[Von Meyenburg complexes in the liver: not metastases]

A 74-year-old woman underwent a laparotomy for a rectal carcinoma. Multiple lesions of the liver were discovered as incidental findings. Histopathology revealed that these were Von Meyenburg complexes (VMCs). VMCs, also called biliary hamartomas, are rare and benign malformations of the bile ducts. The lesions present as diffuse greyish-white to greyish-yellow or black nodules of the liver, which on gross inspection and in radiological examinations strongly resemble liver metastases. VMCs are mostly asymptomatic and therefore often an incidental finding at laparotomy or post-mortem examination. The prevalence of VMC is age dependent and is 5.6% in adult patients at post-mortem examination. VMCs are sometimes associated with cholangiocarcinoma. Diagnostic imaging of VMC is difficult and of little specificity. Intraoperative frozen section analysis to differentiate between malignant and benign lesions has a sensitivity of 97% and a specificity of 99%. The benign nature of VMCs means that they do not require treatment. The patient underwent total mesorectal excision and follow-up after 3, 7 and 9 months did not reveal any indications of recurrent colorectal cancer or metastases.