Pathological analysis of liver and cyst wall in prenatally diagnosed choledochal cysts in children.

UNLABELLED: This study aimed to compare key pathological parameters of the liver and cyst wall between prenatally and postnatally diagnosed choledochal cyst children and analyze the characteristics and clinical implications of pathological changes in these groups. Between June 2023 and December 2023, 85 patients were reviewed: group 1, prenatally diagnosed group (n = 44); group 2, postnatally diagnosed group (n = 41). Patient demographics, liver pathology parameters, and cyst wall pathology parameters were evaluated and compared. The overall rate of advanced fibrosis was 16.5%. The fibrosis rate was comparable between group 1 and group 2, but bile plug formation was more severe in group 1. The degree of cyst wall fibrosis in the middle segment was higher in group 1. The distribution pattern of smooth muscle fibers was predominantly scattered in both groups. Group 1 showed a more severe absence of smooth muscle fibers in both the proximal and middle segments. Cyst diameter and length were positively correlated with the stage of liver fibrosis. The degree of cyst wall fibrosis was negatively correlated with smooth muscle bundle thickness. Two patients (2.4%) exhibited both intestinal metaplasia and pyloric gland metaplasia.

CONCLUSION

Children diagnosed prenatally demonstrated more severe hepatic fibrosis, bile plug formation, cyst wall fibrosis, and smooth muscle deficiency. Early diagnosis and surgery are recommended to avoid postoperative complications.

WHAT IS KNOWN: • Choledochal cyst is the most common congenital malformation in pediatric hepatobiliary disorders, with half of all cases diagnosed prenatally. • Prenatally diagnosed patients exhibit distinct pathological characteristics, but relative studies are very rare.

WHAT IS NEW: • Prenatally diagnosed cases showed a higher incidence of hepatic fibrosis, bile plug formation, cyst wall fibrosis, and smooth muscle deficiency. • Two patients exhibited both intestinal metaplasia and pyloric gland metaplasia.