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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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Kim SU, Hwang JA, Han S, Lee JH, Choi SY, Ha SY. Refining imaging criteria for mucinous cystic neoplasm of the liver: simplified diagnostic approach. Eur Radiol 2025:10.1007/s00330-025-11407-5. [PMID: 39909901 DOI: 10.1007/s00330-025-11407-5] [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: 07/14/2024] [Revised: 12/23/2024] [Accepted: 01/13/2025] [Indexed: 02/07/2025]
Abstract
OBJECTIVES To propose a simplified diagnostic approach for mucinous cystic neoplasm (MCN) of the liver and compare its diagnostic performance with the European Association for the Study of the Liver (EASL) criteria. METHODS We conducted a retrospective cohort study of 124 patients with pathologically confirmed lesions (13 MCNs, 111 hepatic cysts) who underwent CT/MRI between January 2016 and January 2023. Two major features (thick septation, nodularity) and five minor features (upstream biliary dilatation, thin septations, internal hemorrhage, perfusion change, < 3 coexistent hepatic cysts) of the EASL criteria were evaluated. For a septa-wall relationship, the angle of indentation was measured, and the optimal angle predicting MCN was determined by receiver operating characteristic curve analysis. Logistic regression identified features predicting MCN, and a modified criteria was developed. The sensitivity, specificity, and accuracy of both criteria were compared using McNemar's test. RESULTS The optimal indentation angle was 111°. Absence of indentation or indentation at an angle > 111° (odds ratio (OR), 100.4; 95% confidence interval (CI), 4.9-2076.0) and < 3 coexistent hepatic cysts (OR, 47.8; 95% CI, 1.5-1489.1) were independent features predicting MCN. Our modified criteria used a combination of them and demonstrated greater accuracy (98.4% vs. 92.7%; p = 0.035) than the EASL criteria (a combination of ≥ 1 major and ≥ 1 minor feature[s]), with comparable sensitivity (92.3% vs. 76.9%; p = 0.317) and specificity (99.1% vs. 94.6%; p = 0.059). CONCLUSION Our modified criteria using two imaging features may be a promising alternative to current EASL criteria to improve accuracy in diagnosing MCN. KEY POINTS Question Radiological diagnosis of mucinous cystic neoplasm of the liver remains challenging due to the lack of specific imaging features, leading to suboptimal treatment decisions. Findings No external indentation or an indentation angle > 111° and fewer than 3 coexistent hepatic cysts are independent factors predicting mucinous cystic neoplasm of the liver. Clinical relevance The simplified approach using these two imaging features for diagnosing mucinous cystic neoplasm of the liver offers improved accuracy and reliability over the 2022 EASL criteria, potentially reducing misdiagnosis and unnecessary surgeries.
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Affiliation(s)
- Seong Uk Kim
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Ah Hwang
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Seungchul Han
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seo-Youn Choi
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Yun Ha
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Konstantinoff KS, Ludwig DR, Sharbidre K, Arif-Tiwari H, Itani M. Gallbladder and biliary pathology: lessons learned from multidisciplinary conference. Abdom Radiol (NY) 2025; 50:916-935. [PMID: 39259353 DOI: 10.1007/s00261-024-04533-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 08/12/2024] [Accepted: 08/14/2024] [Indexed: 09/13/2024]
Abstract
The radiologic diagnosis of biliary disease can be challenging due to atypical or delayed presentation, rare or less common entities, and imaging overlap of benign and malignant processes. Establishing a specific diagnosis, when possible, is important to avoid progression of infections to sepsis and multiorgan failure, and for appropriate staging and management in cases of malignancy. Gallstones are the most common biliary disease, and along with stone-related complications, including cholecystitis and choledocholithiasis, constitute the majority of acute biliary pathology. Late and atypical manifestations of acute cholecystitis demonstrate imaging overlap with primary gallbladder cholangiocarcinoma, especially with cases of exuberant inflammatory reaction such as xanthogranulomatous cholecystitis. Additional challenging scenarios related to gallbladder disease, that may be benign or malignant, include adjacent fistulas and lymphadenopathy. Dropped gallstones, especially in atypical locations, may be misdiagnosed as neoplastic. Recurrent cholecystitis after cholecystectomy, whether related to subtotal cholecystectomy or to stumpitis, is another entity that can be confusing to the radiologist with a documented history of cholecystectomy. Inflammatory and autoimmune conditions, such as pseudotumors and IgG4 disease, are a less common but not infrequent cause of diagnostic dilemma. Furthermore, biliary strictures and hepatobiliary cystic lesions can be benign or malignant and could constitute a diagnostic and management challenge. The goal of this manuscript is to present the lessons learned from multidisciplinary conferences on the above entities and suggest tips and pearls to maximize the value of radiologists' contribution to patient management.
