# Multiple bile duct adenomas mimicking hepatic metastases during laparoscopic cholecystectomy - A case report

## TL;DR

A rare case of multiple bile duct adenomas was mistaken for liver cancer during surgery, highlighting the need for careful diagnosis to avoid unnecessary treatment.

## Contribution

This case report highlights the diagnostic challenge of distinguishing bile duct adenomas from malignant liver lesions during laparoscopic cholecystectomy.

## Key findings

- Multiple bile duct adenomas were initially mistaken for hepatic metastases during surgery.
- Histological examination and CECT confirmed the benign nature of the lesions.
- The case underscores the importance of intraoperative evaluation to prevent overtreatment.

## Abstract

Bile duct adenoma (BDA) is a rare benign liver neoplasm, with relatively few cases reported in literature.

A 55-year-old man diagnosed with symptomatic gallstone disease who underwent elective laparoscopic cholecystectomy. During the procedure, there were multiple liver nodules mimicking hepatic metastases. Histological examination and contrast-enhanced computed tomography (CECT) of the liver confirmed the diagnosis of BDA.

When incidental liver nodules are encountered intraoperatively, thorough evaluation is essential to confirm the diagnosis. Structured approach using histological examination and imaging (CECT of the liver/ MRI) confirmed the diagnosis of BDA.

BDA is a rare benign liver neoplasm that can be challenging to differentiate from hepatocellular carcinoma or liver metastases. Accurate identification of BDA can prevent overtreatment or mismanagement.

•Rare Clinical Presentation: The manuscript discusses a rare case of multiple bile duct adenomas (BDAs), a benign condition, which [[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14],13,14] mimicked malignant hepatic metastases, presenting a diagnostic and therapeutic challenge.•Significance in Differential Diagnosis: Emphasizes the importance of considering BDAs in the differential diagnosis of liver lesions observed intraoperatively.•Role of Histopathology: Highlights importance of histopathological evaluation were critical in confirming the benign nature of the lesions, thus avoiding unnecessary aggressive surgical interventions.•Imaging and Diagnostic Challenges: Discusses the limitations of preoperative imaging in differentiating BDAs from metastatic disease, stressing the need for intraoperative decision-making based on direct visualization and biopsy.•Clinical Implications and Outcomes: Provides insights into surgical decision-making, emphasizing minimally invasive management strategies and the importance of avoiding overtreatment in cases of suspected metastatic liver lesions with benign pathology.

Rare Clinical Presentation: The manuscript discusses a rare case of multiple bile duct adenomas (BDAs), a benign condition, which [[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14],13,14] mimicked malignant hepatic metastases, presenting a diagnostic and therapeutic challenge.

Significance in Differential Diagnosis: Emphasizes the importance of considering BDAs in the differential diagnosis of liver lesions observed intraoperatively.

Role of Histopathology: Highlights importance of histopathological evaluation were critical in confirming the benign nature of the lesions, thus avoiding unnecessary aggressive surgical interventions.

Imaging and Diagnostic Challenges: Discusses the limitations of preoperative imaging in differentiating BDAs from metastatic disease, stressing the need for intraoperative decision-making based on direct visualization and biopsy.

Clinical Implications and Outcomes: Provides insights into surgical decision-making, emphasizing minimally invasive management strategies and the importance of avoiding overtreatment in cases of suspected metastatic liver lesions with benign pathology.