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Manzari Tavakoli G, Afsharzadeh M, Mobinikhaledi M, Behzad S, Ghorani H, Salahshour F. Differentiation between mucinous cystic neoplasms and simple cysts of the liver: a systematic review and meta-analysis. Abdom Radiol (NY) 2025:10.1007/s00261-025-04874-3. [PMID: 40095015 DOI: 10.1007/s00261-025-04874-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2025] [Revised: 02/26/2025] [Accepted: 03/02/2025] [Indexed: 03/19/2025]
Abstract
PURPOSE Radiologic examinations frequently identify cystic liver lesions, which encompass various entities from simple benign cysts to malignant neoplasms. This work analyses the available data to compare diagnostic features of biliary cystic neoplasms and hepatic simple cysts. METHODS A systematic search of PubMed, Scopus, Embase, and Web of Science up to October 2024 was conducted. The characteristics were categorized into hepatic simple cysts (HSC) and mucinous cystic neoplasms (MCN), including biliary cystadenoma (BCA) and cystadenocarcinoma (BCAC) detected by imaging modalities including ultrasound, CT scans with IV contrast, or MRI. We analyzed biliary cystic neoplasms and hepatic simple cysts across multiple studies using Review Manager Ver. 5, calculating summary measures for each feature. RESULTS The study analyzed 577 lesions in 577 patients and 49 studies. Hepatic simple cysts were the most common finding, with 349 identified, mainly in the right hepatic lobe, presented with abdominal pain or incidentally. Intracystic septation was found in 50.1% of HSC lesions, with thick septation in 10.52% of lesions. 228 (49.9%) patients were diagnosed with MCN, with abdominal swelling and pain as the most common presentation. Septation was the most common radiological feature of MCNs, with thick septa in 50.61%. MCNs had internal septa, solid mural nodule, upstream bile duct dilation, presence in the left hepatic lobe, septal thickening, cystic wall enhancement, calcifications, and internal debris. The presence of a cyst in the left lobe was more related to MCNs. CONCLUSION Characterizing cystic liver lesions necessitates a comprehensive evaluation of the lesions' location, size, and complexity. Imaging and clinical findings are essential for a final diagnosis.
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Affiliation(s)
| | - Mahshad Afsharzadeh
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam-Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
| | - Mahya Mobinikhaledi
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam-Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Shima Behzad
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam-Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Hamed Ghorani
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam-Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Faeze Salahshour
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam-Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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2
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Aziz H, Hamad A, Afyouni S, Kamel IR, Pawlik TM. Management of Mucinous Cystic Neoplasms of the Liver. J Gastrointest Surg 2023; 27:1963-1970. [PMID: 37221388 DOI: 10.1007/s11605-023-05709-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/09/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Mucinous cystic neoplasms of the liver (MCN-L) including biliary cystadenomas (BCA) and biliary cystadenocarcinomas (BCAC) are rare cystic lesions that comprise less than 5% of all liver cysts and affect only a small subset of individuals. We herein review the current evidence regarding the clinical presentation, imaging characteristics, tumor markers, pathological findings, clinical management, and prognosis of MCN-L. METHODS A comprehensive review of the literature was performed using MEDLINE/Pubmed and Web of Science databases. In PubMed, the terms "biliary cystadenoma," "biliary cystadenocarcinoma," and "non parasitic hepatic cysts" were queried to identify the most recent data on MCN-L. RESULTS US imaging, CT, and MRI, as well as consideration of clinicopathological features, are required to appropriately characterize and diagnose hepatic cystic tumors. BCA are premalignant lesions and cannot be reliably differentiated from BCAC based on imaging alone. As such, both types of lesions should be treated with margin-negative surgical resection. Following surgical resection, recurrence is fairly low among patients with BCA and BCAC. Despite having worse long-term outcomes than BCA, the prognosis following surgical resection of BCAC still remains more favorable than other primary malignant liver tumors. CONCLUSION MCN-L are rare cystic liver tumors that include BCA and BCAC, which can be difficult to differentiate based on imaging alone. Surgical resection remains the mainstay of management for MCN-L with recurrence being generally uncommon. Future multi-institutional studies are still required to better understand the biology behind BCA and BCAC to improve the care of patients with MCN-L.
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Affiliation(s)
- Hassan Aziz
- Department of Surgery, University of Iowa, Iowa City, IA, USA
| | - Ahmad Hamad
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, 395 W. 12Th Avenue, Suite 670, Columbus, OH, USA
| | - Shadi Afyouni
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ihab R Kamel
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, 395 W. 12Th Avenue, Suite 670, Columbus, OH, USA.
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Li YC, Shi AD, Li KS. Case report: Obstructive jaundice caused by biliary cystadenoma. Front Oncol 2023; 13:1165979. [PMID: 37064112 PMCID: PMC10097958 DOI: 10.3389/fonc.2023.1165979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/15/2023] [Indexed: 04/03/2023] Open
Abstract
Biliary cystadenoma (also called mucinous cystic neoplasm with low-grade intraepithelial neoplasia) is a rare cystic tumor that arises from the biliary epithelium. The cause of biliary cystadenoma is still unclear. Jaundice is a rare presentation of intrahepatic biliary cystadenoma, which can lead to a diagnostic dilemma. Herein, we present a case of intrahepatic biliary cystadenoma that primarily exhibited as jaundice. A 56-year-old woman has suffered from yellow staining of her skin and sclera for more than 1 month. She had a poor appetite and mild epigastric pain. Laboratory examination showed elevated levels of total bilirubin and elevated carbohydrate antigen 19-9 (CA19-9). A contrast-enhanced computed tomography of the abdomen showed a 7.4 * 5.3-cm, oval, low-density lesion in the left liver parenchyma with a clear boundary and visible septa. The common bile duct was obviously dilated with wall thickening. On magnetic resonance imaging, the lesion in the liver showed a multilocular cystic, unenhanced long T2 signal. There was local thickening of the common bile duct wall with short T2-like filling defects and high signal intensity on diffusion-weighted imaging (DWI). The patient had no history of other malignant tumors and adjuvant therapy such as radiotherapy and chemotherapy. She was clinically suspected of having either biliary cystadenoma or a malignancy; hence, resection was performed. Macroscopically, the excised tissue specimen showed a polypoid mass in the common bile duct, which extended along the bile duct to the intrahepatic bile duct. There was a cystic and solid mass in the left liver with yellow turbid fluid, which was associated with the polypoid mass in the common bile duct. Histopathology suggests mucinous cystadenoma of the liver and hilar bile duct. The differential diagnosis of biliary cystadenoma and treatment selection have been discussed.
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Affiliation(s)
| | | | - Kang-shuai Li
- Department of General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Yang Y, Chen W, Cen H, Li Z, Di X, Wu Y, Liu L. Intrahepatic biliary cystadenoma: Confusion, experience, and lessons learned from our center. Front Oncol 2022; 12:1003885. [DOI: 10.3389/fonc.2022.1003885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/28/2022] [Indexed: 11/12/2022] Open
Abstract
BackgroundIntrahepatic biliary cystadenoma (IBC) is a rare benign cystic tumor of the liver. So far, it has not been comprehensively understood, which causes incorrect diagnosis, treatment confusion, and even inappropriate treatment. Here, we reviewed clinical data of IBC patients in our center, shared our experiences and lessons learned, and improved the level of diagnosis and treatment.MethodsThe clinical data of 10 patients with pathologically diagnosed IBC, admitted to the Department of Hepatobiliary Surgery of the Affiliated Hospital of Guangdong Medical University from January, 2007, to January, 2022 were retrospectively analyzed.Results10 patients underwent surgery and were discharged successfully. Cyst morphology: multiple cysts: 6 cases (6/10), monocular cyst: four cases(4/10). Six patients (6/10) were diagnosed as IBC preoperatively and received hepatectomy. Four patients with monocular cyst IBC underwent intraoperative frozen section examination, except one case showed IBC; the rest were misdiagnosed as simple liver cyst. In three misdiagnosed patients, one underwent open left hepatectomy seven days after the initial operation. The other patient refused to undergo reoperation and required follow-up observation. The last patient could not tolerate hepatectomy due to insufficient residual liver volume and chose follow-up observationConclusionFor IBC, especially monocular IBC, it is easy to be misdiagnosed as simple hepatic cyst, which brings great confusion to clinical treatment. We propose strengthening communication with pathologists to deepen understanding of IBC. Attention should be paid to the cyst wall’s shape and the cyst fluid’s properties during the operation to avoid the missed diagnosis, misdiagnosis, or even improper operation. For suspicious cases, directly choose hepatectomy to avoid reoperation after thoroughly evaluating the patient’s condition.
