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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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Averbukh LD, Wu DC, Cho WC, Wu GY. Biliary Mucinous Cystadenoma: A Review of the Literature. J Clin Transl Hepatol 2019; 7:149-153. [PMID: 31293915 PMCID: PMC6609848 DOI: 10.14218/jcth.2019.00017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 05/25/2019] [Accepted: 06/11/2019] [Indexed: 02/06/2023] Open
Abstract
Biliary mucinous cystadenomas are cystic neoplasms commonly mistaken for simple cysts. They are rare and generally benign tumors, often incidentally found on imaging and during unrelated surgical interventions. They tend to be slow growing though may reach symptomatic dimensions. Misdiagnosis of biliary mucinous cystadenomas may have serious consequences secondary to their potential for malignant transformation into biliary mucinous cystadenocarcinomas. Here, we review the epidemiology, etiology, pathology, diagnostic modalities, histology, and available treatment methods for mucinous cystadenomas reported in current literature.
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Affiliation(s)
- Leon D. Averbukh
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA
- *Correspondence to: Leon D. Averbukh, Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, 236 Farmington Ave., Farmington, CT 06030, USA. E-mail:
| | - David C. Wu
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA
| | - Woo Cheal Cho
- Department of Pathology, Hartford Hospital, Hartford, CT, USA
| | - George Y. Wu
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA
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Xu HJ, Zhu ZY, Yu JH, Wang W, Shen ZH. Misdiagnosis of Intrahepatic Biliary Cystadenoma Located in the Caudate Lobe: A Case Report. Comb Chem High Throughput Screen 2019; 22:276-279. [PMID: 30947661 DOI: 10.2174/1386207322666190402162614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/15/2018] [Accepted: 12/11/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Intrahepatic Biliary Cystadenoma (IBC) is rare but has a high incidence of misdiagnosis, especially for experienceless surgeons. CASE We report a case of IBC located in the caudate lobe and described a typical procedure of misdiagnosing this disease. Finally, the patient was successfully cured, but the procedure of misdiagnosis should attract attention. IBC and atypical biopsy for histological examination are the most important causes of misdiagnosis. Recurrent cystic lesions of the liver and repeated increases in CA 19-9 may suggest a "liver cyst", which is a misdiagnosis. CONCLUSION The experience and lessons of misdiagnosis, in this case, may help other clinicians diagnose the rare disease accurately.
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Affiliation(s)
- Huan-Jian Xu
- Department of General Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine, The First Affiliated Hospital of Shaoxing University), Shaoxing 312000, China
| | - Zhi-Yang Zhu
- Department of General Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine, The First Affiliated Hospital of Shaoxing University), Shaoxing 312000, China
| | - Jian-Hua Yu
- Department of General Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine, The First Affiliated Hospital of Shaoxing University), Shaoxing 312000, China
| | - Wei Wang
- Department of Pathology, Zhejiang Provincial People's Hospital, Hangzhou 310000, Zhejiang, China
| | - Zhi-Hong Shen
- Department of Hepatobiliary Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine, The First Affiliated Hospital of Shaoxing University), Shaoxing 312000, China
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Mavilia MG, Pakala T, Molina M, Wu GY. Differentiating Cystic Liver Lesions: A Review of Imaging Modalities, Diagnosis and Management. J Clin Transl Hepatol 2018; 6:208-216. [PMID: 29951366 PMCID: PMC6018306 DOI: 10.14218/jcth.2017.00069] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/14/2017] [Accepted: 11/20/2017] [Indexed: 12/25/2022] Open
Abstract
Hepatic cysts (HCs) are frequently discovered incidentally on abdominal imaging. The prevalence of HCs has been reported as high as 15-18% in the United States. Although most cysts are benign, some are malignant or premalignant. It is important to diagnose cystic lesions in order to properly manage them. Imaging with conventional ultrasound, computed tomography, magnetic resonance imaging, or contrast-enhanced ultrasound can be used to further characterize and diagnose HCs. Ultrasound is typically the first-line imaging modality, whereas more advanced imaging can help narrow down the specific lesion. Contrast-enhanced ultrasound is a newer modality, recently approved in the United States, which offers non-invasive evaluation in real-time. The first step in diagnosis is stratifying risk by differentiating simple and complex cysts. There are several features that can help identify HCs, including septae, mural consistency, calcifications, and quality of cystic fluid. Simple cysts are mainly congenital cysts, but also occur in polycystic liver disease. Complex cysts include mucinous neoplasms, echinococcal cysts, hemorrhagic cysts, cystic hepatocellular carcinoma and other rare lesions. Treatment is indicated in symptomatic cysts or those suspicious for malignant or premalignant features. Treatment modalities include fenestration, aspiration sclerotherapy, or surgical resection.