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Affiliation(s)
- Katerina S Konstantinoff
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway Blvd, St., St. Louis, MO, 63110, USA
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway Blvd, St., St. Louis, MO, 63110, USA
| | - Kedar Sharbidre
- Department of Radiology, University of Alabama in Birmingham, 500 22nd Street South, Birmingham, AL, 35233, USA
| | - Hina Arif-Tiwari
- Department of Medical Imaging, University of Arizona College of Medicine, 1501 N. Campbell, Tucson, AZ, 85724, USA
| | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway Blvd, St., St. Louis, MO, 63110, USA.
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Gomes MM, Cagliari GAG, Pacheco EO, Torres US, D’Ippolito G. Hepatic cysts: a survival guide. Radiol Bras 2025; 58:e20240101en. [PMID: 40365139 PMCID: PMC12071424 DOI: 10.1590/0100-3984.2024.0101-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 11/01/2024] [Accepted: 12/10/2024] [Indexed: 05/15/2025] Open
Abstract
Hepatic cysts are quite common in the daily practice of radiologists and are generally described as simple cysts or as cystic lesions sparsely distributed throughout the parenchyma, often without the discrimination they merit. Simple cysts have, by definition, thin walls, one or two thin septa, and homogeneous fluid content. Such cysts include congenital epithelial cysts, biliary hamartomas, and peribiliary cysts, as well as those representing Caroli's disease or polycystic liver disease. Complex cysts have variable walls, septa, and contents. They also have various etiologies. A detailed assessment of the clinical history and imaging characteristics can assist in making the diagnosis and choosing a course of clinical management. In this review, hepatic cysts are divided, for educational purposes, into five categories: congenital, traumatic, neoplastic, inflammatory, and miscellaneous.
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Affiliation(s)
- Matheus Menezes Gomes
- Escola Paulista de Medicina da Universidade Federal de São
Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | | | - Eduardo Oliveira Pacheco
- Escola Paulista de Medicina da Universidade Federal de São
Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Ulysses Santos Torres
- Escola Paulista de Medicina da Universidade Federal de São
Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Giuseppe D’Ippolito
- Escola Paulista de Medicina da Universidade Federal de São
Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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5
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Jia JJ, Cheng YF, Feng MB, Liu L, Shuai MQ, Shen XD, Tang XF, Zheng SS. Diagnosis and treatment of biliary mucinous cystic neoplasms: A single-center experience. Hepatobiliary Pancreat Dis Int 2024; 23:495-501. [PMID: 37652799 DOI: 10.1016/j.hbpd.2023.08.011] [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: 01/16/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Biliary mucinous cystic neoplasms (BMCNs) are rare hepatobiliary cystic tumors, which can be divided into noninvasive and invasive types. This study aimed to investigate the diagnosis, treatment, and prognosis of BMCNs in a large single center. METHODS We analyzed 49 patients with BMCNs confirmed by postoperative pathology at the First Affiliated Hospital, Zhejiang University School of Medicine between January 2007 and December 2021. RESULTS Among the 49 patients, 37 were female (75.5%), and the average age was 57.04 years. Common symptoms included abdominal discomfort, jaundice and fever, while 22 patients (44.9%) had no symptoms. Serum carbohydrate antigen (CA) 19-9 and CA125 concentrations were elevated in 34.8% and 19.6% of patients, respectively. Forty-eight patients had tumors in the intrahepatic bile ducts and only one had a tumor in the extrahepatic bile duct. Forty-eight patients with noninvasive intrahepatic BMCNs were further analyzed in terms of pathological features: 34 (70.8%) had low-grade intraepithelial neoplasms (LGINs), and 14 (29.2%) had high-grade intraepithelial neoplasms (HGINs). The potential immunohistochemical markers of BMCNs were cytokeratin (CK) 19, CK7, estrogen receptor and progesterone receptor. Follow-up data for 37 patients with intrahepatic BMCNs were obtained. The median overall survival (OS) of BMCNs was not reached. The longest survival time was 137 months.The 5- and 10-year OS rates were 100% and 85.4%, respectively. The 5- and 10-year recurrence-free survival (RFS) rates were 93.9% and 80.2%, respectively. CONCLUSIONS BMCNs are rare cystic neoplasms that commonly occur in middle-aged females. BMCNs can only be diagnosed and classified by postoperative pathology, as there are no specific clinical presentations, serological indicators or imaging modalities for preoperative diagnosis. Complete surgical resection is necessary for BMCNs, and the postoperative prognosis is favorable.
