Biliary cystadenoma and cystadenocarcinoma pathophysiology: Difference between revisions
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The vast majority of biliary cystadenomas are intrahepatic (97%) with a small proportion extrahepatic (3%). Only rarely are they found in the extrahepatic biliary tree and gallbladder. | The vast majority of biliary cystadenomas are intrahepatic (97%) with a small proportion extrahepatic (3%). Only rarely are they found in the extrahepatic biliary tree and gallbladder. | ||
===Gross Pathology=== | ===Gross Pathology=== | ||
*Biliary cystadenomas are cystic neoplasms that may be either unilocular or multilocular. | *Biliary cystadenomas are cystic [[Neoplasm|neoplasms]] that may be either unilocular or multilocular. | ||
*The septa within the cyst may rarely show calcification.<ref name="Ahanatha PillaiVelayutham2012">{{cite journal|last1=Ahanatha Pillai|first1=Sastha|last2=Velayutham|first2=Vimalraj|last3=Perumal|first3=Senthilkumar|last4=Ulagendra Perumal|first4=Srinivasan|last5=Lakshmanan|first5=Anand|last6=Ramaswami|first6=Sukumar|last7=Ramasamy|first7=Ravi|last8=Sathyanesan|first8=Jeswanth|last9=Palaniappan|first9=Ravichandran|last10=Rajagopal|first10=Surendran|title=Biliary Cystadenomas: A Case for Complete Resection|journal=HPB Surgery|volume=2012|year=2012|pages=1–6|issn=0894-8569|doi=10.1155/2012/501705}}</ref> | *The [[septa]] within the cyst may rarely show [[calcification]].<ref name="Ahanatha PillaiVelayutham2012">{{cite journal|last1=Ahanatha Pillai|first1=Sastha|last2=Velayutham|first2=Vimalraj|last3=Perumal|first3=Senthilkumar|last4=Ulagendra Perumal|first4=Srinivasan|last5=Lakshmanan|first5=Anand|last6=Ramaswami|first6=Sukumar|last7=Ramasamy|first7=Ravi|last8=Sathyanesan|first8=Jeswanth|last9=Palaniappan|first9=Ravichandran|last10=Rajagopal|first10=Surendran|title=Biliary Cystadenomas: A Case for Complete Resection|journal=HPB Surgery|volume=2012|year=2012|pages=1–6|issn=0894-8569|doi=10.1155/2012/501705}}</ref> | ||
*The majority of biliary cystadenomas do not communicate with the bile ducts, but luminal communication may be occasionally observed. | *The majority of biliary cystadenomas do not communicate with the [[Bile duct|bile ducts]], but luminal communication may be occasionally observed. | ||
*The cystic fluid may be clear and mucinous. | *The cystic fluid may be clear and [[mucinous]]. | ||
*Blood stained fluid within the cyst indicates a malignant component (cystadenocarcinoma). | *Blood stained fluid within the [[cyst]] indicates a [[malignant]] component (cystadenocarcinoma). | ||
*Rarely, the fluid may be bile stained, purulent, proteinaceous, or gelatinous. | *Rarely, the fluid may be bile stained, [[purulent]], proteinaceous, or gelatinous. | ||
===Microscopic Pathology=== | ===Microscopic Pathology=== | ||
Biliary cystadenoma is usually a multiloculated cyst covered by a biliary-type epithelium wall and surrounded by an ovarian-like stroma, containing smooth muscle cells. Microscopic evaluation can easily distinguish cystadenoma from cystadenocarcinoma, based on nuclear pleomorphism and loss of nuclear stratification in the latter.<ref name="RamacciatoNigri2006">{{cite journal|last1=Ramacciato|first1=Giovanni|last2=Nigri|first2=Giuseppe R|last3=D'Angelo|first3=Francesco|last4=Aurello|first4=Paolo|last5=Bellagamba|first5=Riccardo|last6=Colarossi|first6=Cristina|last7=Pilozzi|first7=Emanuela|last8=Del Gaudio|first8=Massimo|journal=World Journal of Surgical Oncology|volume=4|issue=1|year=2006|pages=76|issn=14777819|doi=10.1186/1477-7819-4-76}}</ref> | Biliary cystadenoma is usually a multiloculated cyst covered by a biliary-type [[epithelium]] wall and surrounded by an ovarian-like stroma, containing [[Smooth muscle|smooth muscle cells]]. Microscopic evaluation can easily distinguish cystadenoma from cystadenocarcinoma, based on [[nuclear pleomorphism]] and loss of nuclear stratification in the latter.<ref name="RamacciatoNigri2006">{{cite journal|last1=Ramacciato|first1=Giovanni|last2=Nigri|first2=Giuseppe R|last3=D'Angelo|first3=Francesco|last4=Aurello|first4=Paolo|last5=Bellagamba|first5=Riccardo|last6=Colarossi|first6=Cristina|last7=Pilozzi|first7=Emanuela|last8=Del Gaudio|first8=Massimo|journal=World Journal of Surgical Oncology|volume=4|issue=1|year=2006|pages=76|issn=14777819|doi=10.1186/1477-7819-4-76}}</ref> | ||