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Affiliation(s)
- Marianna G. Mavilia
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA
- *Correspondence to: Marianna G. Mavilia, Department of Medicine, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT 06032, USA. Tel: +1-860-679-2509, Fax: +1-860-679-6582, E-mail:
| | - Tina Pakala
- Department of Medicine, Division of Gastroenterology-Hepatology, New York Presbyterian Hospital, New York, NY, USA
| | - Marco Molina
- Department of Radiology, University of Connecticut Health Center, Farmington, CT, USA
| | - George Y. Wu
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA
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Dua MM, Gerry J, Salles A, Tran TB, Triadafilopoulos G, Visser BC. Biliary Cystadenoma: A Suggested "Cystamatic" Approach? Dig Dis Sci 2016; 61:1835-8. [PMID: 26514678 DOI: 10.1007/s10620-015-3943-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 10/22/2015] [Indexed: 01/29/2023]
Affiliation(s)
- Monica M Dua
- Division of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Suite H3691, Stanford, CA, 94305, USA.
| | - Jon Gerry
- Division of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Suite H3691, Stanford, CA, 94305, USA
| | - Arghavan Salles
- Division of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Suite H3691, Stanford, CA, 94305, USA
| | - Thuy B Tran
- Division of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Suite H3691, Stanford, CA, 94305, USA
| | | | - Brendan C Visser
- Division of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Suite H3691, Stanford, CA, 94305, USA
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ACG clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol 2014; 109:1328-47; quiz 1348. [PMID: 25135008 DOI: 10.1038/ajg.2014.213] [Citation(s) in RCA: 278] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 05/22/2014] [Indexed: 12/11/2022]
Abstract
Focal liver lesions (FLL) have been a common reason for consultation faced by gastroenterologists and hepatologists. The increasing and widespread use of imaging studies has led to an increase in detection of incidental FLL. It is important to consider not only malignant liver lesions, but also benign solid and cystic liver lesions such as hemangioma, focal nodular hyperplasia, hepatocellular adenoma, and hepatic cysts, in the differential diagnosis. In this ACG practice guideline, the authors provide an evidence-based approach to the diagnosis and management of FLL.
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Ravololoniaina T, Rantoanina A, Rasoaherinomenjanahary F, Samison LH. Place de la fenestration dans la prise en charge des kystes biliaires simples. JOURNAL AFRICAIN D'HÉPATO-GASTROENTÉROLOGIE 2014; 8:93-96. [DOI: 10.1007/s12157-014-0525-4] [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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Fuks D, Voitot H, Paradis V, Belghiti J, Vilgrain V, Farges O. Intracystic concentrations of tumour markers for the diagnosis of cystic liver lesions. Br J Surg 2014; 101:408-16. [PMID: 24477793 DOI: 10.1002/bjs.9414] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Imaging occasionally fails to differentiate hepatic simple cysts from malignant or premalignant mucinous cystic lesions such as biliary cystadenomas. Hepatic simple cysts can be treated conservatively, whereas malignant or premalignant cysts require complete resection. This study assessed the ability of intracystic tumour marker concentrations to differentiate these disease entities. METHODS Intracystic fluid was sampled in patients undergoing partial or complete resection of a cystic lesion of the liver. The indication for surgery in hepatic simple cysts was symptoms or suspicion of a biliary cystadenoma. Intracystic concentrations of carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9 and tumour-associated glycoprotein (TAG) 72 were measured to assess the diagnostic accuracy of these tumour markers. Cut-off values were defined by receiver operating characteristic (ROC) curves. RESULTS The study population comprised 118 patients (94 women) with a median age of 59 years. There were 75 patients with hepatic simple cysts, 27 with mucinous cysts (19 biliary cystadenomas, 4 biliary cystadenocarcinomas, 4 intraductal papillary mucinous neoplasms of the bile duct) and 16 with miscellaneous cysts. Unlike CEA and CA19-9, a TAG-72 concentration of more than 25 units/ml differentiated hepatic simple cysts from mucinous cysts with a sensitivity and a specificity of 0·79 and 0·97 respectively. The area under the ROC curve was 0·98 for mucinous versus hepatic simple cysts. CONCLUSION The concentration of TAG-72 in cyst fluid accurately identified hepatic cysts that required complete resection.
