Incidental hepatic tissue detected at cholecystectomy is potentially clinically significant

Abstract

Incidental hepatic tissue obtained via cholecystectomy has yet to be fully characterized. Our objective was to demonstrate that this incidental hepatic tissue can be very large, can harbor clinically significant hepatopathology, and can increase billing. We retrospectively reviewed 20 specimens from cholecystectomy that contained hepatic tissue that was very large or that harbored clinically significant hepatopathology. For each case, we assigned theoretical variables corresponding to billing generated for the gallbladder, the liver, and cytochemistry, and compared this billing to standard billing generated if hepatic tissue and cytochemistry were ignored. Five specimens contained prominent wedge-like pieces of liver measuring 0.8 cm to 2.2 cm long and 0.3 cm to 1.8 cm wide, and 15 specimens contained microscopic pieces of liver. Diagnoses included nonalcoholic fatty liver disease or steatohepatitis (17 specimens), de novo α1-antitrypsin deficiency (2 specimens), de novo amyloidosis (1 specimen), hemosiderosis (1 specimen) and necrosis (1 specimen). Theoretical billing generated by including hepatic tissue and cytochemistry was triple the billing generated if hepatic tissue and cytochemistry were ignored. Incidental hepatic tissue obtained via cholecystectomy represents a potentially robust source of diagnostic hepatopathology and billing, and could minimize morbidity by detecting clinically occult hepatic diseases early. Microscopy of incidental hepatic tissue obtained via cholecystectomy should always be performed.