Intra and extra-hepatic cystadenoma of the biliary duct. Review of literature and radiological and pathological characteristics of a very rare case

Abstract

Painless obstructive jaundice is often associated with a malignant disease of the common bile duct or head of the pancreas. The authors present a unique case of a 62-year-old woman affected by an intrahepatic cystadenoma that extended into the common biliary duct. To our knowledge no previous case reports have been published on similar cases. After undergoing an en-block hepatic and bile duct resection, this patient is doing well without signs of recurrent disease.

Figure 1

(A) Ultrafast gradient echo image shows dilatation of intrahepatic bile ducts in the left lobe of the liver (arrow), with fine, hyperintense septations within the affected bile ducts. (B) Ultrafast gradient echo image, acquired 10 min post gadolinium administration, shows enhancement of the septations within dilated intrahepatic bile ducts. There is differential enhancement of the right and left hepatic lobes. The left hepatic lobe is atrophic due to chronic biliary obstruction. (C) Coronal projection MR angiogram shows dilatation of intrahepatic bile ducts and common bile duct, with thin septations seen bile ducts.

Figure 2

Axial portal-venous-phase contrast-enhanced CT scan shows dilatation of intrahepatic bile ducts in the left hepatic lobe. There are subtle, fine septations within the dilated ducts. The left hepatic lobe is atrophic and there is differential enhancement of the hepatic lobes.

Figure 3

(A) Photograph of the resected left hepatic lobe and mass. The common bile duct has been opened. The intraductal mass prolapses through the common bile duct. A incision has been made in the mass and the internal septations are evident. (B) Photograph of the resected left hepatic lobe and mass shows a multi-septated mass within a dilated left intrahepatic bile duct (arrow). The round ligament can be seen adjacent to the dilated bile duct (arrowhead).

Figure 4

Photomicrograph of the resected mass shows a layer of columnar epithelium lining the mass (arrow), and the presence of ovarian-type stroma deep to the epithelial layer.