Giant Cell Tumor of the Common Bile Duct

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Giant cell tumors usually occur in the bone/tendon sheath of children and adolescents. Other less common sites include the pancreas, mediastinum, skin, larynx and thyroid. To date there have only been 4 reported cases in the literature of giant cell tumors of the extrahepatic biliary tree. A 60 year old Hispanic male with diabetes and atrial fibrillation was found to have a common bile duct mass incidentally on CT of the chest, during a work up for pneumonia. The patient was asymptomatic and physical exam was unremarkable. Laboratory values were notable for an alkaline phosphatase of 175 U/L, GGT of 230 U/L, AST of 63 U/L and ALT of 64 U/L. The total bilirubin, viral serologies and tumor markers were normal. The CT showed a dilated common bile duct of 2.3 cm with a 1.7 cm mass projecting into the lumen of the distal common bile duct from the right lateral wall. The patient underwent an ERCP that revealed a dilated common bile duct of 2.2 cm, with a 2 × 4 cm intraluminal filling defect attached to the right wall of the distal common bile duct. A sphincterotomy and basket sweeps were performed, with soft tissue debris extracted. Pathology revealed multinucleated giant cells admixed with mononuclear cells. The patient then underwent surgical resection with a Whipple's procedure. Gross pathology revealed a 1.5 cm polypoid lesion in the common bile duct and histology was significant for multinucleated osteoclast-like giant cells and many mononuclear cells. Findings were confirmed by the Armed Forces Institute of Pathology as a giant cell tumor of the common bile duct. The patient is healthy at 1-year follow up. Polypoid lesions of the gallbladder and extrahepatic biliary tree are rare and primarily include cholesterol polyps, inflammatory polyps, adenomyoma, adenomas, leiomyomas and carcinoids. Since the first case report in 1986, only 4 cases of a giant cell tumor of the gallbladder or extrahepatic biliary tree have been reported. A recent case review of the 4 cases demonstrated that these tumors are similar histologically and immunohistochemically to giant cell tumors of the bone/tendon sheath, staining positive for CD68 and CD163 and pursue a benign course. Yet it is important to distinguish these tumors from anaplastic spindle and giant cell carcinomas with osteoclast-like giant cells of the gallbladder, which are malignant and pursue an aggressive course. This case represents an extremely rare, benign tumor of the extrahepatic biliary tree.