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5
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Drenth J, Barten T, Hartog H, Nevens F, Taubert R, Torra Balcells R, Vilgrain V, Böttler T. EASL Clinical Practice Guidelines on the management of cystic liver diseases. J Hepatol 2022; 77:1083-1108. [PMID: 35728731 DOI: 10.1016/j.jhep.2022.06.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 02/07/2023]
Abstract
The advent of enhanced radiological imaging techniques has facilitated the diagnosis of cystic liver lesions. Concomitantly, the evidence base supporting the management of these diseases has matured over the last decades. As a result, comprehensive clinical guidance on the subject matter is warranted. These Clinical Practice Guidelines cover the diagnosis and management of hepatic cysts, mucinous cystic neoplasms of the liver, biliary hamartomas, polycystic liver disease, Caroli disease, Caroli syndrome, biliary hamartomas and peribiliary cysts. On the basis of in-depth review of the relevant literature we provide recommendations to navigate clinical dilemmas followed by supporting text. The recommendations are graded according to the Oxford Centre for Evidence-Based Medicine system and categorised as 'weak' or 'strong'. We aim to provide the best available evidence to aid the clinical decision-making process in the management of patients with cystic liver disease.
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McIntyre CA, Girshman J, Goldman DA, Gonen M, Soares KC, Wei AC, Balachandran VP, Kingham TP, Drebin JA, Jarnagin WR, Gluskin JS, D'Angelica MI, Gerst SR. Differentiation of mucinous cysts and simple cysts of the liver using preoperative imaging. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:1333-1340. [PMID: 35188592 PMCID: PMC10387191 DOI: 10.1007/s00261-022-03436-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Preoperative radiographic differentiation of mucinous cystic neoplasms (MCN) and simple cysts (SLC) of the liver is challenging. Previous data have demonstrated that the finding of septations arising from the cyst wall without indentation on cross-sectional imaging is associated with MCN. We aim to assess whether this radiographic feature is diagnostic of MCN. METHODS A prospectively maintained database was queried for patients with a preoperative diagnosis of a cystic liver lesion who subsequently underwent operative intervention. The feature of septations without indentation of the cyst wall was evaluated on cross-sectional imaging obtained within 3 months of operation. Imaging was independently evaluated by three radiologists blinded to pathology and interobserver agreement was compared to assess the diagnostic accuracy of this feature as well as the overall likelihood of the lesion representing a MCN. RESULTS There were 95 patients who met inclusion criteria; 80 (84%) had SLC on pathology, while 15 (16%) had MCN. Presence of septa without indentation of cyst wall had high sensitivity (range 80-87%), but low specificity (range 48-66%). Interobserver percent agreement (PA) was 51% [κ = 0.35 (95% CI 0.22-0.47)]. Sensitivity among the three radiologists ranged between 20 and 80% and specificity between 71 and 91% for the likelihood of the lesion representing MCN versus SLC, with an area under the curve (AUC) of 0.67-0.79; however, interobserver agreement was fair [κ = 0.40 (95% CI 0.25-0.55), PA = 67%]. CONCLUSION The presence of septations without indentation of cyst wall demonstrates adequate sensitivity to differentiate MCN and SLC. However, there is variability for detection of this feature and therefore, it alone is of limited clinical value.
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Affiliation(s)
- Caitlin A McIntyre
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeffrey Girshman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Debra A Goldman
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mithat Gonen
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kevin C Soares
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alice C Wei
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vinod P Balachandran
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - T Peter Kingham
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeffrey A Drebin
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William R Jarnagin
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jill S Gluskin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael I D'Angelica
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Scott R Gerst
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Halankar J, Jhaveri K, Metser U. Cystic lesions of the pancreatico-biliary tree: A schematic MRI approach. Indian J Radiol Imaging 2021; 27:167-176. [PMID: 28744077 PMCID: PMC5510314 DOI: 10.4103/ijri.ijri_226_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Although a common occurrence, cystic lesions of the pancreatico-biliary tree (PBT) may pose a diagnostic dilemma because they encompass a large number of neoplastic and benign processes with varied clinical symptoms. Knowledge of lesion classification and characterization are essential in making an accurate prospective diagnosis. This is necessary for identifying clinically significant cystic masses, which at times may require invasive intervention from indolent, nonneoplastic lesions, for which surveillance may suffice. Today, there is an arsenal of modalities for assessing the PBT, however, magnetic resonance imaging (MRI) remains at the forefront for characterizing cystic morphology and fluid content, internal septations, solid component, enhancement patterns, as well as assessing the surrounding normal structures. This pictorial review aims to review the spectrum of MRI features, which will aid in the differential diagnoses of cystic lesions of the PBT and mimickers, enabling the radiologist to reach a more confident diagnosis.
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Affiliation(s)
- Jaydeep Halankar
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kartik Jhaveri
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ur Metser
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
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8
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Mamone G, Di Piazza A, Gentile G, Milazzo M, Carollo V, Crinò F, Marrone G, Caruso S, Sparacia G, Maruzzelli L, Miraglia R. Imaging of calcified hepatic lesions: spectrum of diseases. Abdom Radiol (NY) 2021; 46:2540-2555. [PMID: 33452900 DOI: 10.1007/s00261-020-02924-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/13/2020] [Accepted: 12/19/2020] [Indexed: 01/23/2023]
Abstract
Hepatic calcifications have been increasingly identified over the past decade due to the widespread use of high-resolution Computed Tomography (CT) imaging. Calcifications can be seen in a vast spectrum of common and uncommon diseases, from benign to malignant, including cystic lesions, solid neoplastic masses, and inflammatory focal lesions. The purpose of this paper is to present an updated review of CT imaging findings of a wide range of calcified hepatic focal lesions, which can help radiologists to narrow the differential diagnosis.
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Affiliation(s)
- Giuseppe Mamone
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy.
| | - Ambra Di Piazza
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
| | - Giovanni Gentile
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
| | - Mariapina Milazzo
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
| | - Vincenzo Carollo
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
| | - Francesca Crinò
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
| | - Gianluca Marrone
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
| | - Settimo Caruso
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
| | - Gianvincenzo Sparacia
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
| | - Luigi Maruzzelli
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
| | - Roberto Miraglia
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
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9
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Choe MJ, Hinkel T, Berggruen SM. Imaging of Benign Hepatic lesions. Semin Ultrasound CT MR 2021; 42:347-365. [PMID: 34130848 DOI: 10.1053/j.sult.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
As abdominal imaging volumes have increased, the incidence of incidentally identified benign hepatic lesions has substantially increased. Familiarity with imaging appearances of benign hepatic tumors, both common and less commonly encountered, allows the radiologist to give an informed differential diagnosis. In addition to clinical history, awareness of imaging findings of benign hepatic lesions on ultrasound, computed tomography and magnetic resonance imaging is useful in evaluating these lesions and avoiding unnecessary diagnostic interventions or imaging surveillance.
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Affiliation(s)
- Michael J Choe
- Department of Radiology, Northwestern Memorial Hospital, Chicago, IL
| | - Tyler Hinkel
- Department of Radiology, Northwestern Memorial Hospital, Chicago, IL
| | - Senta M Berggruen
- Department of Radiology, Northwestern Memorial Hospital, Chicago, IL..