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Affiliation(s)
- D Fuks
- Departments of Hepatobiliary Surgery, Hôpital Beaujon, Assistance Publique - Hôpitaux de Paris, Pôle des Maladies de l'Appareil Digestif, Université Paris 7, Clichy, France
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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: 99] [Impact Index Per Article: 8.3] [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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Biliary cystadenoma: short- and long-term outcome after radical hepatic resection. Updates Surg 2011; 64:13-8. [PMID: 22038379 DOI: 10.1007/s13304-011-0117-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 10/14/2011] [Indexed: 02/06/2023]
Abstract
The intrahepatic biliary cystadenoma is a rare benign tumor of the liver, originating from an intrahepatic bile duct: it becomes symptomatic only when it causes obstruction of the bile duct itself. Regardless of the various diagnostic modalities available, it is difficult to distinguish preoperatively the cystadenoma both from a simple liver cyst, and from a cystic carcinoma of the bile duct. An incomplete surgical removal of the cyst often results in a higher risk of size increase and recurrence, even considering that the lesion may degenerate into a cystadenocarcinoma. Between January 2004 and May 2011, 1,173 liver resections were carried out at the Hepatobiliary Surgery Unit of San Raffaele Hospital: 12 of these were performed for cystadenoma. Forty-six patients underwent laparoscopic liver cysts deroofing: definitive histological examination in six of these patients revealed instead the diagnosis of cystadenoma. In 50% of cases, the diagnosis of cystadenoma was therefore acquired as a result of an incidental finding. The patients were all female, median age 45 years. The liver resection included six cases of left hepatectomy, three left lobectomies, and three of the right hepatectomy. The operations were performed by laparotomy, with the exception of two left lobectomies completed laparoscopically. In all cases, the postoperative course was without major complications. The resection was radical in all cases and the median hospital stay was 5 days. At a median follow-up of 16 months (range 7-30), all patients are alive and disease free. Biliary cystadenomas can easily be misunderstood and interpreted as simple hepatic cysts. Radical surgical resection is necessary and provides good short- and long-term outcomes.
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Ghole SA, Bakhtary S, Staudenmayer K, Sze DY, Pai RK, Visser BC, Norton JA, Poultsides GA. Ruptured biliary cystadenoma managed by angiographic embolization and interval partial hepatectomy. Dig Dis Sci 2011; 56:1949-53. [PMID: 21445579 DOI: 10.1007/s10620-011-1677-z] [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] [Received: 03/07/2011] [Accepted: 03/09/2011] [Indexed: 12/22/2022]
Affiliation(s)
- Saif A Ghole
- Department of Surgery, Stanford University Medical Center, Stanford, CA, USA
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12
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Romagnoli R, Patrono D, Paraluppi G, David E, Tandoi F, Strignano P, Lupo F, Salizzoni M. Liver transplantation for symptomatic centrohepatic biliary cystadenoma. Clin Res Hepatol Gastroenterol 2011; 35:408-13. [PMID: 21549659 DOI: 10.1016/j.clinre.2011.03.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2010] [Revised: 03/27/2011] [Accepted: 03/31/2011] [Indexed: 02/04/2023]
Abstract
Biliary cystadenoma is a rare benign cystic tumor of the liver. The mainstay of treatment is complete resection, either by enucleation or by formal hepatectomy, since incomplete removal entails not only constant recurrence but also the risk of malignant transformation to cystadenocarcinoma. A case of symptomatic centrohepatic biliary cystadenoma involving the main vasculobiliary structures of the liver is reported. After an unsuccessful attempt at resection resulting in an intrahepatic biliary injury, relief of jaundice and radical excision were achieved by total hepatectomy and liver transplantation. The patient is now alive and well 4 years after transplant, disease-free, with normal liver and renal function while receiving everolimus monotherapy. This is the first report of liver transplantation performed for the treatment of this tumor. With the case on the background, diagnostic aspects and available therapeutic strategies for biliary cystadenoma are reviewed and discussed.
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Affiliation(s)
- Renato Romagnoli
- General Surgery 8 and Liver Transplantation Center, University of Turin, AOU San Giovanni Battista, Corso Bramante 88, 10126 Turin, Italy.
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Emre A, Serin KR, Özden İ, Tekant Y, Bilge O, Alper A, Güllüoğlu M, Güven K. Intrahepatic biliary cystic neoplasms: Surgical results of 9 patients and literature review. World J Gastroenterol 2011; 17:361-5. [PMID: 21253396 PMCID: PMC3022297 DOI: 10.3748/wjg.v17.i3.361] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 09/18/2010] [Accepted: 09/26/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the eligible management of the cystic neplasms of the liver.
METHODS: The charts of 9 patients who underwent surgery for intrahepatic biliary cystic liver neoplasms between 2003 and 2008 were reviewed retrospectively. Informed consent was obtained from the patients and approval was obtained from the designated review board of the institution.
