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Miron A, Popa LG, Toma EA, Calu V, Parvuletu RF, Enciu O. The Curious Case of the Choledochal Cyst—Revisiting the Todani Classification: Case Report and Review of the Literature. Diagnostics (Basel) 2023; 13:diagnostics13061059. [PMID: 36980367 PMCID: PMC10047054 DOI: 10.3390/diagnostics13061059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023] Open
Abstract
Choledochal cysts (CCs) are rare occurrences presenting as dilatations of biliary structures, which can present as single or multiple dilatations and can appear as both intra- and extrahepatic anomalies. The most widespread classification of CCs is the Todani classification, but there have been numerous reports of cysts that do not fall into any of the types described. We present such a case—a male patient 36 years of age who underwent preoperative CT, MRCP, and ERCP, which mistakenly indicated a type II Todani CC, and intraoperatively was found to be located at the confluence of the hepatic ducts and encompassed the origin of the common bile duct. Complete resection of the cyst and the proximal segment of the common bile duct was performed, and reconstruction was carried out by Roux-en-Y double-tutorized hepaticojejunostomy. Considering the risk of malignant transformation, the frequent preoperative misdiagnosis, as well as the technically challenging surgery required in such cases, we advocate for a revision of the classification and raise awareness of the need for guidelines regarding the proper short-term and long-term management of this disease to ensure adequate quality of life and disease-free survival for patients.
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Affiliation(s)
- Adrian Miron
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania (O.E.)
- Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Liliana Gabriela Popa
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania (O.E.)
- Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Elena Adelina Toma
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania (O.E.)
- Elias Emergency University Hospital, 011461 Bucharest, Romania
- Correspondence: ; Tel.: +40-213161600
| | - Valentin Calu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania (O.E.)
- Elias Emergency University Hospital, 011461 Bucharest, Romania
| | | | - Octavian Enciu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania (O.E.)
- Elias Emergency University Hospital, 011461 Bucharest, Romania
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Ray S, Bhat BK, Yadav A, Nundy S. Isolated dilatation of the cystic duct-Type VI choledochal cyst: a rare case presentation and review of the literature. J Surg Case Rep 2017; 2017:rjx067. [PMID: 28458872 PMCID: PMC5400498 DOI: 10.1093/jscr/rjx067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/24/2017] [Indexed: 02/07/2023] Open
Abstract
An isolated cystic dilatation of the cystic duct is extremely rare and very few cases have been reported in the world literature. The existing Todani's classification does not include this as a separate entity and thereby, it has been vaguely termed as a Type VI choledochal cyst by some authors in the past. We describe a case of a young male with a Type VI choledochal cyst suspected preoperatively on imaging studies and confirmed intraoperatively by laparoscopy. The cyst was localized to the cystic duct with no involvement of the common bile duct. It was excised en masse with the gall bladder by laparoscopic cholecystectomy. Considering the rarity of these lesions, an insight into the cases reported in the world is required and knowledge about the approach to managing such cases is important in surgical practice.
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Affiliation(s)
- Samrat Ray
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi-110060, India
| | - Bharath Kumar Bhat
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi-110060, India
| | - Amitabh Yadav
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi-110060, India
| | - Samiran Nundy
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi-110060, India
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Cholangiocarcinoma Arising from a Type VI Biliary Cyst: A Case Report and Review of the Literature. Case Rep Radiol 2015; 2015:625715. [PMID: 27034876 PMCID: PMC4806668 DOI: 10.1155/2015/625715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 10/29/2015] [Indexed: 02/07/2023] Open
Abstract
Cystic dilatations of the cystic duct which are suggested as type VI biliary cysts are very rare and many of them go unrecognized or are confused with other cysts until the operation although they are obvious on imaging studies. They can present with fusiform or saccular dilatations and can be accompanied by common bile duct dilatations. It is important to identify these cysts as they share the same characteristics as the other biliary cyst types and can be complicated with malignancy. We herein present a very unusual case of a cholangiocarcinoma arising from a type VI biliary cyst in a 58-year-old female patient and review the literature. The patient presented with jaundice, weight loss, and abdominal pain. On imaging, the cystic duct and common bile duct were fusiformly dilated and had a wide communication. There was a mass filling the distal parts of both ducts. The patient was urgently operated on after perforation following ERCP. Histopathology was compatible with a type VI biliary cyst and an associated cholangiocarcinoma.
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Soufi M, Lahlou MK, Chad B. [Cancer developed in cystic dilatation of the bile duct: report of a case]. Pan Afr Med J 2014; 19:346. [PMID: 25922635 PMCID: PMC4406382 DOI: 10.11604/pamj.2014.19.346.5110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 09/27/2014] [Indexed: 11/25/2022] Open
Abstract
Les auteurs rapportent un cas de dilatation kystique du cholédoque intra- pancréatique découvert chez une femme de 46 ans et compliqué d'un carcinome tubulo-papillaire n'envahissant pas le pancréas. Le traitement a consisté en une duodénopancréatectomie céphalique avec un curage ganglionnaire et anastomose hépatico-jéjunale; la survie était de 30 mois; les auteurs abordent les aspects radiologiques, anatomopathologiques, thérapeutiques et pronostiques de ces cancers développé sur dilatation kystique de la voie biliaire et discutent la place d'une radiothérapie complémentaire de la chirurgie susceptible d'améliorer la survie.