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10
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Corvino A, Sandomenico F, Setola SV, Corvino F, Tafuri D, Catalano O. Lesioni cistiche complex di fegato: reperti ecocontrastografici diagnostico-differenziali. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2020; 179. [DOI: 10.23736/s0393-3660.19.04120-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
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Ramavath K, Kaman L, Gupta A, Singh A, Das A. Biliary cystadenoma in an endemic zone of hydatid cyst: A rare surgical surprise. Ann Hepatobiliary Pancreat Surg 2020; 24:85-89. [PMID: 32181435 PMCID: PMC7061038 DOI: 10.14701/ahbps.2020.24.1.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/02/2019] [Accepted: 01/19/2020] [Indexed: 11/23/2022] Open
Abstract
The advancement of radiological investigations has led to the early and incidental detection of hepatic cystic lesions. These are most commonly the simple cysts but can be malignant as well. Despite the recent advances, these lesions still pose a diagnostic as well as therapeutic challenge. The biliary cystadenomas and carcinomas form around 5% of all the malignant cystic lesions of liver. These lesions are hardly diagnosed preoperatively and are usually a histopathological surprise. They warrant a surgical excision. Herewith, the authors are describing a case of cystic hepatic neoplasm initially misdiagnosed as hydatid cyst of liver and discovered to be a vascular cystic lesion intraoperatively. This patient underwent resection of the lesion and was discovered to harbour biliary cystadenoma on histopathological specimen.
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Affiliation(s)
- Krishna Ramavath
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Lileswar Kaman
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Gupta
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Abhinav Singh
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Asim Das
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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12
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Frezin J, Komuta M, Zech F, Annet L, Horsmans Y, Gigot JF, Jouret-Mourin A, Hubert C. Mucin-producing hepatic cystic neoplasms: an uncommon but challenging disease often misdiagnosed and mismanaged. Acta Chir Belg 2020; 120:6-15. [PMID: 30388391 DOI: 10.1080/00015458.2018.1532706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: Mucin-producing hepatic cystic neoplasms (MHCN) are uncommon and potentially malignant.Methods: Nine MHCN were encountered in our centre for over 32 years. Patients' clinical, biological, radiological and pathological features were reviewed. Lesions were classified into Mucinous Cystic Neoplasms (MCN) and Intraductal Papillary Neoplasms of the Bile duct (IPNB) (WHO 2010 classification).Results: Five MCN and 4 IPNB were reviewed. Serum and intracystic tumour markers were insufficient to diagnose malignancy. Complications were encountered in five out of nine patients (56%), mean symptom duration was 26 months (range: 1-132). Three patients were mismanaged pre-referral. Radiological features enabled preoperative diagnosis in eight out of nine patients (89%). Greater tumour size, unilocular lesion and mural nodularity indicated malignancy. Radical tumour excision was achieved in eight patients. One IPNB patient was misdiagnosed and underwent unroofing. For 103 months median follow-up, five out of six patients with benign tumours were alive and disease-free, whereas the misdiagnosed IPNB recurred with fatal malignant transformation seven years later. Among the three patients with malignancies (median follow-up: 77 months), two IPNB died, one from cancer recurrence and one from unrelated causes, whereas the malignant MCN was alive and disease-free.Conclusions: Appropriate MHCN diagnosis is crucial, yet it is often misdiagnosed and mismanaged. The prognosis after complete excision is favourable.
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Affiliation(s)
- J. Frezin
- Hepato-Biliary and Pancreatic Surgery, Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - M. Komuta
- Pathology Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - F. Zech
- Internal Medicine Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - L. Annet
- Medical Imaging Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - Y. Horsmans
- Gastro-Enterology and Hepatology Department, Cliniques universitairesSaint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - J. F. Gigot
- Hepato-Biliary and Pancreatic Surgery, Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - A. Jouret-Mourin
- Pathology Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - C. Hubert
- Hepato-Biliary and Pancreatic Surgery, Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
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13
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Corvino A, Sandomenico F, Setola SV, Corvino F, Tafuri D, Catalano O. Morphological and dynamic evaluation of complex cystic focal liver lesions by contrast-enhanced ultrasound: current state of the art. J Ultrasound 2019; 22:251-259. [PMID: 31087277 PMCID: PMC6704192 DOI: 10.1007/s40477-019-00385-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/02/2019] [Indexed: 12/14/2022] Open
Abstract
Complex cystic and cystic-like focal liver lesions (FLLs) encompass a spectrum of disorders ranging from non-neoplastic conditions to benign and malignant tumors. In this prospective, the possibility of non-invasive differentiation of these lesions is extremely important, because the clinical implications and therapeutic strategies vary considerably. Because of its advantageous cost/benefit ratio, widespread availability and easy execution, ultrasound (US) is the first-line imaging modality in most countries for the initial liver survey and represents the imaging technique that usually detects a complex liver cyst. However, US showed poor efficacy in the differential diagnosis of complex cystic FLLs. Thus, for years, computed tomography (CT) and magnetic resonance (MR) imaging have been used for further assessment of these lesions. Recently, the development of low mechanical index real-time contrast-enhanced ultrasound (CEUS) technique performed with the second generation of US contrast agents has led to an accurate depiction of macrovasculature and microvasculature. The technique yields information about contrast enhancement of the liver and FLLs almost as CT and MRI do, but in real time and without the use of ionizing radiation. To date, there is only a small amount of evidence about the role of CEUS in the less common setting of complex liver cysts. The aim of this review is to offer an up-to-date overview on the state of the art of CEUS in the study of the most common complex cystic focal liver lesions. To our knowledge, there are no literature comprehensive reviews on this topic.
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Affiliation(s)
- Antonio Corvino
- Motor Science and Wellness Department, University of Naples “Parthenope”, VIA F. Acton 38, 80133 Naples, Italy
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), Via S. Pansini 5, 80131 Naples, Italy
- via Croce no. 82, 81033 Casal di Principe, CE Italy
| | - Fabio Sandomenico
- Radiology Department, National Cancer Institute Pascale Foundation, Via M. Semmola 53, 80131 Naples, Italy
| | - Sergio Venanzio Setola
- Radiology Department, National Cancer Institute Pascale Foundation, Via M. Semmola 53, 80131 Naples, Italy
| | - Fabio Corvino
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, 80131 Naples, Italy
| | - Domenico Tafuri
- Motor Science and Wellness Department, University of Naples “Parthenope”, VIA F. Acton 38, 80133 Naples, Italy
| | - Orlando Catalano
- Radiology Unit, Istituto Diagnostico Varelli, Via Cornelia Dei Gracchi 65, 80126 Naples, Italy
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Anand S, Chandrasekar S, Raja K, Pottakkat B. Mucinous cystic neoplasm of the liver with biliary communication: an exception to the current classification. BMJ Case Rep 2019; 12:bcr-2018-227063. [PMID: 30635308 PMCID: PMC6340565 DOI: 10.1136/bcr-2018-227063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2018] [Indexed: 12/25/2022] Open
Abstract
Cystic neoplasms of the liver are rare tumours. According to the recent WHO classification, they are classified into mucinous cystic neoplasm and intraductal papillary neoplasm based on the presence of ovarian-like stroma and biliary communication. We report two rare cases of mucinous cystadenoma of the liver with biliary communication and discuss the shortcomings of current classification.
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Affiliation(s)
- Santhosh Anand
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, Puducherry, India
| | - Sandip Chandrasekar
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, Puducherry, India
| | - Kalayarasan Raja
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, Puducherry, India
| | - Biju Pottakkat
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, Puducherry, India
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15
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Zhang C, Ma YF, Yang YL. Jaundice caused by protrusion of a hepatic cyst into common bile duct that was resolved by choledochoscopic needle-knife electrotomy: a case report. BMC Gastroenterol 2018; 18:90. [PMID: 29921238 PMCID: PMC6009036 DOI: 10.1186/s12876-018-0815-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 06/05/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUD Hepatic cysts are the most frequent, innocuous, space-occupying lesions of the liver. The majority of solitary liver cysts are nonsymptomatic. When liver cysts reach a large size, there are some complications, including infection, rupture, spontaneous hemorrhage, obstructive jaundice, and neoplastic degeneration. Percutaneous aspiration, fenestration, hepatic resection, and liver transplantation have been proposed for symptomatic patients. CASE PRESENTATION In this case report, we describe a 41-year-old woman who presented with persistent liver dysfunction, indolent xanthochromia, and skin itching for 3 months. After a series of tests, she has a 5.0 × 5.3 cm hepatic cyst with many separations in the left medial liver lobe. The obstructive jaundice was caused by a large pedunculated lump protruding into the common bile duct from the left hepatic duct. She was treated with laparotomy and this lump was completely removed from the root by choledochoscopic needle-knife electrotomy with a good clinical response. Postoperative pathology of the lump suggested a hepatic cyst wall without heterocysts or tumor cells. CONCLUSION Hepatic cyst wall protruding into the common bile duct can form capsular lump and result in indolent jaundice. Choledochoscopic high-frequency needle-knife electrotomy could be considered as a simple, safe and effective complementary approach for benign mass on the bile duct wall.