*Biliary cystadenomas are composed of multiple cysts lined by single layer of cuboidal or nonciliated columnar epithelium that resembles normal biliary epithelium resting on a basement membrane. | *Biliary cystadenomas are composed of multiple cysts lined by single layer of cuboidal or nonciliated columnar [[epithelium]] that resembles normal biliary epithelium resting on a [[basement membrane]]. | ||
*At places the epithelium forms multiple polypoidal or papillary projections.<ref name="Ahanatha PillaiVelayutham2012">{{cite journal|last1=Ahanatha Pillai|first1=Sastha|last2=Velayutham|first2=Vimalraj|last3=Perumal|first3=Senthilkumar|last4=UlagendraPerumal|first4=Srinivasan|last5=Lakshmanan|first5=Anand|last6=Ramaswami|first6=Sukumar|last7=Ramasamy|first7=Ravi|last8=Sathyanesan|first8=Jeswanth|last9=Palaniappan|first9=Ravichandran|last10=Rajagopal|first10=Surendran|title=Biliary Cystadenomas: A Case for Complete Resection|journal=HPB Surgery|volume=2012|year=2012|pages=1–6|issn=0894-8569|doi=10.1155/2012/501705}}</ref> | *At places the epithelium forms multiple polypoidal or papillary projections.<ref name="Ahanatha PillaiVelayutham2012">{{cite journal|last1=Ahanatha Pillai|first1=Sastha|last2=Velayutham|first2=Vimalraj|last3=Perumal|first3=Senthilkumar|last4=UlagendraPerumal|first4=Srinivasan|last5=Lakshmanan|first5=Anand|last6=Ramaswami|first6=Sukumar|last7=Ramasamy|first7=Ravi|last8=Sathyanesan|first8=Jeswanth|last9=Palaniappan|first9=Ravichandran|last10=Rajagopal|first10=Surendran|title=Biliary Cystadenomas: A Case for Complete Resection|journal=HPB Surgery|volume=2012|year=2012|pages=1–6|issn=0894-8569|doi=10.1155/2012/501705}}</ref> | ||
*In some of the cases, dysplastic mucinous epithelium itself may proliferate within the bile ducts causing obstruction. This variant is considered an intraductal papillary neoplasm with prominent cystic dilatation of the duct rather than a true biliary cystic neoplasm.<ref name="Ahanatha PillaiVelayutham2012">{{cite journal|last1=Ahanatha Pillai|first1=Sastha|last2=Velayutham|first2=Vimalraj|last3=Perumal|first3=Senthilkumar|last4=Ulagendra Perumal|first4=Srinivasan|last5=Lakshmanan|first5=Anand|last6=Ramaswami|first6=Sukumar|last7=Ramasamy|first7=Ravi|last8=Sathyanesan|first8=Jeswanth|last9=Palaniappan|first9=Ravichandran|last10=Rajagopal|first10=Surendran|title=Biliary Cystadenomas: A Case for Complete Resection|journal=HPB Surgery|volume=2012|year=2012|pages=1–6|issn=0894-8569|doi=10.1155/2012/501705}}</ref> | *In some of the cases, dysplastic mucinous epithelium itself may proliferate within the bile ducts causing obstruction. This variant is considered an intraductal papillary neoplasm with prominent cystic dilatation of the duct rather than a true biliary cystic neoplasm.<ref name="Ahanatha PillaiVelayutham2012">{{cite journal|last1=Ahanatha Pillai|first1=Sastha|last2=Velayutham|first2=Vimalraj|last3=Perumal|first3=Senthilkumar|last4=Ulagendra Perumal|first4=Srinivasan|last5=Lakshmanan|first5=Anand|last6=Ramaswami|first6=Sukumar|last7=Ramasamy|first7=Ravi|last8=Sathyanesan|first8=Jeswanth|last9=Palaniappan|first9=Ravichandran|last10=Rajagopal|first10=Surendran|title=Biliary Cystadenomas: A Case for Complete Resection|journal=HPB Surgery|volume=2012|year=2012|pages=1–6|issn=0894-8569|doi=10.1155/2012/501705}}</ref> | ||
*The ovarian-like stroma is thick consisting of compact spindle-shaped cells and supports the epithelium and is often observed exclusively in women. | *The ovarian-like stroma is thick consisting of compact spindle-shaped cells and supports the epithelium and is often observed exclusively in women. | ||