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Affiliation(s)
- Mehdi Soufi
- Division of Digestive Surgery, Oujda CHU, Faculty of Medicine, University Mohammed First, Oujda, Maroc
| | - Mohammed Khalid Lahlou
- Division of Digestive Surgery, Oujda CHU, Faculty of Medicine, University Mohammed First, Oujda, Maroc
| | - Bouziane Chad
- Division of Digestive Surgery, Oujda CHU, Faculty of Medicine, University Mohammed First, Oujda, Maroc
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Maheshwari P. Cystic malformation of cystic duct: 10 cases and review of literature. World J Radiol 2012; 4:413-7. [PMID: 23024843 PMCID: PMC3460229 DOI: 10.4329/wjr.v4.i9.413] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 09/02/2012] [Accepted: 09/09/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate cystic malformations of the cystic duct.
METHODS: Over a 2-year period, we came across 10 cases of cystic malformation of the cystic duct among patients who were investigated in our radiology department with ultrasonography, multidetector computed tomography, or magnetic resonance imaging for abdominal complaints. Radiological diagnosis of cystic malformation of the cystic duct was made on the basis of a dilated, nonvascular cystic structure near the porta hepatis, and visualization of a clear communication with either the gallbladder, normal caliber cystic duct and/or common bile duct (CBD) on at least one imaging modality.
RESULTS: Four of 10 patients had saccular dilatation of the cystic duct. Six patients had fusiform dilatation of the cystic duct, and two of these had only mild fusiform dilatation. Two patients had associated CBD dilatation and one had associated cystic duct calculi and malignancy.
CONCLUSION: Cystic malformations of the cystic duct should be recognized as a distinct type of choledochal cyst and should be added as type VI cyst in Todani’s classification.
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Roland G, Ruiz A, Arrivé L. Gallbladder carcinoma with anomalous pancreaticobiliary junction. Clin Res Hepatol Gastroenterol 2011; 35:779-80. [PMID: 21945419 DOI: 10.1016/j.clinre.2011.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 08/07/2011] [Indexed: 02/04/2023]
Affiliation(s)
- Gauthier Roland
- Department of Radiology, Hôpital Saint-Antoine, Université Pierre-et-Marie-Curie, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
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Farris AB, Basturk O, Adsay NV. Pancreatitis, Other Inflammatory Lesions, and Pancreatic Pseudotumors. Surg Pathol Clin 2011; 4:625-650. [PMID: 26837491 DOI: 10.1016/j.path.2011.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The pancreas is versatile in the diversity of disorders that it can exhibit. In this article, characteristics of disorders such as chronic, autoimmune, eosinophilic, hereditary, and infectious pancreatitis are described. With regard to autoimmune pancreatitis, the role of clinical evaluation, histologic examination, and IgG4 immunohistochemistry is discussed. The role of pancreatitis in the pathogenesis of diabetes is also mentioned. Some implications of pancreatitis are highlighted, including the neoplastic predisposition caused by inflammatory lesions of the pancreas. The goal of this article is to convey an appreciation of these disorders because their recognition can benefit patients tremendously, as inflammatory lesions of the pancreas can be mass-forming, giving rise to pseudotumors, and leading to surgical resection that may otherwise be unnecessary.
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Affiliation(s)
- Alton B Farris
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Emory University, 1364 Clifton Road Northeast, Room H-188, Atlanta, GA 30322, USA.
| | - Olca Basturk
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - N Volkan Adsay
- Department of Pathology and Laboratory Medicine, Emory University, 1364 Clifton Road NE, Room H-180B, Atlanta, GA 30322, USA
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Abstract
We herein report a case of monolobar hepatobiliary fibropolycystic disease. A 75-year-old woman presented with heartburn. Imaging modalities including US, CT, and MRI revealed marked atrophy and multiple biliary cysts of the hepatic left lobe. The hepatic right lobe was normal. ERCP and bile duct endoscopy revealed anomalous pancreaticobiliary union, choledochal dilation, dilation of left intrahepatic bile ducts, and small choledochal non-invasive adenocarcinoma. Polycystic kidney diseases were absent. The patient underwent pancreatico-duodenectomy and extended hepatic left lobectomy. Grossly, the hepatic left lobe was markedly atrophic, and studded with numerous biliary cysts. The left intrahepatic bile ducts were dilated (Caroli's disease) and the common bile duct showed type I choledochal dilation. The right hepatic lobe was normal. Histologically, the hepatic left lobe was replaced by fibroelastosis. The intrahepatic bile ducts showed ductal plate malformation such as irregular contours, invaginations, and protrusions. The numerous biliary cysts also showed ductal plate malformation. There were numerous persistent ductal plates and microhamartomas. Many hyalinized destructive biliary cysts and ductal plates were recognized. The liver parenchyma was scant and free of hepatocellular malformations. The portal veins showed old obliterative portal thrombosis. The right hepatic lobe was normal. Immunohistochemically, the biliary cells were positive for cytokeratin 7, 8, 18 and 19, and MUC6 and CD10, but negative for MUC2 and MUC5AC. The biliary cysts, persistent ductal plate, and microhamartomas were positive for fetal apomucin antigen MUC1.
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