RESULTS: All patients were female with a median (range) age of 49 (27-60 years). The most frequent symptom was abdominal pain in 6 of the patients. Four patients had undergone previous laparotomy (with other diagnoses) which resulted in incomplete surgery or recurrences. Liver resection (n = 6) or enucleation (n = 3) was performed. The final diagnosis was intrahepatic biliary cystadenoma in 8 patients and cystadenocarcinoma in 1 patient. All symptoms resolved after surgery. There has been no recurrence during a median (range) 31 (7-72) mo of follow up.
CONCLUSION: In spite of the improvement in imaging modalities and increasing recognition of biliary cystadenoma and cystadenocarcinoma, accurate preoperative diagnosis may be difficult. Complete surgical removal (liver resection or enucleation) of these lesions yields satisfying long-term results.
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Navarra G, Iusco DR, Bonomi S, Grassi A, Ismail I, Vicari S, Virzì S. Hepatobiliary cystoadenoma: a wolf in sheep's clothing. Updates Surg 2010; 62:203-6. [PMID: 21128043 DOI: 10.1007/s13304-010-0035-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Accepted: 11/22/2010] [Indexed: 11/25/2022]
Abstract
Hepatobiliary cystoadenoma is a rare cystic tumor of the liver that can undergo malignant change and become lethal. Accurate diagnosis of such lesions, even though not always possible, is of importance as the management is totally different from that of other nonneoplastic cysts. We report a case of a 60-year-old woman with aspecific symptoms, which was diagnosed using ultrasound scan and CT scan and treated with hepatic resection, and review the main features of this tumor.
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Affiliation(s)
- Giuseppe Navarra
- Azienda Unità Sanitaria Locale di Bologna, Ospedale di Bentivoglio, U.O.C di Chirurgia Generale (Direttore: Dott. S. Virzì), Via Marconi 35, Bentivoglio, 40010, Bologna, Italy
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Abstract
Benign pathologies of the liver often include several cystic diseases, such as simple cysts, autosomal dominant polycystic liver disease, and Caroli's disease. The differential of hepatic cysts also includes infectious pathologies, such as pyogenic liver abscess, hydatid cysts, and parasitic infections if the appropriate clinic setting. Understanding of the various causes, clinical presentation, and treatment options is required to ensure the appropriate surgical management of these patients.
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Affiliation(s)
- Kaye M Reid-Lombardo
- Division of Gastroenterologic and General Surgery, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA.
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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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Ren XL, Yan RL, Yu XH, Zheng Y, Liu JE, Hou XB, Zuo SY, Fu XY, Chang H, Lu JH. Biliary cystadenocarcinoma diagnosed with real-time contrast-enhanced ultrasonography: Report of a case with diagnostic features. World J Gastroenterol 2010; 16:131-5. [PMID: 20039461 PMCID: PMC2799910 DOI: 10.3748/wjg.v16.i1.131] [Citation(s) in RCA: 4] [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
Biliary cystadenocarcinoma is a very rare malignant cystic tumor of the liver, which is often misdiagnosed due to a poor recognition of it. We report a case of a 60-year-old man with biliary cystadenocarcinoma with his real time contrast enhanced ultrasound (CEUS) characteristics compared to those of computed tomography (CT) and magnetic resonance imaging (MRI), which were correlated with the surgical and pathologic findings. Cystic wall enhancement, internal septations and intra-cystic solid portions in the arterial phase were observed on CEUS after contrast agent injection. The enhancement was washed out progressively and depicted as hypo-enhancement in the portal and late phases. CT revealed a large irregular cystic lesion in the left liver lobe with no clear septations and solid components. MRI showed an irregular cystic occupying lesion with septations.