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MESH Headings
- Humans
- Female
- Middle Aged
- Male
- Aged
- Adult
- Bile Duct Neoplasms/mortality
- Bile Duct Neoplasms/pathology
- Bile Duct Neoplasms/surgery
- Bile Duct Neoplasms/diagnosis
- Bile Duct Neoplasms/therapy
- Bile Duct Neoplasms/blood
- Retrospective Studies
- CA-125 Antigen/blood
- CA-19-9 Antigen/blood
- Biomarkers, Tumor/blood
- Biomarkers, Tumor/analysis
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Neoplasms, Cystic, Mucinous, and Serous/therapy
- Neoplasms, Cystic, Mucinous, and Serous/mortality
- Neoplasms, Cystic, Mucinous, and Serous/surgery
- Neoplasms, Cystic, Mucinous, and Serous/blood
- China/epidemiology
- Bile Ducts, Intrahepatic/pathology
- Bile Ducts, Intrahepatic/surgery
- Treatment Outcome
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Affiliation(s)
- Jun-Jun Jia
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Ya-Fen Cheng
- Department of International Healthcare Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Mei-Bao Feng
- Department of Pathology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Li Liu
- Department of Library, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Ming-Qi Shuai
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Xiao-Dong Shen
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Xiao-Feng Tang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Shu-Sen Zheng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
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6
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Karashima R, Yamamura K, Oda E, Ozaki N, Ishiko T, Nagayama Y, Yamada R, Komohara Y, Koba I, Beppu T. Hepatic hemangioma in a simple liver cyst mimicking biliary cystic neoplasm. Surg Case Rep 2024; 10:119. [PMID: 38735984 PMCID: PMC11089029 DOI: 10.1186/s40792-024-01908-8] [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: 01/14/2024] [Accepted: 04/24/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Follow-up is recommended for an asymptomatic unilocular hepatic cystic lesion without wall-thickness and nodular components. A few liver cystic lesions represent biliary cystic neoplasms, which are difficult to differentiate from simple cysts with benign mural nodules on imaging alone. CASE PRESENTATION An 84-year-old woman with a history of simple liver cyst diagnosed one year prior was admitted for evaluation of a developed mural nodule in the cystic lesion. She had no specific symptoms and no abnormalities in blood tests except for carcinoembryonic antigen (5.0 ng/mL) and carbohydrate antigen (43.5 U/mL) levels. Contrast-enhanced computed tomography revealed a well-defined, low-attenuation lesion without a septum that had enlarged from 41 to 47 mm. No dilation of the bile duct was observed. A gradually enhancing mural nodule, 14 mm in diameter, was confirmed. MRI revealed a uniform water-intense cystic lesion with a mural nodule. This was followed by T2-enhanced imaging showing peripheral hypointensity and central hyperintensity. Enhanced ultrasonography revealed an enhanced nodule with a distinct artery within it. A needle biopsy of the wall nodule or aspiration of intracystic fluid was not performed to avoid tumor cell spillage. The possibility of a neoplastic cystic tumor could not be ruled out, so a partial hepatectomy was performed with adequate margins. Pathologically, the cystic lesion contained a black 5 mm nodule consisting of a thin, whitish fibrous wall and dilated vessels lined by CD31 and CD34 positive endothelial cells. The final diagnosis was a rare cavernous hemangioma within a simple liver cyst. CONCLUSIONS Cavernous hemangiomas mimicking well-enhanced mural nodules can arise from simple liver cysts. In less malignant cases, laparoscopic biopsy or percutaneous targeted biopsy of the mural nodules, together with needle ablation, may be recommended to avoid unnecessary surgery.
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Affiliation(s)
- Ryuichi Karashima
- Department of Surgery, Yamaga City Medical Center, Yamaga, Kumamoto, 511861-0593, Japan
| | - Kensuke Yamamura
- Department of Surgery, Yamaga City Medical Center, Yamaga, Kumamoto, 511861-0593, Japan
| | - Eri Oda
- Department of Surgery, Yamaga City Medical Center, Yamaga, Kumamoto, 511861-0593, Japan
| | - Nobuyuki Ozaki
- Department of Surgery, Yamaga City Medical Center, Yamaga, Kumamoto, 511861-0593, Japan
| | - Takatoshi Ishiko
- Department of Surgery, Yamaga City Medical Center, Yamaga, Kumamoto, 511861-0593, Japan
| | - Yasunori Nagayama
- Department of Radiology, Yamaga City Medical Center, Kumamoto, Japan
| | - Rin Yamada
- Department of Cell Pathology, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yoshihiko Komohara
- Department of Cell Pathology, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Ikuro Koba
- Department of Gastroenterology, Yamaga Chuo Hospital, Kumamoto, Japan
| | - Toru Beppu
- Department of Surgery, Yamaga City Medical Center, Yamaga, Kumamoto, 511861-0593, Japan.