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Affiliation(s)
- Cheng Zhang
- Department of Biliary Minimally Invasive Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, Liaoning Province, China
| | - Yue-Feng Ma
- Department of Biliary Minimally Invasive Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, Liaoning Province, China
| | - Yu-Long Yang
- Cholelithiasis Center, East Hospital of Tongji University, 150 Jimo Road, Pudong, Shanghai, 200120, China.
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16
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Salerno S, Florena AM, Romano I, Miceli L, Lo Casto A. Multifocal Biliary Cystadenocarcinoma of the Liver: CT and Pathological Findings. TUMORI JOURNAL 2018; 92:358-60. [PMID: 17036531 DOI: 10.1177/030089160609200418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Biliary cystadenocarcinoma is a rare tumor that originates from the hepatobiliary epithelium. Although this tumor can affect any portion of the biliary tree, intrahepatic location is more common. It is usually a slow growing tumor and often asymptomatic until it reaches a considerable size. The lesion is most often solitary and large when discovered; multiple lesions or metastases within the liver are very rare. A 63-year-old man was referred to our institute for weight loss, abdominal discomfort, worsening bulky symptoms in the right upper abdominal quadrant, and an increase in serum aminotransferases that had been present for several months. Spiral CT of the abdomen demonstrated two lesions, a larger one and a distant intrahepatic lesion, with a multiloculated cystic aspect, a thin peripheral capsule, multiple solid peripheral portions, and irregular septa enhancing in the portal phase after intravenous administration of iodinated contrast medium. The diagnosis of multifocal cystadenocarcinoma of the liver was confirmed by surgical laparoscopy and biopsy of the lesion. The patient was treated with chemotherapy.
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Affiliation(s)
- Sergio Salerno
- Sezione di Radiologia, DIBIMEL, Università degli Studi di Palermo, Palermo, Italy.
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17
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Ho A, Girgis S, Low G. Uncommon liver lesions with multimodality imaging and pathology correlation. Clin Radiol 2018; 73:191-204. [DOI: 10.1016/j.crad.2017.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/16/2017] [Accepted: 07/31/2017] [Indexed: 02/08/2023]
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18
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Manuel-Vázquez A, Fuerte-Ruiz S. Mucinous hepatic cystic neoplasm: an uncommon cystic lesion in the liver. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2015; 107:643-4. [PMID: 26437986 DOI: 10.17235/reed.2015.3698/2015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Invasive hepatic mucinous neoplasms, previously referred to as cystoadenomas, are rare tumours of the liver. Many patients are asymptomatic and the lessions are found incidentally. Tha aim of this paper is to present a clinic case about a asymptomatic 78 years-old-man with a cystic neoplasm of the liver, founded incidentanlly and treated by surgery.
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19
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Affiliation(s)
- P V Usiakiĭ
- A.V. Vishnevsky Institute of Surgery, Ministry of Health of Russian Federation, Moscow
| | - V A Kubyshkin
- A.V. Vishnevsky Institute of Surgery, Ministry of Health of Russian Federation, Moscow
| | - Iu A Kovalenko
- A.V. Vishnevsky Institute of Surgery, Ministry of Health of Russian Federation, Moscow
| | - D V Kalinin
- A.V. Vishnevsky Institute of Surgery, Ministry of Health of Russian Federation, Moscow
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20
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Abstract
OBJECTIVE To characterize clinical and radiological features associated with biliary cystic tumors (BCTs) of the liver, and to define recurrence-free and overall survival. BACKGROUND Biliary cystadenoma (BCA) and biliary cystadenocarcinoma (BCAC) are rare tumors that arise in the liver. METHODS Between 1984 and 2013, 248 patients who underwent surgical resection of BCA or BCAC were identified. Clinical and outcome data were analyzed. RESULTS Median total bilirubin, CA19-9, and carcinoembryonic antigen (CEA) levels were 0.6 mg/dL, 15.0 U/mL, and 2.7 ng/mL, respectively. Preoperative imaging included computed tomography only (62.5%), magnetic resonance imaging only (6.9%), or CT + MRI (18.5%). Features on cross-sectional imaging included multiloculation (56.9%), mural nodularity (16.5%), and biliary ductal dilatation (17.7%). The presence of these factors did not reliably predict BCAC versus BCA (sensitivity, 81%; specificity, 21%). Median biliary cyst size was 10.0 cm (interquartile range, 7-13 cm). Operative interventions included unroofing/partial excision of the lesion (14.1%), less than hemihepatectomy (48.8%), or hemi-/extended hepatectomy (36.3%). On pathology most lesions were BCA (89.1%), whereas 27 (10.9%) were BCAC. At last follow-up, there were 46 (18.3%) recurrences; 2 patients who initially had BCA recurred with BCAC. Median overall survival was 18.1 years; 1-year, 3-year, and 5-year survival was 95.0%, 86.8%, and 84.2%, respectively. Long-term outcomes were associated with BCAC versus BCA, as well as the presence of spindle cell/ovarian stroma (both P < 0.05). CONCLUSIONS Among patients undergoing surgery for BCT, associated malignancy was uncommon (10%) and no preoperative findings reliably predicted underlying BCAC. After excision of BCA, long-term outcomes were good; however, patients with BCAC had a worse long-term prognosis.
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21
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Abstract
OBJECTIVE The purpose of this article is to review the different cystic hepatic lesions, with an emphasis on the imaging features that help to differentiate them, and to propose a practical algorithm for approaching the diagnosis of these lesions. CONCLUSION The number and morphology of the lesions and determination of whether there is a solid component are key imaging features that are helpful for approaching the diagnosis of cystic hepatic lesions. Familiarity with these features and knowledge of the clinical associations will help the radiologist to establish a definitive diagnosis or provide a reasonable differential diagnosis.
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22
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Qian LJ, Zhu J, Zhuang ZG, Xia Q, Liu Q, Xu JR. Spectrum of multilocular cystic hepatic lesions: CT and MR imaging findings with pathologic correlation. Radiographics 2014; 33:1419-33. [PMID: 24025933 DOI: 10.1148/rg.335125063] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A multilocular cystic hepatic lesion detected at computed tomography (CT) and magnetic resonance (MR) imaging is a common but nonspecific radiologic finding that can cause potential challenges for differential diagnosis. This imaging pattern may be observed in a wide spectrum of common and uncommon neoplastic or nonneoplastic entities. Neoplastic lesions include cystadenoma, cystadenocarcinoma, hepatocellular carcinoma (HCC), metastases, mesenchymal hamartoma, and inflammatory myofibroblastic tumor. Nonneoplastic lesions include hepatic abscess, echinococcal cyst, intrahepatic hematoma, and biloma. The multiple coalescent cysts seen in polycystic liver disease may exhibit an imaging pattern similar to that of a multilocular cystic lesion. Mural nodularity, irregular thickness of the septa, ragged inner surface, and typical enhancement pattern in the solid portion of the lesion are often indicative of malignancy, although multilocular primary or secondary malignant tumors are uncommon. Recognition of the more common necrosis or cystic change of HCC and metastases induced by locoregional or systemic treatment also is important. The nonenhanced cystic component may be composed of different types of fluids (eg, serous, mucinous, proteinaceous, hemorrhagic, bilious, or mixed) or spontaneous or treatment-related necrosis, whereas the septa may be formed by a wide range of tissues depending on the lesion type. An understanding of the CT and MR imaging findings of these lesions and their respective pathologic correlation aids in accurate diagnosis.
