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Liver Histopathology in Pediatric Patients with Choledochal Cyst
Kumar Mayank1, Subhasis Roy Choudhury1, Smita Singh2
1Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.
Insights
Pediatric choledochal cyst (CC) patients exhibit liver histopathology changes. Younger CC patients (<1 year) often present with jaundice and have cystic CC types with more severe liver damage.
Area of Science:
- Pediatric Hepatology
- Surgical Pathology
- Gastroenterology
Background:
- Choledochal cysts (CC) are congenital biliary tract malformations.
- Liver histopathological changes are common in pediatric CC patients.
- Understanding these changes is crucial for patient management.
Purpose of the Study:
- To investigate liver histopathological alterations in pediatric CC patients.
- To correlate these changes with clinical presentation and cyst type.
Main Methods:
- Prospective observational study of pediatric CC patients undergoing excision.
- Histopathological analysis of liver tissue for cholestasis, portal inflammation, bile duct proliferation, and fibrosis.
- Grading of changes using a scoring system.
- Correlation with age, sex, symptoms, and cyst type.
Main Results:
- All 30 CC patients showed varying degrees of liver histopathological changes.
- Patients <1 year old predominantly had cystic CC (69.2%) and presented with jaundice/hepatomegaly.
- Patients >1 year old predominantly had fusiform CC (100%) and presented with abdominal pain.
- Cystic CC correlated with higher grades of liver fibrosis and bile duct proliferation (P < 0.001).
Conclusions:
- Liver histopathological changes are universal in pediatric CC.
- Younger CC patients (<1 year) often have cystic types, present with jaundice, and exhibit more severe liver damage.
- Age and cyst type are significant factors influencing liver histopathology in pediatric CC.
Aim:
The aim is to study the various histopathological changes in the liver in pediatric patients with choledochal cyst (CC) and correlate with the presentation and type of cyst.
Methods:
In a prospective observational study including all pediatric patients who underwent CC excision, histopathological changes of the liver in the form of cholestasis (CHS), portal inflammation (PI), bile duct proliferation (BDP), and fibrosis were studied and graded using a scoring system. They were analyzed in relation to age, sex, symptoms, and type of the cyst.
Results:
All 30 patients of CC showed various degrees of histopathological changes in the liver in the form of CHS, PI, BDP, and liver fibrosis. Patients <1 years had 9/13 (69.2%) cystic variety and those >1 years had 17/17 (100%) fusiform variety of CC (P < 0.001). Patients <1 years frequently presented with jaundice and hepatomegaly and those >1 years presented with pain abdomen (P < 0.002). Higher grades of liver fibrosis and BDP were seen in the cystic variety compared to the fusiform variety (P < 0.001). However, no significant association was found with CHS and PI (P > 1.23).
Conclusions:
Histopathological changes in the liver of varying grades are seen in all patients of CC. Patients of CC <1 year presented frequently with jaundice, had the cystic type, and had a higher degree of liver damage on histopathology.
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