Portal Plate with Hyaline Cartilage in Biliary Atresia

Hyaline cartilage at the portal plate and gallbladder in biliary atresia

Biliary atresia (BA) is a fibro-obliterative cholestatic disease of infancy. The presence of cartilage in the resected tissue is an uncommon finding. We documented the presence of both mature and immature hyaline cartilage in the portal plate and the wall of the gallbladder in a 2-month-old girl infant with BA who had undergone Kasai portoenterostomy. The presence of cartilage could be part of a heterotopia or an uncommon connective tissue metaplasia. The presence of immature cartilage with the merging of the perichondrium with the soft tissue highlights a metaplastic etiology in the index case.

The Presence of Pericholedochal Hyaline Cartilage in Biliary Atresia: A Report and A Review

Background: The presence of cartilage in extra hepatic biliary tree is an unusual finding. An isolated presence of the cartilage is possibly heterotopic or occurs as a metaplastic response to the inflammatory insult.Material and methods: We had examined the liver biopsy and the resected specimen of a biliary atresia (BA) after Kasai procedure.Results: There was hyaline cartilage around the common hepatic and common bile duct in a 3-months-old male infant with distal obstructive cholangiopathy on liver biopsy and had positive serum IgM for cytomegalovirus (CMV). Similar findings could not be documented in the pericholedochal tissue of any of the 25 other pediatric cases operated for BA or choledochal cyst and three neonatal autopsies performed for liver-related deaths.Conclusion: Peri-bile duct cartilage is a unique finding and could represent an unusual form of heterotopia or connective tissue metaplasia.

Biliary atresia: pathology, etiology and pathogenesis

Biliary atresia is a progressive fibrosing obstructive cholangiopathy of the intrahepatic and extrahepatic biliary system, resulting in obstruction of bile flow and neonatal jaundice. Histopathological findings in liver biopsies include the expansion of the portal tracts, with edematous fibroplasia and bile ductular proliferation, with bile plugs in duct lumen. Lobular morphological features may include variable multinucleate giant cells, bilirubinostasis and hemopoiesis. The etiopathogenesis of biliary atresia is multifactorial and multiple pathomechanisms have been proposed. Experimental and clinical studies have suggested that viral infection initiates biliary epithelium destruction and release of antigens that trigger a Th1 immune response, which leads to further injury of the bile duct, resulting in inflammation and obstructive scarring of the biliary tree. It has also been postulated that biliary atresia is caused by a defect in the normal remodelling process. Genetic predisposition has also been proposed as a factor for the development of biliary atresia.

Hyaline cartilage at porta hepatis in extrahepatic biliary atresia: metaplasia or choristoma

We report a case of a 5-month-old child who presented with the features of obstructive jaundice, anaemia and had no associated congenital anomalies. The child was suspected to have biliary atresia on hepatobiliary iminodiacetic acid (HIDA) scan and underwent Kasai portoenterostomy. Microscopic examination of the atretic gallbladder revealed islands of mature hyaline cartilage, lymphoid aggregates and fibrosis. There was an abrupt transition between the cartilage and the adjacent stroma. Only rare case reports have documented this finding with hypothesis ranging from metaplasia occurring secondary to the associated chronic inflammation or whether it is a choristoma. These cases need to be documented to elucidate the pathways of occurrence and may lead to have a better and detailed understanding of the disease process.