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Affiliation(s)
- Li Jun Qian
- Departments of Radiology, Hepatic Surgery, and Pathology, Renji Hospital, Shanghai Jiaotong University School of Medicine, No. 1630 Dongfang Rd, Pudong, Shanghai 200127, P.R. China
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23
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Abstract
Focal liver lesions (FLLs) are commonly encountered on routine imaging studies. Most lesions detected are benign, but many are indeterminate at the time of initial imaging. This article reviews the important role of MR imaging for the detection and characterization of various benign FLLs while illustrating typical imaging appearances and potential pitfalls in interpretation. The utility of diffusion-weighted imaging and hepatocyte-specific contrast agents is also discussed.
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Affiliation(s)
- Jonathan R Cogley
- Section of Body Imaging, Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA
| | - Frank H Miller
- Department of Radiology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA.
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24
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Shimoda T, Yoshida H, Hirakata A, Makino H, Yokoyama T, Maruyama H, Ueda J, Tanno M, Naito Z, Uchida E. Surgical resection of cystic intraductal papillary adenocarcinoma of the bile duct: report of a case. J NIPPON MED SCH 2013; 80:234-9. [PMID: 23832409 DOI: 10.1272/jnms.80.234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We describe a cystic intraductal papillary neoplasm of bile duct (IPNB) of adenocarcinoma treated with surgical resection. An 82-year-old man was admitted to our hospital because of distension of the right upper quadrant of the abdomen. On admission, a huge nontender mass was palpated in the right upper abdomen. Initial laboratory tests revealed the following serum values: aspartate aminotransferase, 123 IU/L; alanine aminotransferase, 113 IU/L; alkaline phosphatase, 376 IU/L; bilirubin, 1.6 mg/dL; alpha-fetoprotein, 7.4 ng/mL; CA19-9, 39.8 U/mL; carcinoembryonic antigen, 4.1 ng/mL; and Duke pancreatic monoclonal antigen type 2, 200 U/mL. Abdominal ultrasonography revealed an anechoic mass with an elevated papillary lesion in the right paramedian section. Computed tomography showed a low-density hepatic lesion, measuring 12 × 10 cm, with thick, irregular walls. A T2-weighted magnetic resonance scan showed mural nodules with signal intensity higher than that of the liver. The cystic lesion was suspected to be a cystic IPNB, but we could not determine whether it was a carcinoma. We performed extensive right paramedian sectionectomy and cholecystectomy. The resected multilocular tumor was filled with a yellow fluid, and the cut surface showed multiple, yellowish papillary nodules lining the cystic wall. On histologic examination, the neoplastic biliary epithelium showed papillary growth in the dilated lumen. Papillary and micropapillary lesions exhibited cellular atypia: nuclear enlargement and hyperchromasia, mutilayering, and mitosis. Ovarian-like stroma was not detected. The tumor was diagnosed as an IPNB (carcinoma in situ lesion). These lesions had expanded into several intrabiliary ducts. No recurrence has been detected 2 year after operation.
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Affiliation(s)
- Tomohiro Shimoda
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
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25
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Bakoyiannis A, Delis S, Triantopoulou C, Dervenis C. Rare cystic liver lesions: A diagnostic and managing challenge. World J Gastroenterol 2013; 19:7603-7619. [PMID: 24282350 PMCID: PMC3837259 DOI: 10.3748/wjg.v19.i43.7603] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 09/09/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023] Open
Abstract
Cystic formations within the liver are a frequent finding among populations. Besides the common cystic lesions, like simple liver cysts, rare cystic liver lesions like cystadenocarcinoma should also be considered in the differential diagnosis. Thorough knowledge of each entity’s nature and course are key elements to successful treatment. Detailed search in PubMed, Cochrane Database, and international published literature regarding rare cystic liver lesions was carried out. In our research are included not only primary rare lesions like cystadenoma, hydatid cyst, and polycystic liver disease, but also secondary ones like metastasis from gastrointestinal stromal tumors lesions. Up-to date knowledge regarding diagnosis and management of rare cystic liver lesions is provided. A diagnostic and therapeutic algorithm is also proposed. The need for a multidisciplinary approach by a team including radiologists and surgeons familiar with liver cystic entities, diagnostic tools, and treatment modalities is stressed. Patients with cystic liver lesions must be carefully evaluated by a multidisciplinary team, in order to receive the most appropriate treatment, since many cystic liver lesions have a malignant potential and evolution.
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26
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Soares KC, Arnaoutakis DJ, Kamel I, Anders R, Adams RB, Bauer TW, Pawlik TM. Cystic neoplasms of the liver: biliary cystadenoma and cystadenocarcinoma. J Am Coll Surg 2013; 218:119-28. [PMID: 24045144 DOI: 10.1016/j.jamcollsurg.2013.08.014] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 08/18/2013] [Accepted: 08/20/2013] [Indexed: 02/06/2023]
Affiliation(s)
- Kevin C Soares
- Division of Surgical Oncology, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dean J Arnaoutakis
- Division of Surgical Oncology, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ihab Kamel
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robert Anders
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Reid B Adams
- Division of Surgical Oncology, Department of Surgery, University of Virginia Health System, Charlottesville, VA
| | - Todd W Bauer
- Division of Surgical Oncology, Department of Surgery, University of Virginia Health System, Charlottesville, VA
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
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27
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Fei Z, Zhou Y, Peng A, Wu B, Sun M, Wu S. Asymptomatic hepatobiliary cystadenoma of the hepatic caudate lobe: a case report. J Biomed Res 2013; 27:336-8. [PMID: 23885274 PMCID: PMC3721043 DOI: 10.7555/jbr.27.20120069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 12/25/2012] [Accepted: 02/08/2013] [Indexed: 12/31/2022] Open
Abstract
Human hepatobiliary cystadenoma is a rare benign cystic tumor of the liver, and is extremely rare in the caudate lobe. We herein present a case of a 70-year-old male with a hepatobiliary cystadenoma originating from the caudate lobe.
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28
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Yamashita S, Tanaka N, Takahashi M, Hata S, Nomura Y, Ooe K, Suzuki Y. Clinicopathological subclassification of biliary cystic tumors: Report of 4 cases with a review of the literature. Intractable Rare Dis Res 2013; 2:63-8. [PMID: 25343105 PMCID: PMC4204578 DOI: 10.5582/irdr.2013.v2.2.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 05/12/2013] [Accepted: 05/14/2013] [Indexed: 12/13/2022] Open
Abstract
Biliary cystic tumors are rare hepatic neoplasms, and knowledge regarding the origin and pathology of these tumors remains vague. They should be analyzed in more detail. In our institution, 4 biliary cystic tumor surgeries were performed between December 1999 and March 2010. Pathological evaluation of resected specimens was performed to evaluate the characteristics of the intracystic epithelium and to determine the presence or absence of interstitial infiltrate, ovarian mesenchymal stroma (OMS), luminal communication between the cystic tumor and the bile duct, and mucin (MUC) protein expression. We evaluated the following 4 cases: case 1, a 21-year-old woman with a biliary cystadenoma who underwent extended right hepatectomy; case 2, a 39-year-old woman with a biliary cystadenoma who underwent left hepatectomy; case 3, an 80-year-old man with a biliary cystadenoma who underwent left hepatectomy; and case 4, a 61-year-old man with a biliary cystadenocarcinoma revealing papillary proliferation of atypical epithelium and interstitial infiltrates who underwent left hepatectomy. Case 3 had papillary proliferation of the intracystic atypical epithelium but showed interstitial infiltrates. Luminal communication with the bile duct, centrally or peripherally, was found in all 4 cases. Only case 2 showed OMS. Immunohistochemical staining revealed the following findings: cases 1 and 2, MUC1-/MUC2-; case 3, MUC1+/MUC2-; and case 4, MUC1+/MUC2+. It is important to gather information on more cases of biliary cystic tumors because atypical cases were observed, where both OMS and luminal communication with the bile duct were present or absent.
