Korean J Gastroenterol.  2016 Jun;67(6):332-336. 10.4166/kjg.2016.67.6.332.

A Case of Adenomyomatous Hyperplasia of the Distal Common Bile Duct Mimicking Malignant Stricture

• Choi JH
• Lee SH
• Kim JS
• Kim J
• Shin BS
• Jang DK
• Ryu JK
• Kim YT

• KMID: 2307761
• DOI: http://doi.org/10.4166/kjg.2016.67.6.332

Abstract

Adenomyomatous hyperplasia is a reactive malformation or non-neoplastic tumor-like lesion frequently observed in the gallbladder, stomach, duodenum and jejunum, but rare in the extrahepatic bile duct. A 42-year-old man with epigastric discomfort had a stricture in the common bile duct on initial CT scans. Initially, it was regarded as a malignant lesion with some evidence, but histopathologic examinations of multiple biopsies obtained by multiple sessions of endoscopic retrograde cholangiopancreatography showed no evidence of malignancy. The patient had undergone the pylorus preserving pancreaticoduodenectomy because of the possibility of malignancy; however, the final diagnosis was adenomyomatous hyperplasia. It is important to distinguish a malignancy from benign biliary stricture with endoscopic biopsies. Surgery for suspected biliary malignancy often reveals benign lesions. Therefore, a correct diagnosis is important before deciding upon treatment of bile duct stricture. In conclusion, in younger patients with bile duct stricture where there is no evidence of histologic malignancy despite multiple biopsies, the possibility of benign disease such as adenomyomatous hyperplasia should be considered, to avoid unnecessary radical surgery.

Keyword

Adenomyoma; Extrahepatic bile ducts; Common bile duct neoplasms

MeSH Terms

Adenomyoma
Adult
Bile Ducts
Bile Ducts, Extrahepatic
Biopsy
Cholangiopancreatography, Endoscopic Retrograde
Common Bile Duct Neoplasms
Common Bile Duct*
Constriction, Pathologic*
Diagnosis
Duodenum
Gallbladder
Humans
Hyperplasia*
Jejunum
Pancreaticoduodenectomy
Pylorus
Stomach
Tomography, X-Ray Computed

Figure

• 

  Fig. 1. CT scan images and fluoroscopic findings. (A) An axial CT image shows a prominent enlarged pancreatic duct and mild peripancreatic infiltration around pancreatic head and uncinated process. Iso-attenuating distal bile duct cancer cannot be ruled out as the peripancreatic duct is not delineated clearly. (B-D) In addition to a CT image suspicious for malignancy, axial and coronal MRI show a distal common bile duct (CBD) obstruction and proximal bile duct dilatation with mild peripancreatic infiltration with pancreatic duct dilatation. (E) A cholangiogram obtained by ERCP. Abrupt narrowing distal CBD and dilatation of proximal bile duct are seen in this image.

• 

  Fig. 2. Histologic findings of distal common bile duct (H&E, ×100). Chronic inflammation with fibrosis and periductal glandular proliferation is seen in the tissue.

• 

  Fig. 3. Gross examination of the surgically resected specimen. A sclerosing solid mass in distal common bile duct was 3×2 cm in size and spaced 1.5 cm apart from Ampulla of Vater.

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  Fig. 4. Histologic findings in common bile duct tissue removed at surgery (H&E). (A) Diffuse adenomyomatous hyperplasia of the distal bile duct and periductal fibrosis is seen (×200). (B) Chronic active pancreatitis with fibrosis, intraductal eosinophillic amorphous protein plugging, and fat necrosis of the pancreas head are also noted (×400).

Reference

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