Villous adenoma of the extrahepatic duct is a rare disease. Even though it is benign, it has malignant potential and is considered a premalignant lesion. We here report one case of villous adenoma with foci of adenocarcinoma arising in the common hepatic duct. A 60-year-old male was admitted to our hospital because of epigastric pain. The cholangiogram revealed a large filling defect in the right intrahepatic and common hepatic duct with intrahepatic bile duct dilatation. The patient underwent right lobectomy. Grossly, stalked papillay tumor originated in the common hepatic duct was overriding the right intrahepatic duct. Microscopically, the tumor was composed of stratified tall columnar cells with various dysplasia and there were foci of invasive adenocarcinoma.
Adenocarcinoma* ; Adenoma, Villous* ; Bile Ducts ; Bile Ducts, Intrahepatic ; Dilatation ; Hepatic Duct, Common* ; Humans ; Male ; Middle Aged ; Rare Diseases

Background: Current international guidelines recommend against deep sedation as it is associated with worse outcomes in the intensive care unit (ICU). However, in Korea the prevalence of deep sedation and its impact on patients in the ICU are not well known. Methods: From April 2020 to July 2021, a multicenter, prospective, longitudinal, noninterventional cohort study was performed in 20 Korean ICUs. Sedation depth extent was divided into light and deep using a mean Richmond Agitation–Sedation Scale value within the first 48 hours. Propensity score matching was used to balance covariables; the outcomes were compared between the two groups. Results: Overall, 631 patients (418 [66.2%] and 213 [33.8%] in the deep and light sedation groups, respectively) were included. Mortality rates were 14.1% and 8.4% in the deep and light sedation groups (P = 0.039), respectively. Kaplan-Meier estimates showed that time to extubation (P < 0.001), ICU length of stay (P = 0.005), and death P = 0.041) differed between the groups. After adjusting for confounders, early deep sedation was only associated with delayed time to extubation (hazard ratio [HR], 0.66; 95% confidence inter val [CI], 0.55– 0.80; P < 0.001). In the matched cohort, deep sedation remained significantly associated with delayed time to extubation (HR, 0.68; 95% 0.56–0.83; P < 0.001) but was not associated with ICU length of stay (HR, 0.94; 95% CI, 0.79–1.13; P = 0.500) and in-hospital mortality (HR, 1.19; 95% CI, 0.65–2.17; P = 0.582). Conclusion In many Korean ICUs, early deep sedation was highly prevalent in mechanically ventilated patients and was associated with delayed extubation, but not prolonged ICU stay or in-hospital death.