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Affiliation(s)
- Suguru Yamashita
- Department of Surgery, Asahi General Hospital, Chiba, Japan
- Address correspondence to: Dr. Suguru Yamashita, Department of Surgery, Kanto Medical Center NTT EC, Higashi-Gotanda 5-9-22, Shinagawa-ku, Tokyo 141-8625, Japan. E-mail:
| | | | | | - Shojiro Hata
- Department of Surgery, Asahi General Hospital, Chiba, Japan
| | | | - Kenji Ooe
- Department of Pathology, Asahi General Hospital, Chiba, Japan
| | - Yoshio Suzuki
- Department of Pathology, Asahi General Hospital, Chiba, Japan
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29
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Giant hepatic cyst with septal structure: diagnosis and management. Int J Hepatol 2013; 2013:981975. [PMID: 23819056 PMCID: PMC3681255 DOI: 10.1155/2013/981975] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 05/06/2013] [Indexed: 01/18/2023] Open
Abstract
The hepatic cyst is a common benign liver tumor, and no surgical treatment is necessary. However, it is difficult to correctly diagnose the giant hepatic cyst containing the solid septal structures inside, from the malignant cystadenocarcinomas. The various imaging modalities such as computed tomography, magnetic resonance imaging, and ultrasonography, have been developed and are useful for the diagnosis of these liver tumors. Reviewing the other reports in this paper, the combination of more than 2 modalities will help to diagnose these tumors; however, the malignant potential is unable to be excluded if the tumor is huge. Therefore, the surgical resection should be considered for the huge hepatic cysts with septal structures if the correct diagnosis is unable to be made. For example, when the hemorrhages cause the granulation in the septa which often shows neovascularization, the imaging modalities are unable to define this situation from the malignant tissue with hypervascularity. Therefore, with the careful review of other reports, we conclude that if the imaging studies show the possible malignant potential or the sizing-up is marked, the surgical treatment should be considered with the consent from the patients.
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30
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Mulholland MW, Hussain HK, Fritze DM. Hepatic Cyst Disease. SHACKELFORD'S SURGERY OF THE ALIMENTARY TRACT 2013:1453-1463. [DOI: 10.1016/b978-1-4377-2206-2.00117-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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31
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Psaltis E, Prescott R, Chang D, Lapsia S. Biliary cystadenocarcinoma complicated by intralesional haemorrhage. Br J Hosp Med (Lond) 2012; 73:590-1. [PMID: 23124292 DOI: 10.12968/hmed.2012.73.10.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Emmanouil Psaltis
- Department of General Surgery, Grantham and District Hospital, Grantham, UK.
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32
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Simo KA, Mckillop IH, Ahrens WA, Martinie JB, Iannitti DA, Sindram D. Invasive biliary mucinous cystic neoplasm: a review. HPB (Oxford) 2012; 14:725-40. [PMID: 23043661 PMCID: PMC3482668 DOI: 10.1111/j.1477-2574.2012.00532.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Biliary mucinous cystic neoplasms (BMCNs) are recently redefined rare liver tumours in which insufficient recognition frequently leads to an incorrect initial or delayed diagnosis. A concise review of the subtle, sometimes non-specific, clinical, serologic and radiographic features will allow for a heightened awareness and more comprehensive understanding of these entities. METHODS Literature relating to the presentation, diagnosis, treatment, pathology and outcomes of BMCNs and published prior to March 2012 was reviewed. RESULTS Biliary mucinous cystic neoplasms most commonly occur in females (≥60%) in the fifth decade of life. Clinical symptoms, serologic markers and imaging modalities are unreliable for diagnosis of BMCNs, which leads to misdiagnosis in 55-100% of patients. Perioperative cyst aspiration is not recommended as invasive BMCNs can only be differentiated from non-invasive BMCNs by microscopic evaluation for the presence of ovarian-type stroma. Intraoperative biopsy and frozen section(s) are essential to differentiate BMCNs from other cystic liver lesions. The treatment of choice is complete excision and can result in excellent survival with initial correct diagnosis. CONCLUSIONS A low threshold for considering BMCN in the differential diagnosis of cystic liver lesions and increased attentiveness to its subtle diagnostic characteristics are imperative. The complete surgical resection of BMCNs and the use of appropriate nomenclature are necessary to improve outcomes and accurately define prognosis.
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Affiliation(s)
- Kerri A Simo
- Section of Hepatobiliary and Pancreas Surgery, Department of SurgeryCharlotte, NC, USA
| | - Iain H Mckillop
- Section of Hepatobiliary and Pancreas Surgery, Department of SurgeryCharlotte, NC, USA
| | - William A Ahrens
- Department of Pathology, Carolinas Medical CenterCharlotte, NC, USA
| | - John B Martinie
- Section of Hepatobiliary and Pancreas Surgery, Department of SurgeryCharlotte, NC, USA
| | - David A Iannitti
- Section of Hepatobiliary and Pancreas Surgery, Department of SurgeryCharlotte, NC, USA
| | - David Sindram
- Section of Hepatobiliary and Pancreas Surgery, Department of SurgeryCharlotte, NC, USA
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Nasrin A, Baharak A, Reza K. Concurrent cystic endometrial hyperplasia, ovarian luteoma and biliary cyst adenoma in an aged rabbit (Oryctolagus cuniculus): case report and literature review. Asian Pac J Trop Biomed 2012; 2:S1975-S1978. [DOI: 10.1016/s2221-1691(12)60527-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Cyst-forming intraductal papillary neoplasm of the bile ducts: description of imaging and pathologic aspects. AJR Am J Roentgenol 2011; 197:1111-20. [PMID: 22021503 DOI: 10.2214/ajr.10.6363] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Intraductal papillary neoplasm (IPN) of the bile duct is a newly described pathologic entity characterized by the presence of intraluminal tumors, which sometimes produce a large amount of mucin and form a cystic tumor. Cystic IPN of the bile duct is different from biliary cystadenoma or cystadenocarcinoma in that the former produces intraductal microscopic and macroscopic papillary tumors without ovarian-like stroma, whereas the latter produce a mucin-containing septate cystic tumor without communication with bile duct and with ovarian-like stroma in the cyst wall. The purpose of this study was to evaluate the potential relationships between cyst-forming IPNs of the bile duct and peribiliary glands and also intraductal papillary mucinous neoplasms of the pancreas. MATERIALS AND METHODS From a cohort of 87 patients with surgically resected and pathologically proved IPN of the bile duct, 12 patients with cystic IPN of the bile duct who underwent CT (n = 12), MRCP (n = 3), ultrasound (n = 3), and ERCP (n = 4) were included. Imaging findings were evaluated for the relationship of cystic tumors to the bile ducts; in particular, a diverticulum-like appearance was considered as suggestive of the peribiliary gland origin. Pathologic examination was conducted, and both gross and microscopic findings were recorded. RESULTS Radiologic examination revealed aneurysm-like dilatation of the involved bile ducts in five patients and intrahepatic biliary cystic tumor in two patients. Interestingly, the remaining five patients had diverticulum-like cystic tumor with or without communication; one patient had a cystic tumor laterally attached to the extrahepatic bile duct. Histopathologically, cystic tumors are lined by atypical biliary epithelium showing intracystic papillary proliferation, with an appearance similar to that of pancreatic intraductal papillary mucinous neoplasm. CONCLUSION This study suggests that cyst-forming IPN of the bile duct may be a biliary counterpart to pancreatic intraductal papillary mucinous neoplasm. In particular, at least some of the tumors seem to arise from peribiliary glands, and these cases might be a counterpart to branch-duct intraductal papillary mucinous neoplasm of the pancreas, given the histologic similarity between peribiliary glands and pancreatic branch ducts.