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7
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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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Furtado FS, Badenes-Romero Á, Hesami M, Mostafavi L, Najmi Z, Queiroz M, Mojtahed A, Anderson MA, Catalano OA. External validation of a machine learning based algorithm to differentiate hepatic mucinous cystic neoplasms from benign hepatic cysts. Abdom Radiol (NY) 2023; 48:2311-2320. [PMID: 37055585 DOI: 10.1007/s00261-023-03907-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE To externally validate an algorithm for non-invasive differentiation of hepatic mucinous cystic neoplasms (MCN) from benign hepatic cysts (BHC), which differ in management. METHODS Patients with cystic liver lesions pathologically confirmed as MCN or BHC between January 2005 and March 2022 from multiple institutions were retrospectively included. Five readers (2 radiologists, 3 non-radiologist physicians) independently reviewed contrast-enhanced CT or MRI examinations before tissue sampling and applied the 3-feature classification algorithm described by Hardie et al. to differentiate between MCN and BHC, which had a reported accuracy of 93.5%. The classification was then compared to the pathology results. Interreader agreement between readers across different levels of experience was evaluated with Fleiss' Kappa. RESULTS The final cohort included 159 patients, median age of 62 years (IQR [52.0, 70.0]), 66.7% female (106). Of all patients, 89.3% (142) had BHC, and the remaining 10.7% (17) had MCN on pathology. Agreement for class designation between the radiologists was almost perfect (Fleiss' Kappa 0.840, p < 0.001). The algorithm had an accuracy of 98.1% (95% CI [94.6%, 99.6%]), a positive predictive value of 100.0% (95% CI [76.8%, 100.0%]), a negative predictive value of 97.9% (95% CI [94.1%, 99.6%]), and an area under the receiver operator characteristic curve (AUC) of 0.911 (95% CI [0.818, 1.000]). CONCLUSION The evaluated algorithm showed similarly high diagnostic accuracy in our external, multi-institutional validation cohort. This 3-feature algorithm is easily and rapidly applied and its features are reproducible among radiologists, showing promise as a clinical decision support tool.
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Affiliation(s)
- Felipe S Furtado
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, 02129, USA
| | - Álvaro Badenes-Romero
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, 02129, USA
- Department of Nuclear Medicine, Hospital Universitario de Tarragona Juan XXIII, Tarragona, Spain
| | - Mina Hesami
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, 02129, USA
| | - Leila Mostafavi
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Zahra Najmi
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, 02129, USA
| | | | - Amirkasra Mojtahed
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, 02129, USA
| | - Mark A Anderson
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, 02129, USA.
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9
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Deng X, Wang J, Mou T, Pan L, Du C, Wu Q. Case report: Single-operator peroral cholangioscopy system (SpyGlass) diagnosis of an extrahepatic biliary cystadenoma (video). Front Med (Lausanne) 2023; 10:1175034. [PMID: 37425323 PMCID: PMC10327893 DOI: 10.3389/fmed.2023.1175034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/17/2023] [Indexed: 07/11/2023] Open
Abstract
Biliary cystadenoma is a type of rare liver cystic tumor. Intrahepatic biliary cystadenomas are the most common, while extrahepatic biliary cystadenomas are rarely seen. Biliary cystadenoma tends to occur in middle-aged to older women and there is a lack of specific preoperative diagnostic markers. Recent advancements in technology and the development of the SpyGlass system have led to an increased use of cholangioscopy. Herein, we report a patient in whom a space-occupying lesion was found in the bile duct by SpyGlass, and who later underwent radical surgery. The pathology report indicated that the final diagnosis was biliary cystadenoma. SpyGlass cholangioscopy may be a novel and effective diagnostic method for biliary cystadenoma.
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Affiliation(s)
- Xin Deng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jingwen Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tong Mou
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Long Pan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chengyou Du
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiao Wu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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10
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Anderson MA, Bhati CS, Ganeshan D, Itani M. Hepatobiliary mucinous cystic neoplasms and mimics. Abdom Radiol (NY) 2023; 48:79-90. [PMID: 34687327 DOI: 10.1007/s00261-021-03303-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 02/06/2023]
Abstract
This review will provide an overview of hepatobiliary mucinous cystic neoplasms and their mimics such as complex appearing benign cysts, intraductal papillary neoplasm of bile ducts, choledochal cysts, infectious cysts, and other cystic neoplasms. Preoperative imaging, particularly abdominal MRI with MRCP, plays a key role in differentiating these entities which differ widely in management. Familiarity with the differentiating imaging features of mucinous cystic neoplasms and their mimics allows radiologists to provide management-guiding reports.
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Affiliation(s)
- Mark A Anderson
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White Building, Room 270, Boston, MA, 02114, USA.
