PMC7502785_01
Abdominopelvic CT scan of the patient before surgery demonstrating a well defined round hypodense mass at the porta hepatis adjacent to the gall bladder.
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There is no evidence of biliary tree obstruction and the conclusion was cystic mass at the porta hepatis likely to be type II CC (Fig. 1).
Intraoperative finding of the unusual choledochal cyst variant which is a 5 x 3 x 2 cm sized cyst with a narrow (0.2 cm diameter and 0.5 cm length) pedicle arising from the confluence of the right and left hepatic duct just posteriorly at the level of the porta hepatis (A) Image taken intraoperatively and (B) schematic description of intraoperative finding.
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A 5 x 3 x 2 cm sized cyst with a narrow (0.2 cm diameter and 0.5 cm length) pedicle arising from the confluence of the right and left hepatic duct just posteriorly at the level of the porta hepatis with normal hepatic and common bile duct was found (Fig. 2) which did not fit with any of the current recognized CC classification types.
Microscopic examination shows cyst wall focally lined by bland single layer of columnar cells with sub epithelial fibrotic wall, scanty inflammatory and disorganized smooth muscle but not well formed muscular layer. (Hematoxylin and eosin stain, (A) low power magnification, 40X, (B and C, high power magnification, 100X and 400X respectively).
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Microscopic sections showed cyst wall focally lined by bland columnar cells with subepithelial fibrotic wall, scanty inflammatory and disorganized smooth muscle but not well formed muscular layer (Fig. 3).