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Pais-Costa SR, Martins SJ, Araújo SLM, Lima OAT, Paes MA, Guimarães ML. Successful surgical management of an extrahepatic biliary cystadenocarcinoma. Rare Tumors 2011; 3:e36. [PMID: 22355491 PMCID: PMC3282441 DOI: 10.4081/rt.2011.e36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Accepted: 08/04/2011] [Indexed: 11/23/2022] Open
Abstract
Extrahepatic bile duct cancer is an uncommon disease, and few cases are curable by surgery. We report a case of extrahepatic biliary cystadenocarcinoma (BCAC) associated with atrophy of the left hepatic lobe. A 54-year old male was admitted with painless obstructive jaundice and a hepatic palpable mass noticed one month before presentation. Liver functions tests were consistent with cholestatic damage and serum carbohydrate antigen 19.9 (CA 19-9) was increased before treatment. Magnetic resonance imaging (MRI) disclosed dilatation of the left hepatic bile duct with irregular wall thickening close to the hepatic confluence, and atrophy of left hepatic lobe. The patient was submitted to en bloc extended left hepatectomy with resection of caudate lobe, hilar lymphadenectomy, and suprapancreatic biliary tree resection. All surgical margins were grossly negative, and postoperative course was uneventful, except for a minor bile leak. The patient was discharged on the 15th postoperative day; he is alive without tumor recurrence one year after primary therapy. Although technically challenging, extended en bloc resection is feasible in adults with extrahepatic BCAC and can improve survival with acceptable and manageable morbidity.
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Kaneya Y, Yoshida H, Matsutani T, Hirakata A, Matsushita A, Suzuki S, Yokoyama T, Maruyama H, Sasajima K, Uchida E. Biliary obstruction due to a huge simple hepatic cyst treated with laparoscopic resection. J NIPPON MED SCH 2011; 78:105-9. [PMID: 21551968 DOI: 10.1272/jnms.78.105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Most hepatic cysts are asymptomatic, but complications occasionally occur. We describe a patient with biliary obstruction due to a huge simple hepatic cyst treated with laparoscopic resection. A 60-year-old Japanese woman was admitted to our hospital because of a nontender mass in the right upper quadrant of the abdomen. Laboratory tests revealed the following: serum total bilirubin, 0.6 mg/dL; serum aspartate aminotransferase, 100 IU/L; serum alanine aminotransferase, 78 IU/L; serum alkaline phosphatase, 521 IU/L; and serum gamma glutamic transpeptidase, 298 IU/L. Abdominal computed tomography, ultrasonography, and magnetic resonance cholangiopancreatography revealed a huge hepatic cyst, 13 cm in diameter, at the hepatic hilum, accompanied by dilatation of the intrahepatic bile duct and obstruction of the common bile duct. We diagnosed biliary obstruction due to a huge hepatic cyst at the hepatic hilum, and laparoscopic surgery was performed. A huge hepatic cyst was seen at the hepatic hilum. After needle puncture of the huge cyst, the anterior wall of the cyst was unroofed, and cholecystectomy was done. Intraoperative cholangiography through a cystic duct revealed stenosis of the duct. Subsequent decapsulation of the cyst was performed in front of the common bile duct. After this procedure, cholangiography revealed that the stenosis of the common bile duct had resolved. Histopathological examination of the surgical specimen confirmed the hepatic cyst was benign. The postoperative course was uneventful, and the results of liver function tests normalized. The patient was discharged 7 days after operation. Computed tomography 3 months after operation revealed disappearance of the hepatic cyst and no dilatation of the intrahepatic bile duct.
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Affiliation(s)
- Yohei Kaneya
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
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Abstract
Technologic advancements have allowed imaging modalities to become more useful in the diagnosis of hepatobiliary and pancreatic disorders. Computed tomography scanners now use multidetector row technology with contrast-delayed imaging for quicker and more accurate imaging. Magnetic resonance imaging with cholangiopancreatography can more clearly delineate liver lesions and the biliary and pancreatic ducts, and can diagnose pathologic conditions early in their course. Newer technologies, such as single-operator cholangioscopy and endoscopic ultrasonography, have sometimes shown superiority to traditional modalities. This article addresses the literature regarding available imaging techniques in the diagnosis and treatment of common surgical hepatobiliary and pancreatic diseases.
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Differentiation between biliary cystic neoplasms and simple cysts of the liver: accuracy of CT. AJR Am J Roentgenol 2010; 195:1142-8. [PMID: 20966320 DOI: 10.2214/ajr.09.4026] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The objective of our study was to determine significant CT findings for the differentiation of biliary cystic neoplasms from simple hepatic cysts and to assess whether radiologists' performance for the differentiation is improved with the knowledge of significant CT criteria. MATERIALS AND METHODS Review of surgical and pathologic records identified 25 patients with pathologically proven biliary cystic neoplasms (biliary cystadenomas [n = 8], biliary cystadenocarcinomas [n = 4]) or simple cysts [n = 13]). Two radiologists retrospectively reviewed CT images in consensus for the location, size, and outer margin of the lesion and for the presence of an internal septum, upstream bile duct dilatation, a transient hepatic attenuation difference (THAD), calcifications, a mural nodule, three or more other cysts, and a thick septum or outer wall. Individual CT findings considered significant for the differentiation were determined using univariate statistical analyses. Then, two successive review sessions for the differentiation between the two disease entities were independently performed by two other reviewers using a 4-point confidence scale. At the first session, no information was provided to reviewers for differentiation. At the second session, however, the reviewers were told of the results of univariate analyses. Radiologists' performance was evaluated using pairwise comparison of receiver operating characteristic (ROC) curves. RESULTS The mean size of biliary cystic neoplasms (9.5 cm) was not significantly different from that of simple cysts (11.2 cm). The presence of upstream bile duct dilatation achieved the highest specificity (100%) for the differentiation of biliary cystic neoplasms from simple cysts, followed by THAD (84.6%), lesion location at the left lobe (76.9%), and coexistence of fewer than three other cysts (69.2%). The area under the curve of reviewers 1 and 2 significantly increased from 0.686 and 0.654 to 0.997 and 0.936, respectively, when the reviewers knew the information about the significant CT criteria (p = 0.003 and p = 0.008, respectively). CONCLUSION Upstream bile duct dilatation, lesion location at the left hepatic lobe, fewer than three coexistent cysts, and THAD were found to be highly suggestive CT findings for the differentiation of biliary cystic neoplasms from simple hepatic cysts. Radiologists' performance was significantly improved with the knowledge of these highly suggestive CT criteria.
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Appropriate diagnosis of biliary cystic tumors: comparison with atypical hepatic simple cysts. Eur J Gastroenterol Hepatol 2010; 22:989-96. [PMID: 20300006 DOI: 10.1097/meg.0b013e328337c971] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Biliary cystadenoma (BCA) and biliary cystadenocarcinoma (BCAC) are often confused with other intrahepatic cystic diseases. AIMS The aims of this study were to investigate predictive factors of biliary cystic tumor (BCT) and clinical characteristic of BCAC. METHODS We retrospectively reviewed preoperative diagnoses, overall characteristics and postoperative outcome of 20 BCTs and 19 cystadenoma-mimicking simple cysts that were pathologically confirmed. RESULTS Comparing with atypical simple cysts, symptoms, left-lobe cyst, thick wall, septation, mural nodule, bile duct dilatation and an increase of serum alkaline phosphatase were associated with BCTs. However, on multivariate analysis, mural nodule, left-lobe cyst, and an increase of serum alkaline phosphatase were significantly frequent in BCTs with odds ratios of 75.5, 13.8, and 33.0, respectively. Among the 20 BCTs, seven BCACs were diagnosed. The characteristics of BCACs were mural nodule (P<0.01), intrahepatic cyst debris (P<0.01), and bile duct dilation (P=0.04). Cystic fluid analysis provided no significant differences between BCT and simple cyst. After fine needle aspiration cytology of BCTs, all except one BCAC with atypical cell showed nonspecific findings. After complete surgical excision (97.4% of patients), only one patient with BCAC had recurrence during 29 months of follow-up period. CONCLUSION In hepatic cysts with mural nodule, left-lobe cyst or increment of serum alkaline phosphatase seem to be indicative of BCTs in the diagnosis of suspicious hepatic cyst. Intracystic debris, bile duct dilation, and mural nodule may be suggestive clinical features of malignancy in BCTs.