| | - Chandra S Bhati
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, 23298, USA
| | - Dhakshinamoorthy Ganeshan
- Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Malak Itani
- Mallinckrodt Institute of Radiology, St. Louis, MO, 63110, USA
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11
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Focal Benign Liver Lesions and Their Diagnostic Pitfalls. Radiol Clin North Am 2022; 60:755-773. [DOI: 10.1016/j.rcl.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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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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13
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Lee MH, Katabathina VS, Lubner MG, Shah HU, Prasad SR, Matkowskyj KA, Pickhardt PJ. Mucin-producing Cystic Hepatobiliary Neoplasms: Updated Nomenclature and Clinical, Pathologic, and Imaging Features. Radiographics 2021; 41:1592-1610. [PMID: 34597230 DOI: 10.1148/rg.2021210011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cystic hepatobiliary neoplasms with mucin-producing epithelium-mucinous cystic neoplasm of the liver (MCN) and intraductal papillary neoplasm of the bile duct (IPNB)-are rare and distinct entities that have unique clinical, pathologic, and imaging features. They are differentiated pathologically by the presence of subepithelial ovarian-like hypercellular stroma (OLS), which is the defining histopathologic feature of MCN. MCN is commonly a benign, large, solitary, symptomatic, multiloculated cystic mass without biliary communication that occurs in middle-aged women. On the other hand, IPNBs are a heterogeneous spectrum of tumors, which are commonly associated with invasive carcinoma, occur in older patients, and can be differentiated from MCN by communication with the biliary tree, intraductal masses, associated biliary ductal dilatation, and absent OLS. Understanding of these rare neoplasms has grown and evolved over time and continues to today, but uncertainty and controversy persist, related to the rarity of these tumors, relatively recent designation as separate entities, inherent clinicopathologic heterogeneity, overlapping imaging features, and the fact that many prior studies likely included MCN and cystic IPNB together as a single entity. Confusion regarding these neoplasms is evident by historical inconsistencies and nonstandardized nomenclature through the years. Awareness of these entities is important for the interpreting radiologist to suggest a particular diagnosis or generate a meaningful differential diagnosis in the appropriate setting, and is of particular significance as MCN and cystic IPNB have overlapping imaging features with other more common hepatobiliary cystic masses but have different management and prognosis. Online supplemental material is available for this article. Work of the U.S. Government published under an exclusive license with the RSNA.
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Affiliation(s)
- Matthew H Lee
- From the Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 (M.H.L.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.); Departments of Radiology (M.G.L., P.J.P.) and Pathology (K.A.M.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Emory University School of Medicine, Atlanta, Ga (H.U.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Venkata S Katabathina
- From the Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 (M.H.L.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.); Departments of Radiology (M.G.L., P.J.P.) and Pathology (K.A.M.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Emory University School of Medicine, Atlanta, Ga (H.U.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Meghan G Lubner
- From the Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 (M.H.L.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.); Departments of Radiology (M.G.L., P.J.P.) and Pathology (K.A.M.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Emory University School of Medicine, Atlanta, Ga (H.U.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Hardik U Shah
- From the Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 (M.H.L.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.); Departments of Radiology (M.G.L., P.J.P.) and Pathology (K.A.M.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Emory University School of Medicine, Atlanta, Ga (H.U.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Srinivasa R Prasad
- From the Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 (M.H.L.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.); Departments of Radiology (M.G.L., P.J.P.) and Pathology (K.A.M.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Emory University School of Medicine, Atlanta, Ga (H.U.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Kristina A Matkowskyj
- From the Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 (M.H.L.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.); Departments of Radiology (M.G.L., P.J.P.) and Pathology (K.A.M.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Emory University School of Medicine, Atlanta, Ga (H.U.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Perry J Pickhardt
- From the Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 (M.H.L.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.); Departments of Radiology (M.G.L., P.J.P.) and Pathology (K.A.M.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Emory University School of Medicine, Atlanta, Ga (H.U.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
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14
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Paspala A, Machairas N, Damaskou V, Ntomi V, Kykalos S, Machairas A, Schizas D. A rare case of extrahepatic biliary mucinous cystic neoplasm in a middle-aged woman: A case report. Mol Clin Oncol 2021; 15:196. [PMID: 34462652 DOI: 10.3892/mco.2021.2358] [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: 12/08/2020] [Accepted: 04/21/2021] [Indexed: 11/05/2022] Open
Abstract
Biliary mucinous cystic neoplasms are very rare tumors of the biliary tract with malignant potential. Preoperative diagnosis is challenging, as clinical, biochemical and radiological features are not specific. Surgical resection with negative margins is the gold standard treatment for these uncommon lesions. A 55-year-old woman presented at the Third Department of Surgery (Attikon University Hospital, Athens, Greece) with a history of mild right upper quadrant (RUQ) abdominal pain and jaundice. A 2-cm lesion in the distal common bile was identified by imaging. Following discussion in our multidisciplinary board meeting the patient underwent a pylorus preserving pancreatoduodenectomy, and histopathological examination revealed an ovarian-stromal type intraductal mucinous cystic neoplasm of the extra hepatic biliary. Since biliary mucinous cystic neoplasms are characterized by malignant transformation and high rates of recurrence, surgical resection with negative margins is the treatment of choice for both non-invasive and invasive biliary mucinous cystic neoplasms.
