Solitary cystic dilatation of the intrahepatic bile duct.

Abstract

A 31 year old man was hospitalised with general fatigue and epigastric pain. Abdominalultrasonography, computedtomography, and magnetic resonance imaging showed a cystic lesion in the left lobe ofthe liver. Endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography revealed a localised dilatation of the intrahepatic bile duct without any obstruction. However, a large mass of mucinous material was noted in the saccular intrahepatic duct and the common bile duct. There was no evidence of a choledochal cyst, anomalous pancreaticobiliary ductal union, or congenital cystic change of the kidneys. A possible diagnosis ofmucinous cystic neoplasm of the intrahepatic bile duct was made and a left hepatectomy performed. Cholangiography of the resected specimen showed a non-obstructive solitary cystic dilatation of the left hepatic duct. Histologically, the dilated duct was lined with columnar biliary epithelium without any papillary proliferation and/or atypia. Neither malignancy nor hepatic fibrosis was observed; the term "solitary cystic dilatation of the intrahepatic bile duct" perhaps is more descriptive and the concept easier to understand. (7 Clin Pathol 1997;50:617-618) presented with neither a pertinent family history nor a personal history of blood transfusion, tattooing, or drug abuse. On physical examination, there was a slight tenderness in the epigastrium and right hypochondrium, and the liver was slightly enlarged. Results of liver function tests were: total bilirubin, 2.1 mg/l (normal value 0.2-1.0); alkaline phosphate, 127 IU/l (28-84); 7 glutamyltranspeptidase 314 IU/l (4-30); aspartate aminotransferase 117 IU/l (7-20); and alanine aminotransferase 425 IU/l (7-28). Virus markers were negative for hepatitis A, B, and C. Abdominal ultrasonography, computed tomography, and magnetic resonance imaging showed a cystic lesion in the left lobe of the liver. Choledochal cysts and anomalous pancreaticobiliary ductal union were not demonstrated on endoscopic retrograde cholangiopancreatography. Percutaneous transhepatic cholangiography revealed a localised dilatation of the left intrahepatic bile duct. There was a large mass of mucinous material in the saccular intrahepatic bile ducts and the common bile duct. Under the diagnosis of a possible mucinous cystic neoplasm of the intrahepatic bile duct, we performed a left hepatectomy. A cholangiogram of the resected specimen showed a solitary cystic dilatation of the left hepatic duct (fig 1). Histologically, the

Clinical characteristics of solitary intrahepatic biliary cyst

“…As far as we know, although there have been previous case reports of SIBC (17,18), including cases of SIBC in infants (13,19), our series of SIBC cases reported this time are more comprehensive and representative, including multiple surgeries after initial misdiagnosis, the occurrence and treatment of surgical complications, the first diagnosis combined with carcinogenesis, and surgical approach adjustment after accidental detection of malignant lesions during surgery, which is the first comprehensive series of cases and comprehensive analysis of SIBC reports so far. Accordingly, we suggest that SIBC should be considered in the differential diagnosis of patients with solitary cystic mass at the hilum.…”

Diagnostic and Therapeutic Challenges in Nonparasitic Liver Cysts

“…Caroli disease is an autosomal recessive inheritance linked to mutation in PKHD1 gene. It is classified as type V choledochal cyst by the Todani classification [10]. The cystic lesions are depicted as irregular in shape, fusiform, or saccular (Figures 4A).…”

Cysto‐cholecystostomy: A More Physiological Procedure for Hepatic Cysts with Biliary Communications and Cystic Dilatations of Main Intrahepatic Ducts

“…Conventionally, Roux-Y cysto-jejunostomy is the operative treatment of choice for both HC and CIHD. However, it is technically difficult, with major biliary tract disruption [1,2,[11][12][13]. The migration of bacteria from the intestine to the intrahepatic ducts increases the risk of cholangitis [14][15][16][17].…”