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Calcifications hépatiques de l’adulte : les stars de l’ASP trop souvent négligées à l’ère du scanner. ACTA ACUST UNITED AC 2010; 91:759-68. [DOI: 10.1016/s0221-0363(10)70113-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Gokalp G, Dusak A, Topal NB, Aker S. Cystadenoma originating from the gallbladder. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:663-666. [PMID: 20375388 DOI: 10.7863/jum.2010.29.4.663] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Gokhan Gokalp
- Department of Radiology, Uludag University Medical Faculty, 16059 Gorukle, Bursa, Turkey.
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Yi B, Cheng QB, Jiang XQ, Liu C, Luo XJ, Dong H, Zhang BH, Wu MC. A special growth manner of intrahepatic biliary cystadenoma. World J Gastroenterol 2009; 15:6134-6. [PMID: 20027691 PMCID: PMC2797675 DOI: 10.3748/wjg.15.6134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We report a case of a 56-year-old woman with intrahepatic biliary cystadenoma (IBC) accompanying a tumor embolus in the extrahepatic bile duct, who was admitted to our department on October 13, 2008. Imaging showed an asymmetry dilation of the biliary tree, different bile signals in the biliary tree, a multiloculated lesion and an extrahepatic bile duct lesion with internal septation. A regular left hemihepatectomy en bloc was performed with resection of the entire tumor, during which a tumor embolus protruding into the extrahepatic bile duct and originating from biliary duct of segment 4 was revealed. Microscopically, the multiloculated tumor was confirmed to be a biliary cystadenoma with an epithelial lining composed of biliary-type cuboidal cells and surrounded by an ovarian-like stroma. An aggressive en bloc resection was recommended for the multiloculated lesion. Imaging workup, clinicians and surgeons need to be aware of this different presentation.
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Sistla SC, Sankar G, Basu D, Venkatesan B. Biliary cystadenocarcinoma of the gall bladder: a case report. J Med Case Rep 2009; 3:75. [PMID: 19946551 PMCID: PMC2783074 DOI: 10.1186/1752-1947-3-75] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 10/15/2009] [Indexed: 11/18/2022] Open
Abstract
Introduction While biliary cystadenoma and biliary cystadenocarcinoma involving the liver are not uncommon, biliary cystadenocarcinoma of the gall bladder is an extremely rare lesion and can be very difficult to diagnose. Case presentation A 50-year-old Indian woman presented with pain and swelling in the right hypochondrium. An ultrasonography revealed a cystic lesion arising from the gallbladder fossa. This lesion was initially managed with aspiration and antibiotics by the treating physician. The patient was referred for surgical management because the abscess was not resolved through conservative treatment. A diagnosis of an infected nonparasitic cyst was made and deroofing of the cyst was performed. A histopathological examination of the excised cyst wall showed cystadenocarcinoma. The patient subsequently underwent a successful surgical excision of the lesion. Conclusion Infective lesions of the liver are common in developing countries and are usually managed through aspiration and antibiotics. Cystadenocarcinoma of the gallbladder needs to be considered in the differential diagnosis of cystic lesions arising from the gallbladder fossa. A high index of suspicion and cytological examination from the wall of such complex lesions will help in the timely management of such lesions.
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Affiliation(s)
- Sarath Chandra Sistla
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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Mortelé KJ, Peters HE. Multimodality Imaging of Common and Uncommon Cystic Focal Liver Lesions. Semin Ultrasound CT MR 2009; 30:368-86. [DOI: 10.1053/j.sult.2009.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Sankar S, Subramanian M, Joseph LD, Rajinikanth S, Nandigam V. Pedunculated extra hepatic biliary cystadenoma mimicking as a stone. Indian J Gastroenterol 2009; 28:37. [PMID: 19529904 DOI: 10.1007/s12664-009-0011-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- S Sankar
- Department of Surgical Gastroenterology, Sri Ramachandra Medical College & Research Institute, Chennai, India.
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47
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Abstract
Incidentally discovered liver masses are becoming more common with the increasing application and power of imaging techniques for the evaluation of abdominal conditions. Although such masses are often benign, conclusive diagnoses must be established in order to provide appropriate patient care. Various imaging modalities can be utilized to accurately diagnose such masses without resort to more invasive diagnostic measures.
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Qu ZW, He Q, Lang R, Pan F, Jin ZK, Sheng QS, Zhang D, Zhang XS, Chen DZ. Giant hepatobiliary cystadenoma in a male with obvious convex papillate. World J Gastroenterol 2009; 15:1906-1909. [PMID: 19370793 PMCID: PMC2670423 DOI: 10.3748/wjg.15.1906] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2009] [Revised: 03/18/2009] [Accepted: 03/25/2009] [Indexed: 02/06/2023] Open
Abstract
Hepatobiliary cystadenoma is an uncommon lesion that is most often found in middle-aged women and difficult to diagnose preoperatively. Here, we report a case of giant hepatobiliary cystadenoma in a male patient with obvious convex papillate. On the basis of imaging examinations, the patient was diagnosed as hepatobiliary cystadenoma prior to operation. Left hepatectomy was performed and the patient was symptom-free during a 6-mo follow-up period, suggesting that imaging examination is the major diagnostic method of hepatobiliary cystadenoma, and operation is its best treatment modality.
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Lin MX, Xu HX, Lu MD, Xie XY, Chen LD, Xu ZF, Liu GJ, Xie XH, Liang JY, Wang Z. Diagnostic performance of contrast-enhanced ultrasound for complex cystic focal liver lesions: blinded reader study. Eur Radiol 2009; 19:358-69. [PMID: 18795298 DOI: 10.1007/s00330-008-1166-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 08/04/2008] [Accepted: 08/06/2008] [Indexed: 12/24/2022]
Abstract
The study was aimed at evaluating the diagnostic performance of contrast-enhanced ultrasound (CEUS) in characterizing complex cystic focal liver lesions (FLLs). Sixty-seven complex cystic FLLs in 65 patients were examined with conventional ultrasound (US) and real-time CEUS. The US and CEUS images were reviewed by a resident radiologist and a staff radiologist independently. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic performance, and the interobserver agreement was analysed. The results showed that complete non-enhancement throughout three phases of CEUS or sustained enhancement in the portal and late phases were exhibited in most benign lesions. Conversely, hypo-enhancement in the late phase was seen in all malignancies. After ROC analysis, the areas (Az) under the ROC curve were 0.774 at US versus 0.922 at CEUS (P=0.047) by the resident radiologist, and 0.917 versus 0.935 (P=0.38) by the staff radiologist. A significant difference in Az between the resident and the staff radiologists was found for US (0.774 versus 0.917, P=0.044), whereas not found for CEUS (0.922 versus 0.935, P=0.42). Interobserver agreement was improved after CEUS (kappa=0.325 at US versus kappa=0.774 at CEUS). Real-time CEUS improves the capability of discrimination between benign and malignant complex cystic FLLs, especially for the resident radiologist.
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Affiliation(s)
- Man-Xia Lin
- Department of Medical Ultrasonics, The First Affiliated Hospital, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, China
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Tani A, Yoshida H, Mamada Y, Taniai N, Naito Z, Tajiri T. Case of biliary cystadenocarcinoma with intracystic bleeding. J NIPPON MED SCH 2008; 75:293-7. [PMID: 19023170 DOI: 10.1272/jnms.75.293] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Biliary cystadenocarcinomas are rare cystic tumors arising from the biliary epithelium. Symptoms vary and are sometimes absent. Most lesions are found incidentally during diagnostic radiologic procedures or surgical exploration for unrelated conditions. We describe an 80-year-old man with anemia due to intracystic bleeding. A computed tomographic scan showed a low-density hepatic lesion with thick, irregular walls and septa. Left lobectomy with cholecystectomy was performed. Histological examination revealed that the surgical specimen was a biliary cystadenocarcinoma. The concentrations of both carcinoembryonic antigen and CA19-9 were high in the cyst contents. The patient died of pneumonia 1 year 4 months after the operation, without the recurrence of cystadenocarcinoma.
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Affiliation(s)
- Aya Tani
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan.
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