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Fukunaga N, Ishikawa M, Ishikura H, Ichimori T, Kimura S, Sakata A, Sato K, Nagata J, Fujii Y. Hepatobiliary cystadenoma exhibiting morphologic changes from simple hepatic cyst shown by 11-year follow up imagings. World J Surg Oncol 2008; 6:129. [PMID: 19077232 PMCID: PMC2614429 DOI: 10.1186/1477-7819-6-129] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 12/11/2008] [Indexed: 11/13/2022] Open
Abstract
Background A long-term follow up case of hepatobiliary cystadenoma originating from simple hepatic cyst is rare. Case presentation We report a case of progressive morphologic changes from simple hepatic cyst to hepatobiliary cystadenoma by 11 – year follow up imaging. A 25-year-old man visited our hospital in 1993 for a simple hepatic cyst. The cyst was located in the left lobe of the liver, was 6 cm in diameter, and did not exhibit calcification, septa or papillary projections. No surgical treatment was performed, although the cyst was observed to gradually enlarge upon subsequent examination. The patient was admitted to our hospital in 2004 due to epigastralgia. Re-examination of the simple hepatic cyst revealed mounting calcification and septa. Abdominal CT on admission revealed a hepatic cyst over 10 cm in diameter and a high-density area within the thickened wall. MRI revealed a mass of low intensity and partly high intensity on a T1-weighted image. Abdominal angiography revealed hypovascular tumor. The serum levels of AST and ALT were elevated slightly, but tumor markers were within normal ranges. Left lobectomy of the liver was performed with diagnosis of hepatobiliary cystadenoma or hepatobiliary cystadenocarcinoma. The resected specimen had a solid component with papillary projections and the cyst was filled with liquid-like muddy bile. Histologically, the inner layer of the cyst was lined with columnar epithelium showing mild grade dysplasia. On the basis of these findings, hepatobiliary cystadenoma was diagnosed. Conclusion We believe this case provides evidence of a simple hepatic cyst gradually changing into hepatobiliary cystadenoma.
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Affiliation(s)
- Naoto Fukunaga
- Department of Surgery, Tokushima Red Cross Hospital, Komatsushima-City, Tokushima Prefecture, Japan.
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Yanai H, Tada N. A simple hepatic cyst with elevated serum and cyst fluid CA19-9 levels: a case report. J Med Case Rep 2008; 2:329. [PMID: 18851758 PMCID: PMC2572621 DOI: 10.1186/1752-1947-2-329] [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: 03/28/2008] [Accepted: 10/14/2008] [Indexed: 12/14/2022] Open
Abstract
Introduction Simple hepatic cysts rarely cause symptoms, however, occasionally they become symptomatic due to mass effect, rupture, hemorrhage, and infection. We report a patient with a large hepatic cyst with elevated serum and cyst fluid CA19-9 levels. We studied serum and cyst fluid CA19-9 levels in this patient, before and after the intracystic instillation of minocycline hydrochloride. Case presentation A 76-year-old Japanese woman was diagnosed as having an infected hepatic cyst, by physical examination and enhanced abdominal computed tomography. Serum (170 U/ml; reference: < 37 U/ml) and hepatic cyst fluid (371 U/ml) CA19-9 levels were elevated. After the intracystic instillation of minocycline hydrochloride, necrotic cells in the cyst were drained, and it totally collapsed after 1 week. Cyst fluid CA19-9 levels increased remarkably after the intracystic instillation of minocycline hydrochloride, while serum CA19-9 levels decreased significantly. Conclusion Our study is the first report to reveal the influence of intracystic instillation of minocycline hydrochloride on serum and cyst fluid CA19-9 levels in a patient with a simple hepatic cyst.
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Affiliation(s)
- Hidekatsu Yanai
- Department of Internal Medicine, Division of General Medicine, Kashiwa Hospital, The Jikei University School of Medicine, Kashiwashita, Kashiwa, Chiba, Japan.
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20
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Carson JG, Huerta S, Butler JA. Hepatobiliary cystadenoma: a case report and a review of the literature. ACTA ACUST UNITED AC 2006; 63:285-9. [PMID: 16843782 DOI: 10.1016/j.cursur.2006.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatic cystic lesions are rare; however, their management and treatment is dependent on early recognition and diagnosis. METHODS In this report, the authors discuss a 72-year-old woman who presented to their clinic for treatment of a hepatocystadenoma. RESULTS The history, physical examination, and diagnostic modalities lead to surgical intervention despite an unclear diagnosis. CONCLUSIONS This case illustrates an unusual hepatic lesion in which the diagnosis was not known until the time of laparotomy. However, diagnostic modalities were important in establishing the need for surgical intervention. The authors offer a pertinent review of the literature and discuss current treatment modalities.
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Affiliation(s)
- John G Carson
- Department of Surgery, University of California, Irvine, Orange, 92868, USA.
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Ramacciato G, Nigri GR, D'Angelo F, Aurello P, Bellagamba R, Colarossi C, Pilozzi E, Del Gaudio M. Emergency laparotomy for misdiagnosed biliary cystadenoma originating from caudate lobe. World J Surg Oncol 2006; 4:76. [PMID: 17090300 PMCID: PMC1635700 DOI: 10.1186/1477-7819-4-76] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Accepted: 11/07/2006] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Biliary cystadenoma is a rare benign neoplasm, which is often misdiagnosed for a hepatic abscess or a hydatid cyst that tends to recur and is at risk for progression to malignant neoplasm. CASE PRESENTATION This case describes a 30-year-old woman admitted to our institution in an emergency setting. The patient was originally misdiagnosed as affected by a hepatic hydatid cyst at another hospital, and then emergently treated at our Institution for severe abdominal pain. Histologic evaluation of the cyst showed that it was a biliary cystadenoma and, therefore, the patient underwent a hepatic resection in order to completely remove the lesion. CONCLUSION Complete excision of any suspicious hepatic cystic lesion remains the best method for diagnosis and treatment of cystadenoma. Incomplete excision of most biliary cystadenoma results in a higher rate of recurrence and the risk of malignant transformation. We report this case to elucidate the clinical presentation, preoperative evaluation, and surgical treatment of these rare lesions.
