Symptomatic Bile Duct Hamartomas: Surgical Management in an MRI Driven Practice

Excerpt

The differential diagnosis of hepatic cysts includes bile duct hamartomas (BDH), which have traditionally been thought of as simple cysts of the liver. These malformed and dilated ducts, set in the background of fibrous stroma, are thought to be constituents on the spectrum of fibropolycystic disease.1,2 Often found as small, scattered cysts,2‐5 they have the potential to grow extremely large, becoming symptomatic and therefore prompting referral to a surgeon. Echoing this picture, the yearly incidence at our institution of non-surgical BDH and symptomatic, giant BDH is 7.3% and 0.4%, respectively.6 Always benign, it has nevertheless been exceptionally difficult to preoperatively differentiate BDH from malignant or pre-malignant lesions. The so-called ‘malignant masquerade’ haunts many facets of a general surgical practice.7,8 Indeed, it has long been presumed that BDH appear radiographically indistinguishable from cystadenomas or other lesions with potential for malignant transformation or metastases,9,10 necessitating various degrees of hepatic resection. …