Gallbladder-associated symptomatic hepatic choristoma: Should you resect?

Hepatic choristomas or ectopic livers are uncommon, and occur due to a failure of embryological liver development. They pose a risk of carcinogenesis, with transformation to hepatocellular carcinoma (HCC) being described in the literature (Arakawa et al., 1999). It is often a silent clinical finding that can occur anywhere in the body and is usually diagnosed incidentally during abdominal surgical procedures or autopsies (Eiserth et al., 1940). We present the case of a patient with a symptomatic ectopic liver that was detected preoperatively, and removed laparoscopically with the gallbladder.

A 73-year-old lady was referred to our unit for a gallbladder tumor on ultrasound which was done for biliary colic. Tumor markers were normal. Computed tomography (CT) scan showed an enhanced soft tissue lesion measuring about 3×1.5cm interposed between the gallbladder and liver. Laparoscopic exploration revealed a bean-shaped hepatic choristoma attached to the liver on the medial wall of the gallbladder. The lesion was removed by en-bloc resection during laparoscopic cholecystectomy and extracted carefully in an endobag. Histopathological examination confirmed the absence of carcinogenesis.

Hepatic choristomas (HC) are a rare entity, usually identified during abdominal surgeries. It had been reported in several studies with different presentations. Awareness of this unexpected finding and familiarity of its potential complications and carcinogenesis will improve care delivery when encountered. Surgical treatment should be considered when the choristoma is not attached to the liver, in light of its potential transformation into HCC.