Neoplasms and Pseudotumors Associated with Low (Intrapancreatic) Union of Cystic Duct into Common Bile Duct: A Clinicopathologic Analysis of 15 Cases of a Hitherto Unrecognized Phenomenon
Raul S Gonzalez, Burcu Saka, Pelin Bagci, Ipek Erbarut, Shishir K Maithel, David Kooby, Charles Staley, Bassel El-Rayes, Juan Sarmiento, Rhonda Everett, Alton B Farris, Michelle Reid, Volkan Adsay. Emory University, Atlanta, GA
Background: Anatomic variations and physical anomalies of biliary tract such as anomalous union of ducts or choledochal cysts have been established as risk factors for cancer, believed to be due to abnormal mucosal exposure to different mileu and subsequent carcinogenesis with different biologic/molecular properties. Over the years, we have encountered a previously uncharacterized anatomic variant, low (intrapancreatic) union of cystic duct into common bile duct (CBD), associated with various pathologic conditions.
Design: 15 cases with low union detected prospectively by the authors during routine practice were analyzed.
Results: The patients were 8 female, 7 male; 9 Caucasian, 4 African American, 2 unknown; Mean age= 62 (42-80). 5 cases had history of cholecystectomy, suggesting associated secondary problems in the gallbladder. 1 had diverticulum at the ampulla (suggestive of a conjoint anomaly). All patients underwent pancreatoduodenectomy with the diagnosis of a mass and the clinical impression of “cancer”. 5 were classifiable clearly as CBD carcinomas (otherwise only 5% of Whipples in the authors' experience), 5 pancreatic ductal adenoca, 2 ampullary ca, 1 pancreatic neuroendocrine neoplasm and 2 proved to be pseudotumors (chronic pancreatitis forming pseudo-mass). In 6 cases, the pathology was localized immediately distal to the junction of these ducts. The median survival of the 13 cases with carcinoma was 7 mos. The median size of invasive carcinoma was 3.5 cm. The carcinomas were ordinary pancreatobiliary type. The two pseudotumors were also of focal type and largely localized to the groove region, suggesting a mechanistic relationship to the low union anomaly.
Conclusions: We hereby document a hitherto unrecognized anatomic variation in which the cystic and common hepatic ducts adjoin each other within the pancreas, which we propose to refer to as “low union”. Low union cases can be associated with pancreatobiliary adenocarcinomas, as well as pseudotumors, often arising identifiably in this anomalous junction.
Wednesday, March 6, 2013 1:00 PM
Poster Session VI # 133, Wednesday Afternoon