{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T03:08:10Z","timestamp":1774494490395,"version":"3.50.1"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2020,2,3]],"date-time":"2020-02-03T00:00:00Z","timestamp":1580688000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Asan Institute for Life Sciences","award":["2015-554"],"award-info":[{"award-number":["2015-554"]}]},{"DOI":"10.13039\/501100014188","name":"Ministry of Science and ICT, South Korea","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100014188","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001321","name":"National Research Foundation","doi-asserted-by":"publisher","award":["2012R1A2B4009381"],"award-info":[{"award-number":["2012R1A2B4009381"]}],"id":[{"id":"10.13039\/501100001321","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,5,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Histopathologic characteristics of choledochal cysts and their clinical implications have not been previously comprehensively studied.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Smooth muscle distribution patterns and other histologic findings (inflammation, metaplasia, dysplasia, and heterotopia) in 233 surgically resected choledochal cysts were evaluated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Mean patient age was 23.3\u2005\u00b1\u200519.8 years, with male:female ratio of 0.3. Most cases were Todani type I (175 cases, 75.1%) or IVa (56 cases, 24.1%). Choledochal cysts with thin scattered\/no muscle fiber (175 cases, 75.1%) were the predominant pattern and were associated with more frequent postoperative biliary stricture (P\u2005=\u2005.031), less frequent pyloric metaplasia (P\u2005=\u2005.016), and mucosal smooth muscle aggregates (P\u2005&amp;lt;\u2005.001) compared to cysts with thick muscle bundles. Severe chronic cholangitis (P\u2005=\u2005.049), pyloric metaplasia (P\u2005=\u2005.019), mucosal smooth muscle aggregates (P\u2005&amp;lt;\u2005.001), biliary intraepithelial neoplasia (P\u2005=\u2005.021), and associated bile duct (P\u2005=\u2005.021) and gallbladder carcinomas (P\u2005=\u2005.03) were more common in adults (age\u2005&amp;gt;20 years vs \u226420 years), suggesting that chronic irritation in association with developmental anomalies involves tumorigenesis from choledochal cysts.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Smooth muscle distribution pattern of choledochal cyst may predict postoperative complication, raising clinical implications of smooth muscle patterns in postoperative management of choledochal cysts.<\/jats:p>\n               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