Extrahepatic biliary atresia with cartilaginous metaplasia in the gallbladder remnants

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.

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.

Pseudo gallbladder sign in biliary atresia--an imaging pitfall

BACKGROUND

Ultrasound (US) is used to identify causes of neonatal cholestasis. We describe a potential sonographic pitfall, the "pseudo gallbladder," in biliary atresia (BA).

OBJECTIVE

To describe the Pseudo Gallbladder sign (PsGB sign).

MATERIALS AND METHODS

Sonograms/clinical records of 20 confirmed BA infants and 20 non-BA cases were reviewed retrospectively. For the BA group, preoperative sonography and surgical and pathological findings were examined. For the non-BA group, sonographic features and pathological findings were examined. The PsGB sign is defined as a fluid-filled structure, located in the expected region of the gallbladder, measuring ≤ 15 mm in length but without a well-defined or normal-appearing gallbladder wall.

RESULTS

A recognizable gallbladder and normal gallbladder wall were present in all non-BA infants. However, none of the BA infants had a sonographically normal gallbladder. Seventy-three percent of BA patients had a PsGB, and in 27% no gallbladder or gallbladder-like structure was detected.

CONCLUSION

A gallbladder-like structure in BA is common and can be misinterpreted as a normal gallbladder, delaying diagnosis and therapy. Recognition of this imaging pitfall, described here as the pseudo gallbladder sign, will help avoid this error.