Gallbladder-associated symptomatic hepatic choristoma: Should you resect?

Termos, Salah; AlDuwaisan, Abdullah; Alali, Mohammad; Faour, Hussein; Alhomoud, Hana; Alsaleh, Ahmad

doi:10.1016/j.ijscr.2017.10.044

Cited by 7 publications

(10 citation statements)

References 16 publications

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“…ELT may be connected to the gallbladder wall by a handle containing blood vessels and bile ducts [5] . Because of the lack of well-developed blood vessels and excretory system, ELT has certain metabolic disorders, that can cause fatty change, haemosiderosis, cholestasis, or cirrhosis [2,12] . Moreover, same as the mother liver, ELT is exposed to carcinogens, [6] which include not only viral infection but also chemical carcinogens which cannot be completely excreted due to the poorly-developed blood vessel and excretory system of the ELT [13] , which adds to the increased risk of carcinogenesis [14] .…”

Section: Discussionmentioning

confidence: 99%

Why does Ectopic Liver Tissue on the Gallbladder rarely have malignant transformation：Case Series

Zhou

Liu

Wang

et al. 2023

Preprint

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Background Ectopic liver tissue (ELT) is a rare developmental abnormality in which normally functioning liver tissue develops at an extra-hepatic site. Due to the atypical clinical symptoms of ELT, its clinical diagnosis is rarely easy, however, the risk of carcinogenesis is strongly increased due to its special pathological characteristics. So it should always be considered in the differential diagnosis of tumors or symptomatic mass. Case presentation Case 1：A 57-year-old female patient presented herself to the outpatient department of our hospital complaining of paroxysmal upper abdominal pain for one month. She was admitted due to "Multiple intrahepatic bile duct stones and chronic cholecystitis". During the surgery, an abnormally enlarged gallbladder of size about 12*8*5cmwas found. A tiny mass of about 1.2*0.6*0.3cm on the free wall of the gallbladder with a similar texture to the liver was also found. Case 2：An 87-year-old male patient presented himself to the emergency department of our hospital complaining of right upper abdomen pain for three days. He was admitted to the hospital due to "cholecystolithiasis and chronic cholecystitis". During the surgery, an abnormally enlarged gallbladder of size about 12*8*5cm. A tiny mass of about 1.2*0.6*0.3cm on the free wall of the gallbladder with a similar texture to the liver was also found. After surgery, the two patients are now in good overall condition. Discussion and conclusions In this two continuous cases of Ectopic liver tissue, the pathological examination and liver cancer markers “AFP” and “Glypican-3” did not support tumor lesions. Accordingly, we proposed a new hypothesis for this phenomenon, that cryptogenic functional excretory system (helps to excrete chemical carcinogens) from ELT into the gallbladder (a part of the biliary system) does exist but it cannot be found in ELT located in other organs. This phenomenon may provide a rational response to the question why does Ectopic Liver Tissue on the Gallbladder rarely have malignant transformation.

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Section: Discussionmentioning

confidence: 99%

Why does Ectopic Liver Tissue on the Gallbladder rarely have malignant transformation：Case Series

Zhou

Liu

Wang

et al. 2023

Preprint

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show abstract

“…EL has the same histopathology as the mother liver, including cirrhosis, hemosiderosis, hepatitis, and hepatocellular carcinoma (HCC) [ 3 ]. HCC was found in less than 5% of gallbladder cases associated with EL, and several cases had normal native liver tissue [ 7 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…EL is a rare congenital anomaly lacking an anatomical connection to the liver proper [ 3 ]. EL is thought to be caused by an abnormal migration of hepatic tissue from the foregut diver-ticulum at cystic formations.…”

Section: Introductionmentioning

confidence: 99%

Case Report: Ectopic Liver (Choristoma) Discovered During Laparoscopic Cholecystectomy

Moshref

Alotaibi

2021

Am J Case Rep

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Patient: Male, 47-year-old Final Diagnosis: Ectopic liver Symptoms: Right upper quadrant pain Medication:— Clinical Procedure: — Specialty: Surgery Objective: Congenital defects/diseases Background: Ectopic liver (EL) is liver tissue that is not attached to the mother liver, and is also known as choristoma and hepar succenturiatum. According to Watanabe’s 1060-patient series, it has an incidence rate of less than 1% (0.47%). The absence of an anatomical attachment to the hepatic proper is a rare congenital departure from the norm, known as EL. EL is thought to be caused by abnormal hepatic tissue growth from the foregut diver-ticulum, particularly at cystic structures. Case Report: We report the successful management of a 47-year-old male patient, not known to have any medical illness, who was referred to the surgical team with a clinical picture of biliary colic. An ultrasound (US) abdomen was performed, and cholecystitis was confirmed. During a laparoscopic cholecystectomy, ET was identified by chance. He tolerated the operation well. Gallbladder histological examination revealed significant mucosal and wall ulcers, chronic inflammation, many black stones, no dysplasia or malignancy, and connected liver tissue measuring 12×5 mm. As a result, chronic calcular cholecystitis was confirmed, as was normal EL architecture and no evidence of malignancy. Conclusions: We conclude that EL is a rare condition, but there have been cases reported in the literature. Imaging modalities such as US and computed tomography scans are recommended to rule out other underlying diagnoses and should be tailored to each individual when necessary. Because the presence of EL attached to the vesicle is a rare occurrence in the literature, a histological examination is required due to the elevated risk of hepatocellular carcinoma. Keeping such an abnormality in mind can help surgeons demarcate the embryological plane of dissection during cholecystitis to avoid tumor cell spillages if present.

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“…ELT is a rare congenital anomaly which lacks an anatomical connection to the liver proper. Its frequency is surprisingly low given the complexity of hepatogenesis which relies on hepatoblast migration . ELT is thought to arise from aberrant migration of hepatic tissue which develops together with cystic structures from a diverticulum of foregut.…”

mentioning

confidence: 99%

“…ELT is subject to the same pathology as native liver, such as hepatitis, hemosiderosis, cirrhosis and hepatocellular carcinoma (HCC) . However, ELT is less equipped to deal with parenchymal insults as it lacks a complete physiological hepatic architecture.…”

mentioning

confidence: 99%

Ectopic liver attached to a chronically inflamed gallbladder: a rare and surgically challenging combination

Granek

Battye

Wijeratne

2018

ANZ Journal of Surgery

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Gallbladder-associated symptomatic hepatic choristoma: Should you resect?

Cited by 7 publications

References 16 publications

Why does Ectopic Liver Tissue on the Gallbladder rarely have malignant transformation：Case Series

Why does Ectopic Liver Tissue on the Gallbladder rarely have malignant transformation：Case Series

Case Report: Ectopic Liver (Choristoma) Discovered During Laparoscopic Cholecystectomy

Ectopic liver attached to a chronically inflamed gallbladder: a rare and surgically challenging combination

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