*The tumor may express receptors for progesterone while histological characteristics include positivity for vimentin and cytokeratin. | *A histological variant of biliary cystadenomas has been described, namely cystadenomas with mesenchymal stroma. This variant, which is more common in females, is characterized by the presence of [[spindle cells]] in the mesenchymal stroma. These cells are capable of differentiating into different cell types, with a high premalignant potential. | ||
*The tumor may express [[Receptor|receptors]] for [[progesterone]] while histological characteristics include positivity for [[vimentin]] and [[cytokeratin]]. | |||
==References== | ==References== | ||
Revision as of 15:59, 18 December 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Suveenkrishna Pothuru, M.B,B.S. [2]
Overview
On gross pathology, biliary cystadenoma is unilocular or multilocular cystic lesion filled with fluid. Cystic fluid may be clear and mucinous. On microscopic histopathological analysis, presence of biliary-type epithelium wall, occasional papillary projections, and ovarian-like stroma are characteristic findings of biliary cystadenoma.
Pathophysiology
The vast majority of biliary cystadenomas are intrahepatic (97%) with a small proportion extrahepatic (3%). Only rarely are they found in the extrahepatic biliary tree and gallbladder.
Gross Pathology
- Biliary cystadenomas are cystic neoplasms that may be either unilocular or multilocular.
- The septa within the cyst may rarely show calcification.[1]
- The majority of biliary cystadenomas do not communicate with the bile ducts, but luminal communication may be occasionally observed.
- The cystic fluid may be clear and mucinous.
- Blood stained fluid within the cyst indicates a malignant component (cystadenocarcinoma).
- Rarely, the fluid may be bile stained, purulent, proteinaceous, or gelatinous.
Microscopic Pathology
Biliary cystadenoma is usually a multiloculated cyst covered by a biliary-type epithelium wall and surrounded by an ovarian-like stroma, containing smooth muscle cells. Microscopic evaluation can easily distinguish cystadenoma from cystadenocarcinoma, based on nuclear pleomorphism and loss of nuclear stratification in the latter.[2]
- Biliary cystadenomas are composed of multiple cysts lined by single layer of cuboidal or nonciliated columnar epithelium that resembles normal biliary epithelium resting on a basement membrane.
- At places the epithelium forms multiple polypoidal or papillary projections.[1]
- In some of the cases, dysplastic mucinous epithelium itself may proliferate within the bile ducts causing obstruction. This variant is considered an intraductal papillary neoplasm with prominent cystic dilatation of the duct rather than a true biliary cystic neoplasm.[1]
- The ovarian-like stroma is thick consisting of compact spindle-shaped cells and supports the epithelium and is often observed exclusively in women.
- A histological variant of biliary cystadenomas has been described, namely cystadenomas with mesenchymal stroma. This variant, which is more common in females, is characterized by the presence of spindle cells in the mesenchymal stroma. These cells are capable of differentiating into different cell types, with a high premalignant potential.
- The tumor may express receptors for progesterone while histological characteristics include positivity for vimentin and cytokeratin.
References
- ↑ 1.0 1.1 1.2 Ahanatha Pillai, Sastha; Velayutham, Vimalraj; Perumal, Senthilkumar; Ulagendra Perumal, Srinivasan; Lakshmanan, Anand; Ramaswami, Sukumar; Ramasamy, Ravi; Sathyanesan, Jeswanth; Palaniappan, Ravichandran; Rajagopal, Surendran (2012). "Biliary Cystadenomas: A Case for Complete Resection". HPB Surgery. 2012: 1–6. doi:10.1155/2012/501705. ISSN 0894-8569.
- ↑ Ramacciato, Giovanni; Nigri, Giuseppe R; D'Angelo, Francesco; Aurello, Paolo; Bellagamba, Riccardo; Colarossi, Cristina; Pilozzi, Emanuela; Del Gaudio, Massimo (2006). World Journal of Surgical Oncology. 4 (1): 76. doi:10.1186/1477-7819-4-76. ISSN 1477-7819. Missing or empty
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