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Affiliation(s)
- Giovanni Ramacciato
- Hepatobiliary-pancreatic Surgery, University of Rome "La Sapienza", II School of Medicine, Sant'Andrea Hospital, Rome, Italy
| | - Giuseppe R Nigri
- Hepatobiliary-pancreatic Surgery, University of Rome "La Sapienza", II School of Medicine, Sant'Andrea Hospital, Rome, Italy
| | - Francesco D'Angelo
- Hepatobiliary-pancreatic Surgery, University of Rome "La Sapienza", II School of Medicine, Sant'Andrea Hospital, Rome, Italy
| | - Paolo Aurello
- Hepatobiliary-pancreatic Surgery, University of Rome "La Sapienza", II School of Medicine, Sant'Andrea Hospital, Rome, Italy
| | - Riccardo Bellagamba
- Hepatobiliary-pancreatic Surgery, University of Rome "La Sapienza", II School of Medicine, Sant'Andrea Hospital, Rome, Italy
| | - Cristina Colarossi
- Department of Pathology, University of Rome "La Sapienza", II School of Medicine, Sant'Andrea Hospital, Rome, Italy
| | - Emanuela Pilozzi
- Department of Pathology, University of Rome "La Sapienza", II School of Medicine, Sant'Andrea Hospital, Rome, Italy
| | - Massimo Del Gaudio
- Department of General Surgery, Liver and Multivisceral Transplantation Unit., University of Modena and Reggio Emilia, Italy
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22
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Manouras A, Markogiannakis H, Lagoudianakis E, Katergiannakis V. Biliary cystadenoma with mesenchymal stroma: Report of a case and review of the literature. World J Gastroenterol 2006; 12:6062-9. [PMID: 17009411 PMCID: PMC4124420 DOI: 10.3748/wjg.v12.i37.6062] [Citation(s) in RCA: 46] [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] [Indexed: 02/07/2023] Open
Abstract
Biliary cystadenomas are rare, cystic neoplasms of the biliary ductal system that usually occur in middle-aged women. They cannot be safely differentiated from cystadenocarcinomas before operation and should always be considered for resection. Cystadenomas have a strong tendency to recur, particularly following incomplete excision, and a potential of malignant transformation. Therefore, complete resection is the therapy of choice and thorough histopathologic evaluation is imperative. A case of benign biliary cystadenoma with mesenchymal stroma is presented along with a review of the relative literature addressing the clinical presentation, histology, histogenesis, differential diagnosis, imaging features, treatment and prognosis of this interesting and rare entity.
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Affiliation(s)
- Andreas Manouras
- 1st Department of Propaedeutic Surgery, Hippokration Hospital, Athens, Greece
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23
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Naganuma H, Funaoka M, Fujimori S, Niwa M, Ishida H, Komatsuda T, Yamada M, Furukawa K. Contrast-enhanced sonographic findings in a case of hepatobiliary cystadenoma with intracystic bleeding. JOURNAL OF CLINICAL ULTRASOUND : JCU 2006; 34:412-5. [PMID: 16944488 DOI: 10.1002/jcu.20262] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Intracystic slow bleeding is very difficult to diagnose using conventional sonography; consequently, a new sonographic technique has been sought. We present a histologically proven hepatobiliary cystadenoma with intracystic bleeding in which contrast-enhanced sonography (CEUS) showed microbubbles oozing from the cyst wall into the cystic cavity 10 minutes after intravenous injection of contrast medium. CEUS is an important diagnostic tool for diagnosing liver tumors, but the CEUS finding of slow intracystic bleeding has not been reported. Our observation suggests that this technique may be a new diagnostic tool for this purpose.
