PMC3907201_01
(a) Intraoperative photograph. After lowering the hilar plate the hepatic duct was transected at the confluence of the right and left hepatic ducts. Following this, an extended Lane-Kocher maneuver was performed to allow the dissection of the distal bile duct up to the level of the head of the pancreas. As depicted in the photograph the retroduodenal segment of the CBD was meticulously separated from the portal vein. The dissection was advanced more distally by detaching the CBD from the pancreatic tissue to achieve a free distal resection margin. (b) Resected specimen opened (box in (a)). After opening the duct, a 3 cm in diameter pedunculated polypoid mass, being well-demarcated with smooth surface protruding freely into the CBD lumen was evident. These gross features were indicative for the benignity of the lesion.
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To achieve a free distal resection margin the dissection was advanced more distally by detaching the bile duct from the pancreatic tissue (Fig. 1a). Negative for malignancy fast frozen sections microscopic analysis of the proximal and distal resection margins of the extrahepatic biliary tract, and regional lymph nodes in addition to the macroscopic appearance of the mass (Fig. 1b) were indicative for the benignity of the lesion.
(a) Enlargement of the macroscopic appearance of the inflammatory pseudotumor located in the distal common bile duct: a well demarcated polypoid-like lesion, with smooth surface protruding into the CBD lumen (Hematoxylin and Eosin stain, original magnification 20x). (b) Photomicrograph showing the microscopic features of the IPT (box in (a)): the lesion is composed of fibrous stroma with dense, mixed inflammatory cell infiltrate of lymphocytes, eosinophils, neutrophils and plasmocytes (Hematoxylin and Eosin stain, original magnification 100x).
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Macroscopically the lesion was 3 cm in diameter and had a pedunculated polypoid-like appearance, being well-demarcated with smooth surface, protruding freely into the CBD lumen (Fig. 2a). Microscopically the lesion was composed of fibrous stroma with dense inflammatory cell infiltrate and reactive mesenchymal tissue, while the connective tissue stroma of the distal CBD exhibited a severe mixed inflammatory infiltrate also (Fig. 2b).