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Affiliation(s)
- Anna Paspala
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Nikolaos Machairas
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Vasileia Damaskou
- Second Department of Pathology, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Vasileia Ntomi
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Stylianos Kykalos
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Anastasios Machairas
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
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15
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Incidental Liver Findings on Cross-sectional Imaging. Radiol Clin North Am 2021; 59:569-590. [PMID: 34053606 DOI: 10.1016/j.rcl.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hepatic incidental findings often are seen on cross-sectional imaging examinations of the chest, spine, pelvis, or other nondedicated hepatic imaging. Radiologists are tasked with appropriately triaging, which requires further evaluation, even in the setting of an otherwise limited evaluation. This article reviews common benign entities encountered on ultrasound, computed tomography, or magnetic resonance imaging, along with their characteristic imaging features. Imaging features that are suspicious for malignancy or suggest the need for further evaluation also are discussed. Two algorithms are proposed to guide radiologists in their recommendations based on patient risk factors, focal hepatic abnormality size, and available imaging features.
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16
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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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17
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Bag ND, Mohakud S, Naik S, Shri A. Recurrent giant simple hepatic cyst: an unusual cause of dyspnoea in an elderly man. BMJ Case Rep 2021; 14:14/2/e238882. [PMID: 33541987 PMCID: PMC7868208 DOI: 10.1136/bcr-2020-238882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
An 88-year-old man presented to the emergency department with exertional dyspnoea and orthopnoea. Clinical examination revealed mildly raised jugular venous pressure, increased respiratory rate, palpable non-tender hepatomegaly and reduced right basal breath sounds. Ultrasonography showed a large right simple hepatic cyst, multiple small left hepatic and renal cysts. A non-contrast CT scan revealed a large, right hepatic thin-walled cyst of volume 4.2 L, exhibiting few thin septae and tiny nodular mural calcifications. Pressure effects were elevated right haemidiaphragm, right atrial compression and adjacent atelectasis. He had a similar episode 2 years ago, treated by percutaneous needle aspiration. Giant simple hepatic cysts are rare and present when symptomatic due to pain, mass effect on adjacent organs, infection or rupture. These may unusually cause dyspnoea or orthopnoea by compressing cardiac chambers. Simple aspiration has a high recurrence rate. Percutaneous sclerosant injection, laparoscopic deroofing and cystectomy are better treatment modalities.
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Affiliation(s)
- Nerbadyswari Deep Bag
- Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
| | - Sudipta Mohakud
- Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
| | - Suprava Naik
- Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
| | - Aishvarya Shri
- Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
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18
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Anderson MA, Dhami RS, Fadzen CM, Molina G, Taylor MS, Deshpande V, Qadan M, Catalano OA, Ferrone CR, Mojtahed A. CT and MRI features differentiating mucinous cystic neoplasms of the liver from pathologically simple cysts. Clin Imaging 2021; 76:46-52. [PMID: 33549919 DOI: 10.1016/j.clinimag.2021.01.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/18/2021] [Accepted: 01/28/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE The purpose of this study was to determine if CT and MRI features can accurately differentiate mucinous cystic neoplasms (MCNs) from simple liver cysts and to compare accuracy of CT and MRI in detecting these features. METHODS Eighty-four surgically treated lesions with pre-operative CT or MRI were evaluated by two abdominal radiologists for upstream biliary dilatation, perfusional change, internal hemorrhage, thin septations, thick septations/nodularity, lobar location, and number of coexistent liver cysts. Odds ratios, sensitivities, specificities, and positive and negative predictive values were calculated for association of each feature with MCNs. RESULTS Of 84 liver lesions, 13 (15%) were MCNs, all in women, and 71 (85%) were simple cysts, in 59 women and 12 men. Thick septations/nodularity, upstream biliary dilation, thin septations, internal hemorrhage, perfusional change, and fewer than 3 coexistent liver cysts were more frequent in MCNs than in simple cysts. The combination of thick septations/nodularity and at least one additional associated feature showed high specificity for MCNs (94-98%). MRI detected significant associations of biliary dilation, thin septations, and hemorrhage/debris with MCNs which CT did not. CONCLUSION Surgically treated MCNs of the liver with preoperative imaging occurred at our institution only in women. Thick septations or nodularity, biliary dilation, thin septations, internal hemorrhage or debris, perfusional change, and fewer than 3 coexistent liver cysts are features that help differentiate MCNs from simple cysts. MRI has advantages over CT in detecting these features.
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Affiliation(s)
- Mark A Anderson
- Massachusetts General Hospital, Department of Radiology, 55 Fruit Street, Boston, MA 02114, USA.
| | - Ranjodh S Dhami
- Massachusetts General Hospital, Department of Radiology, 55 Fruit Street, Boston, MA 02114, USA.
| | - Colin M Fadzen
- Massachusetts General Hospital, Department of Surgery, 55 Fruit Street, Boston, MA 02114, USA.
| | - George Molina
- Brigham and Women's Hospital, Department of Surgery, 75 Francis Street, Boston, MA 02115, USA.
| | - Martin S Taylor
- Massachusetts General Hospital, Department of Pathology, 55 Fruit Street, Boston, MA 02114, USA.
| | - Vikram Deshpande
- Massachusetts General Hospital, Department of Pathology, 55 Fruit Street, Boston, MA 02114, USA.
| | - Motaz Qadan
- Massachusetts General Hospital, Department of Surgery, 55 Fruit Street, Boston, MA 02114, USA.
| | - Onofrio A Catalano
- Massachusetts General Hospital, Department of Radiology, 55 Fruit Street, Boston, MA 02114, USA.
| | - Cristina R Ferrone
- Massachusetts General Hospital, Department of Surgery, 55 Fruit Street, Boston, MA 02114, USA.
| | - Amirkasra Mojtahed
- Massachusetts General Hospital, Department of Radiology, 55 Fruit Street, Boston, MA 02114, USA.
