Xu LM, Hu DM, Tang W, Wei SH, Chen W, Chen GQ. Adenomyoma of the distal common bile duct demonstrated by endoscopic ultrasound: A case report and review of the literature. World J Clin Cases 2019; 7(21): 3615-3621 [PMID: 31750345 DOI: 10.12998/wjcc.v7.i21.3615]
Corresponding Author of This Article
Duan-Min Hu, PhD, Chief Doctor, Director, Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Suzhou 215004, Jiangsu Province, China. huduanmins@126.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Li-Ming Xu, Duan-Min Hu, Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
Wen Tang, Endoscopy Center, The Second Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
Shao-Hua Wei, Wei Chen, Department of Hepatological Surgery, The Second Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
Guang-Qiang Chen, Imaging Department, The Second Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
Author contributions: Xu LM was responsible for interpretation of the clinical data and drafting of the manuscript; Hu DM conceived the case report and revised the manuscript; Tang W revised the manuscript for important intellectual content; Wei SH and Chen W were in charge of the operation; Chen GQ provided the figures showing the computed tomography and magnetic resonance imaging findings.
Supported byThe Program for Diagnostic and Therapeutic Technique of Clinically Important Disease in Suzhou, No. LCZX201707; and Program for GUSU Medicine Talents, No. GSWS2019012.
Informed consent statement: Written informed consent was obtained from the patient.
Conflict-of-interest statement: The authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Duan-Min Hu, PhD, Chief Doctor, Director, Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Suzhou 215004, Jiangsu Province, China. huduanmins@126.com
Telephone: +86-512-66784805
Received: July 4, 2019 Peer-review started: July 16, 2019 First decision: September 9, 2019 Revised: September 20, 2019 Accepted: October 5, 2019 Article in press: October 5, 2019 Published online: November 6, 2019 Processing time: 127 Days and 20.1 Hours
Abstract
BACKGROUND
Adenomyomatous hyperplasia of the distal common bile duct (CBD) is very rare, with only scarce case reports in the literature. Diagnosis is usually based on imaging findings, and endoscopic biopsy is very difficult before operation. It is believed that adenomyomatous hyperplasia has little or no risk of malignant transformation.
CASE SUMMARY
A 68-year-old woman with abdominal pain in the right upper quadrant was referred to our hospital. Abdominal ultrasonography in the emergency ward revealed acute cholecystitis and dilated CBD. Laboratory findings showed elevated levels of transaminases, phosphatase, and γ-glutamyltranspeptidase. Pharmaceutical treatment for 3 d did not relieve the symptoms. Magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT) showed proximal bile duct dilatation but could not identify the cause. Endoscopic ultrasonography (EUS) demonstrated a mixed echogenic mass in the distal CBD. During surgery, a firm mass was found in the distal CBD and the Whipple procedure was performed with the initial concern of malignancy. Histology showed diffuse adenomyomatous hyperplasia.
CONCLUSION
EUS may be a useful choice to diagnose adenomyoma of the distal CBD before operation, especially in patients with ambiguous MRCP/CT findings.
Core tip: The distal common bile duct is an extremely rare site of adenomyomatous hyperplasia. Diagnosis is usually based on imaging findings, and endoscopic biopsy is difficult before operation. We present here a rare case of adenomyomatous hyperplasia of the distal common bile duct demonstrated by endoscopic ultrasound, which revealed a nodular change and bile duct wall thickening. We concluded that the mass was a benign, non-neoplastic lesion. This case highlights how endoscopic ultrasound may be a useful choice for the diagnosis of adenomyoma of the distal common bile duct, especially in patients with ambiguous magnetic resonance cholangiopancreatography/computed tomography findings.
