual slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1461819267158980 .

No MeSH data available.


Related in: MedlinePlus

Abdominal computed tomography scan before surgery. a–b: Abdominal computed tomography scan (plain and arterial phase) revealed multiple cholesterol stones in intrahepatic bile ducts of the left hepatic lobe concomitant with intrahepatic cholangiectases; c–d: A low-density mass (arrow) with an estimated magnitude of 2.0 × 1.8 cm and a vague margin was also observed
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Fig1: Abdominal computed tomography scan before surgery. a–b: Abdominal computed tomography scan (plain and arterial phase) revealed multiple cholesterol stones in intrahepatic bile ducts of the left hepatic lobe concomitant with intrahepatic cholangiectases; c–d: A low-density mass (arrow) with an estimated magnitude of 2.0 × 1.8 cm and a vague margin was also observed

Mentions: A 39-year-old male who was diagnosed with primary cholesterol hepatolithiasis attended our out-patient department for a routine medical check-up. Further inquiry revealed a history of extracorporeal shock wave lithotripsy (ESWL) due to left ureteral calculus one year ago; no other aberrations were noted and physical examinations were normal. Liver function tests demonstrated a normal level of liver transaminases, including aspartate aminotransferase, alanine aminotransferase and γ-glutamyl transpeptidase. No clear elevation of tumor markers including α-fetoprotein (AFP), carcinoembryonic antigen (CEA), CA125 and CA-19-9 was observed. Hepatitis virus markers were all negative. Ultrasound examination showed multiple cholesterol stones in the intrahepatic bile ducts of the left lobe and hepatic steatosis. Further examinations were performed after admission of the patient to hospital. Abdominal computed tomography (CT) scans revealed several round high-density shadows within the intrahepatic biliary tract of the left lobe, which was noticeably dilated (Fig. 1a and b). A low-density mass with an estimated magnitude of 2.0 × 1.8 cm and a vague margin was also observed in the CT scan. The mass was located in the right hepatic lobe and showed signal enhancement around the wall in arterial phase, gradual enhancement toward the central area of the lesion in the portal venous and delayed phases (Fig. 1c and d). No other abnormalities were noted. Magnetic resonance cholangiopaneretography (MRCP) demonstrated multiple T2 low signal intensity foci in the left intrahepatic bile duct concomitant with cholangiectases. At the request of the patient and to rule out the possibility of cancer, a transabdominal radical excision was performed based on the clinical diagnosis of hepatolithiasis and the left hepatic lobe was successfully removed. Postoperative recovery was uneventful.Fig. 1


Hepatolithiasis associated with intrahepatic heterotopic pancreas: a case report and literature review.

Yu ZY, Sun ZQ, Zhang M, Wang B, Lu W, Zheng SS - Diagn Pathol (2015)

Abdominal computed tomography scan before surgery. a–b: Abdominal computed tomography scan (plain and arterial phase) revealed multiple cholesterol stones in intrahepatic bile ducts of the left hepatic lobe concomitant with intrahepatic cholangiectases; c–d: A low-density mass (arrow) with an estimated magnitude of 2.0 × 1.8 cm and a vague margin was also observed
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4477297&req=5

Fig1: Abdominal computed tomography scan before surgery. a–b: Abdominal computed tomography scan (plain and arterial phase) revealed multiple cholesterol stones in intrahepatic bile ducts of the left hepatic lobe concomitant with intrahepatic cholangiectases; c–d: A low-density mass (arrow) with an estimated magnitude of 2.0 × 1.8 cm and a vague margin was also observed
Mentions: A 39-year-old male who was diagnosed with primary cholesterol hepatolithiasis attended our out-patient department for a routine medical check-up. Further inquiry revealed a history of extracorporeal shock wave lithotripsy (ESWL) due to left ureteral calculus one year ago; no other aberrations were noted and physical examinations were normal. Liver function tests demonstrated a normal level of liver transaminases, including aspartate aminotransferase, alanine aminotransferase and γ-glutamyl transpeptidase. No clear elevation of tumor markers including α-fetoprotein (AFP), carcinoembryonic antigen (CEA), CA125 and CA-19-9 was observed. Hepatitis virus markers were all negative. Ultrasound examination showed multiple cholesterol stones in the intrahepatic bile ducts of the left lobe and hepatic steatosis. Further examinations were performed after admission of the patient to hospital. Abdominal computed tomography (CT) scans revealed several round high-density shadows within the intrahepatic biliary tract of the left lobe, which was noticeably dilated (Fig. 1a and b). A low-density mass with an estimated magnitude of 2.0 × 1.8 cm and a vague margin was also observed in the CT scan. The mass was located in the right hepatic lobe and showed signal enhancement around the wall in arterial phase, gradual enhancement toward the central area of the lesion in the portal venous and delayed phases (Fig. 1c and d). No other abnormalities were noted. Magnetic resonance cholangiopaneretography (MRCP) demonstrated multiple T2 low signal intensity foci in the left intrahepatic bile duct concomitant with cholangiectases. At the request of the patient and to rule out the possibility of cancer, a transabdominal radical excision was performed based on the clinical diagnosis of hepatolithiasis and the left hepatic lobe was successfully removed. Postoperative recovery was uneventful.Fig. 1

Bottom Line: Here, we report a case of a 39-year-old male with intrahepatic heterotopic pancreas associated with primary cholesterol hepatolithiasis.These observations were confirmed by magnetic resonance cholangiopaneretography (MRCP).Postoperative histological examination of the resected specimen showed pancreatic tissues distributed along the wall of the bile duct and composed of acinar cells and duct elements without islets of Langerhans, therefore strongly suggesting that the heterotopic pancreas occurred in response to chronic injury due to the primary cholesterol hepatolithiasis and was derived from the biliary epithelial cells.

View Article: PubMed Central - PubMed

Affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejing University School of Medicine, Hangzhou, 310003, Zhejing Province, China. purprain@163.com.

ABSTRACT

Unlabelled: Intrahepatic heterotopic pancreas is rarely reported in the literature. Here, we report a case of a 39-year-old male with intrahepatic heterotopic pancreas associated with primary cholesterol hepatolithiasis. Computed tomography (CT) scans revealed multiple cholesterol stones in intrahepatic bile ducts of the left lobe concomitant with intrahepatic cholangiectases. These observations were confirmed by magnetic resonance cholangiopaneretography (MRCP). The patient underwent transabdominal left hepatic lobectomy. Postoperative histological examination of the resected specimen showed pancreatic tissues distributed along the wall of the bile duct and composed of acinar cells and duct elements without islets of Langerhans, therefore strongly suggesting that the heterotopic pancreas occurred in response to chronic injury due to the primary cholesterol hepatolithiasis and was derived from the biliary epithelial cells.

Virtual slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1461819267158980 .

No MeSH data available.


Related in: MedlinePlus