Smooth Muscle Distribution Patterns of Choledochal Cysts and Their Implications for Pathogenesis and Postoperative Complications. Issue 6 (3rd February 2020)

• Record Type: Journal Article
• Authors: Hwang, Hee Sang; Kim, Mee-Jeong; Lee, Seung-Soo; Lee, Jae Hoon; Song, Ki Byung; Kim, Hyoung Jung; Hwang, Shin; Lee, Sung Koo; Kim, Myung-Hwan; Hong, Seung-Mo
• Is Part Of: American journal of clinical pathology. Volume 153:Issue 6(2020)
• Page Start: 760
• Page End: 771
• Publication Date: 2020-02-03
• Subjects: Bile duct -- Choledochal cyst -- Smooth muscle -- Pathogenesis -- Postoperative complication; Diagnosis, Laboratory -- Periodicals; Pathology -- Periodicals; 616.07
• DOI: 10.1093/ajcp/aqaa002
• Languages: English
• ISSNs: 0002-9173

Abstract

Abstract: Objectives: Histopathologic characteristics of choledochal cysts and their clinical implications have not been previously comprehensively studied. Methods: Smooth muscle distribution patterns and other histologic findings (inflammation, metaplasia, dysplasia, and heterotopia) in 233 surgically resected choledochal cysts were evaluated. Results: Mean patient age was 23.3 ± 19.8 years, with male:female ratio of 0.3. Most cases were Todani type I (175 cases, 75.1%) or IVa (56 cases, 24.1%). Choledochal cysts with thin scattered/no muscle fiber (175 cases, 75.1%) were the predominant pattern and were associated with more frequent postoperative biliary stricture ( P = .031), less frequent pyloric metaplasia ( P = .016), and mucosal smooth muscle aggregates ( P < .001) compared to cysts with thick muscle bundles. Severe chronic cholangitis ( P = .049), pyloric metaplasia ( P = .019), mucosal smooth muscle aggregates ( P < .001), biliary intraepithelial neoplasia ( P = .021), and associated bile duct ( P = .021) and gallbladder carcinomas ( P = .03) were more common in adults (age >20 years vs ≤20 years), suggesting that chronic irritation in association with developmental anomalies involves tumorigenesis from choledochal cysts. Conclusion: Smooth muscle distribution pattern of choledochal cyst may predict postoperative complication, raising clinical implications of smooth muscle patterns in postoperative management of choledochal cysts.