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Affiliation(s)
- Hiroko Naganuma
- Department of Internal Medicine, Yokote Municipal Hospital, 5-31 Negishi-cho, Yokote, Akita, Japan
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Marcos Hernández R, Rodríguez Pascual A, Martín Fernández J, Ramos Guillén P, Galván Huarte M, Gutiérrez Calvo A, Díez Alonso M, Granell Vicent FJ. [Hepatobiliary cystoadenomas]. Cir Esp 2006; 79:375-8. [PMID: 16769003 DOI: 10.1016/s0009-739x(06)70894-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cystoadenomas of the liver are rare cystic tumors that have seldom been reported. Accurate preoperative diagnosis is difficult because they are usually mistaken for more frequent lesions. Due to their malignant potential, complete surgical removal of the lesion is required. Correct diagnosis is guided by clinical history, radiological imaging, and laboratory parameters. We report two of these rare cases and discuss the spectrum of presentation, pathological features and treatment of these tumors.
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Affiliation(s)
- Ruth Marcos Hernández
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Príncipe de Asturias, Departamento de Cirugía, Universidad de Alcalá de Henares, Madrid, España.
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25
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Teoh AYB, Ng SSM, Lee KF, Lai PBS. Biliary Cystadenoma and Other Complicated Cystic Lesions of The Liver: Diagnostic and Therapeutic Challenges. World J Surg 2006; 30:1560-6. [PMID: 16865321 DOI: 10.1007/s00268-005-0461-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Biliary cystadenomas are complicated cystic lesions of the liver. They are rare and pose considerable diagnostic and therapeutic challenges. METHODS We present our experience managing these lesions by performing a retrospective review of all patients with a preoperative diagnosis of or histologically proven biliary cystadenoma who underwent surgery between January 1995 and January 2005 at our institution. Altogether, 20 patients (16 women, 4 men) with a mean age of 58 years underwent a total of 22 operations. The diagnosis of biliary cystadenoma was based on exclusion of other pathologic entities and the presence of radiologic characteristics of biliary cystadenoma. Abdominal ultrasonography (US), computed tomography, or both were performed in all patients. US-guided fine-needle aspiration cytology was performed in seven patients and all of them were negative for malignancy. A preoperative diagnosis of biliary cystadenoma was made in 16 patients based on clinical and radiologic features and was correct in 6 of them. Diagnosis of biliary cystadenoma was not suspected in four patients. RESULTS The overall diagnostic accuracy was 30%. Enucleation was the most common surgical procedure and was performed in 10 patients. The mean follow-up period was 5.5+/-2.8 years. No recurrence was detected in patients with confirmed biliary cystadenoma after adequate excision. CONCLUSIONS The findings of this study highlight the difficulty with preoperative diagnosis of biliary cystadenoma, which has seldom been discussed in the literature. Preoperative differentiation by means of radiologic imaging is inaccurate (30%). Any therapy short of complete excision leads to local recurrence and risk of malignant transformation. Complete excision of any suspicious lesion remains the best method of diagnosis and treatment.
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Affiliation(s)
- Anthony Y B Teoh
- Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
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26
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Kazama S, Hiramatsu T, Kuriyama S, Kuriki K, Kobayashi R, Takabayashi N, Furukawa K, Kosukegawa M, Nakajima H, Hara K. Giant intrahepatic biliary cystadenoma in a male: a case report, immunohistopathological analysis, and review of the literature. Dig Dis Sci 2005; 50:1384-9. [PMID: 16047491 DOI: 10.1007/s10620-005-2791-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Shinsuke Kazama
- Department of Surgery, Yaizu Municipal Hospital, 1000 Dobara, Yaizu-city, Shizuoka, 425-8505, Japan.
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Lewin M, Mourra N, Honigman I, Fléjou JF, Parc R, Arrivé L, Tubiana JM. Assessment of MRI and MRCP in diagnosis of biliary cystadenoma and cystadenocarcinoma. Eur Radiol 2005; 16:407-13. [PMID: 15983777 DOI: 10.1007/s00330-005-2822-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2004] [Revised: 05/04/2005] [Accepted: 05/10/2005] [Indexed: 12/16/2022]
Abstract
Magnetic resonance imaging (MRI) and magnetic resonance cholangio-pancreatography (MRCP) features were analyzed in the diagnosis of seven surgically resected hepatobiliary cystic tumors with reference to histopathological data. Homogeneity, size, location, signal intensity, presence or absence of septa and/or nodules and MRCP features of the lesions were studied. Histological evidence demonstrated six biliary cystadenoma (BCA) including four pseudo-ovarian stroma (POS) and one biliary cystadenocarcinoma (BCAC). Cystic lesions (3-15 cm in diameter) were homogeneous in the six BCA, heterogeneous in the one BCAC, and were located in the left and right liver, respectively. On T2-weighted images all lesions were hyperintense. On T1-weighted images hypointensity was found in three BCA (all serous fluid, including one POS), isointensity was found in the three others (two mucinous and one hemorrhagic fluid, including three POS) and in the one BCAC (containing mucinous fluid). Septas were present in all cases and nodules only in the one BCAC. On MRCP a hyperintense cystic lesion was found in all cases and a bile ducts dilatation in two BCA and the one BCAC. Gadolinium-enhanced MRI in combination with MRCP is a valuable tool for the diagnosis of BCA or BCAC. However, no specific information is gained for POS detection.