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19
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Furumaya A, van Rosmalen BV, de Graeff JJ, Haring MPD, de Meijer VE, van Gulik TM, Verheij J, Besselink MG, van Delden OM, Erdmann JI. Systematic review on percutaneous aspiration and sclerotherapy versus surgery in symptomatic simple hepatic cysts. HPB (Oxford) 2021; 23:11-24. [PMID: 32830070 DOI: 10.1016/j.hpb.2020.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/09/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Simple hepatic cysts (SHC) may cause pain and bloating and thus impair quality of life. Whereas current guidelines recommend laparoscopic cyst deroofing, percutaneous aspiration and sclerotherapy (PAS) may be used as a less invasive alternative. This review aimed to assess the efficacy of PAS and surgical management in patients with symptomatic SHC. METHODS A systematic search in PubMed and Embase was performed according to PRISMA-guidelines. Studies reporting symptoms were included. Methodological quality was assessed by the MINORS-tool. Primary outcomes were symptom relief, symptomatic recurrence and quality of life, for which a meta-analysis of proportions was performed. RESULTS In total, 736 patients from 34 studies were included of whom 265 (36%) underwent PAS, 348 (47%) laparoscopic cyst deroofing, and 123 (17%) open surgical management. During weighted mean follow-up of 26.1, 38.2 and 21.3 months, symptoms persisted in 3.5%, 2.1%, 4.2%, for PAS, laparoscopic and open surgical management, respectively. Major complication rates were 0.8%, 1.7%, and 2.4% and cyst recurrence rates were 0.0%, 5.6%, and 7.7%, respectively. CONCLUSION Outcomes of PAS for symptomatic SHC appear to be excellent. Studies including a step-up approach which reserves laparoscopic cyst deroofing for symptomatic recurrence after one or two PAS procedures are needed.
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Affiliation(s)
- Alicia Furumaya
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Belle V van Rosmalen
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Jan Jaap de Graeff
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Martijn P D Haring
- Department of Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Vincent E de Meijer
- Department of Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Thomas M van Gulik
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Joanne Verheij
- Department of Pathology, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Otto M van Delden
- Department of Interventional Radiology, Amsterdam UMC, University of Amsterdam, Netherlands
| | - Joris I Erdmann
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands.
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20
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Gomez A, Wisneski AD, Luu HY, Hirose K, Roberts JP, Hirose R, Freise CE, Nakakura EK, Corvera CU. Contemporary Management of Hepatic Cyst Disease: Techniques and Outcomes at a Tertiary Hepatobiliary Center. J Gastrointest Surg 2021; 25:77-84. [PMID: 33083858 PMCID: PMC7850990 DOI: 10.1007/s11605-020-04821-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/01/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hepatic cyst disease is often asymptomatic, but treatment is warranted if patients experience symptoms. We describe our management approach to these patients and review the technical nuances of the laparoscopic approach. METHODS Medical records were reviewed for operative management of hepatic cysts from 2012 to 2019 at a single, tertiary academic medical center. RESULTS Fifty-three patients (39 female) met the inclusion criteria with median age at presentation of 65 years. Fifty cases (94.3%) were performed laparoscopically. Fourteen patients carried diagnosis of polycystic liver disease. Dominant cyst diameter was median 129 mm and located within the right lobe (30), left lobe (17), caudate (2), or was bilobar (4). Pre-operative concern for biliary cystadenoma/cystadenocarcinoma existed for 7 patients. Operative techniques included fenestration (40), fenestration with decapitation (7), decapitation alone (3), and excision (2). Partial hepatectomy was performed in conjunction with fenestration/decapitation for 15 cases: right sided (7), left sided (7), and central (1). One formal left hepatectomy was performed in a polycystic liver disease patient. Final pathology yielded simple cyst (52) and one biliary cystadenoma. Post-operative complications included bile leak (2), perihepatic fluid collection (1), pleural effusion (1), and ascites (1). At median 7.1-month follow-up, complete resolution of symptoms occurred for 34/49 patients (69.4%) who had symptoms preoperatively. Reintervention for cyst recurrence occurred for 5 cases (9.4%). CONCLUSIONS Outcomes for hepatic cyst disease are described with predominantly laparoscopic approach, approach with minimal morbidity, and excellent clinical results.
