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Positive cystic duct margin for low grade dysplasia with intestinal metaplasia after routine laparoscopic
Haider A Alshurafa1, Khalid H Altoukhi2, Bassam F Alhassan3
1Hepatopancreatobiliary, General Surgery Consultant, General Surgery Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
Introduction:
Incidental neoplastic findings after routine cholecystectomy are becoming more common. However, low-grade dysplasia at the cystic duct resection margin remains rare and lacks established management guidelines.
Case Presentation:
A 37-year-old male underwent a routine laparoscopic cholecystectomy. Subsequent histology revealed low-grade dysplasia and intestinal metaplasia at the resected cystic duct margin. A laparoscopic resection of the cystic duct stump up to its junction with the common bile duct was performed, resulting in an uneventful recovery. Post-operative histological examination confirmed the absence of dysplasia at the new cystic margins.
Discussion:
The management of low-grade dysplasia at the cystic duct margin is challenging due to its rarity and the lack of standardized treatment protocols. Our case demonstrates the feasibility and potential benefits of surgical intervention in such scenarios.
Conclusion:
Resection of the remaining cystic stump with confirmation of negative margins appears to be an optimal treatment for low-grade dysplasia at the cystic duct margin. However, further studies are necessary to evaluate the roles of surgery and surveillance in managing this rare condition.