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Affiliation(s)
- Maïté Lewin
- Department of Radiology, Saint-Antoine University-Hospital, Assistance Publique des Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France.
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Thomas KT, Welch D, Trueblood A, Sulur P, Wise P, Gorden DL, Chari RS, Wright JK, Washington K, Pinson CW. Effective treatment of biliary cystadenoma. Ann Surg 2005; 241:769-73; discussion 773-5. [PMID: 15849512 PMCID: PMC1357131 DOI: 10.1097/01.sla.0000161982.57360.1b] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Evaluate experience over 15 years with treatment of this lesion. SUMMARY BACKGROUND DATA Biliary cystadenoma, a benign hepatic tumor arising from Von Meyenberg complexes, usually present as septated intrahepatic cystic lesions. METHODS Data were collected concurrently and retrospectively on patients identified from hospital medical records reviewed for pertinent International Classification of Diseases, Ninth Revision, Clinical Modification and CPT codes, pathology logs, and from operative case logs. Pathology specimens were rereviewed to confirm the diagnosis of biliary cystadenoma or biliary cystadenocarcinoma by 2 GI pathologists. RESULTS From October 1989 to April 2004 at our institution, 19 (18F:1M) patients had pathologically confirmed biliary cystadenomas, including one with a biliary cystadenocarcinoma. The mean age was 48 +/- 15 years at initial evaluation. Complaints included abdominal pain in 74%, abdominal distension in 26%, and nausea/vomiting in 11%. Only 1 patient presented with an incidental finding. Symptoms had been present for 3 +/- 5 years, with 1 to 4 different surgeons and many other physicians involved in the diagnosis or treatment prior to definitive ablation. Eight patients had undergone 20 previous treatments, including multiple percutaneous aspirations in 4 and 11 operative procedures. CT or US was diagnostic in 95%, with internal septations present in the hepatic cysts. Definitive operative intervention consisted of hepatic resection in 12 patients, enucleation in 6 patients, and fenestration and complete fulguration in 1 patient. There were no perioperative deaths. No recurrences were observed after definitive therapy, with follow-up of 4 +/- 4 years. CONCLUSIONS Biliary cystadenoma must be recognized and treated differently than most hepatic cysts. There remains a need for education about the imaging findings for biliary cystadenoma to reduce the demonstrated delay in appropriate treatment. Traditional treatment of simple cysts such as aspiration, drainage, and marsupialization results in near universal recurrence and occasional malignant degeneration. This experience demonstrates effective options include total ablation by standard hepatic resection and cyst enucleation.
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Affiliation(s)
- K Tyson Thomas
- Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-5545, USA
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Dixon E, Sutherland FR, Burak K, McKinnon G, May G. Cystadenoma of the liver without mesenchymal stroma in a female following hormonal therapy for acne. HPB (Oxford) 2001; 3:183-6. [PMID: 18332923 PMCID: PMC2020801 DOI: 10.1080/136518201317077224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Liver cystadenomas are relatively rare tumours that can be difficult to diagnose; treatment entails complete surgical extirpation either by either anatomical resection or enucleation. CASE OUTLINE A 19-year-old woman presented with acute onset of abdominal pain and was found to have a multilocular giant liver cyst.The cyst was percutaneously drained; CEA and CA 19-9 tumour markers were elevated in this cyst fluid: CEA 96 microg/L, CAI9-9 37 550 kU/L. The cyst was completely enucleated and has not recurred. Pathological examination confirmed a cystadenoma without mesenchymal stroma, and tumour oestrogen and progesterone receptors were negative. DISCUSSION This is the fourth report of a liver cystadenoma without mesenchymal stroma in a female and the first to document elevated cyst fluid tumour markers. This case also illustrates the possible relationship between hormonal therapy and tumour growth.
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Affiliation(s)
- E Dixon
- Department of Surgery, Department of Gastroenterology, University of CalgaryCalgary AlbertaCanada
| | - FR Sutherland
- Peter Lougheed Hospital, University of CalgaryCalgary AlbertaCanada
| | - K Burak
- Peter Lougheed Hospital, University of CalgaryCalgary AlbertaCanada
| | - G McKinnon
- Foothills Hospital, University of CalgaryCalgary AlbertaCanada
| | - G May
- Peter Lougheed Hospital, University of CalgaryCalgary AlbertaCanada
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