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Affiliation(s)
- Axel Gomez
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Andrew D Wisneski
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Hubert Y Luu
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Kenzo Hirose
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - John P Roberts
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Ryutaro Hirose
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Christopher E Freise
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Eric K Nakakura
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA
| | - Carlos U Corvera
- Department of Surgery, University of California San Francisco, 533 Parnassus Avenue, Room 370, San Francisco, CA, USA.
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21
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Hepatic Mucinous Cystic Neoplasm Versus Simple Biliary Cyst: Assessment of Distinguishing Imaging Features Using CT and MRI. AJR Am J Roentgenol 2020; 216:403-411. [PMID: 33356432 DOI: 10.2214/ajr.20.22768] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE. The purpose of our study was to identify the imaging features that differentiate a hepatic mucinous cystic neoplasm (MCN) from a simple biliary cyst. MATERIALS AND METHODS. Surgically resected hepatic MCNs and simple biliary cysts over a 20-year period (October 29, 1997-January 23, 2018) with preoperative CT, MRI, or both were retrospectively identified. Included cases underwent histopathologic confirmation of diagnosis based on the 2010 World Health Organization criteria and blinded imaging review. Various imaging features, including cyst shape and septal enhancement, were assessed for performance. For septate cysts, the relationship of the septation to the cyst wall-that is, arising from the wall without an indentation versus arising from an external macrolobulation-was recorded. Statistical analysis was performed for the imaging features with the chi-square test. RESULTS. The study group comprised 22 hepatic MCNs and 56 simple biliary cysts. A unilocular hepatic cystic lesion was highly predictive of a simple biliary cyst (positive predictive value = 95.2%). The imaging feature of septations arising only from macro-lobulations was 100% specific for a simple biliary cyst on CT (p = 0.001). The presence of septations arising from the cyst wall without indentation was 100% sensitive for hepatic MCN but was only 56.3% specific on CT. Septal enhancement reached 100% sensitivity for hepatic MCN on MRI (p = 0.018). CONCLUSION. The presence of septations, relationship of the septations to the cyst wall, and septal enhancement were sensitive imaging features in the detection of hepatic MCN. The imaging feature of septations arising only from macrolobulations in the cyst wall was specific for simple biliary cysts on CT and helped differentiate simple biliary cysts from hepatic MCNs.
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Bird JR, Brahm GL, Fung C, Sebastian S, Kirkpatrick IDC. Recommendations for the Management of Incidental Hepatobiliary Findings in Adults: Endorsement and Adaptation of the 2017 and 2013 ACR Incidental Findings Committee White Papers by the Canadian Association of Radiologists Incidental Findings Working Group. Can Assoc Radiol J 2020; 71:437-447. [DOI: 10.1177/0846537120928349] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The Canadian Association of Radiologists Incidental Findings Working Group consists of both academic subspecialty and general radiologists and is tasked with adapting and expanding upon the American College of Radiology incidental findings white papers to more closely apply to Canadian practice patterns, particularly more comprehensively dealing with the role of ultrasound and pursuing more cost-effective approaches to the workup of incidental findings without compromising patient care. Presented here are the 2020 Canadian guidelines for the management of hepatobiliary incidental findings. Topics covered include initial assessment of hepatic steatosis and cirrhosis, the workup of incidental liver masses identified on ultrasound and computed tomography (with algorithms presented), incidental gallbladder findings (wall thickening, calcification, and polyps), and management of incidental biliary dilatation.
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Affiliation(s)
- Jeffery R. Bird
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Gary L. Brahm
- Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Christopher Fung
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Sunit Sebastian
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
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Neidert NB, Venkatesh SK. Cystic Lesions of the Liver. EVALUATION AND MANAGEMENT OF LIVER MASSES 2020:263-277. [DOI: 10.1007/978-3-030-46699-2_12] [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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Klompenhouwer AJ, Ten Cate DWG, Willemssen FEJA, Bramer WM, Doukas M, de Man RA, Ijzermans JNM. The impact of imaging on the surgical management of biliary cystadenomas and cystadenocarcinomas; a systematic review. HPB (Oxford) 2019; 21:1257-1267. [PMID: 31085104 DOI: 10.1016/j.hpb.2019.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/27/2019] [Accepted: 04/12/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Biliary Cystadenomas (BCA) are considered to be benign but may transform to Biliary Cystadenocarcinomas (BCAC). The aim of this systematic review was to assess the diagnostic work-up and necessity of complete surgical resection. METHOD A systematic literature search was performed in Embase.com, Medline (Ovid), Cochrane Central, Web-of-Science and Google Scholar. Articles reporting on diagnostic work-up or outcome of various treatment strategies were included. RESULTS Fifty-one articles with 1218 patients were included: 971 with BCA and 247 with BCAC. Patients with BCA were more often female (91% vs 63.8%, p < 0.001). On radiologic imaging BCAC more often had calcifications (p = 0.008), mural nodules (p < 0.001) and wall enhancement (p < 0.001). Reported treatment strategies were resection, enucleation, or fenestration/marsupialization. Recurrence was reported in 5.4% after resection for BCA and 4.8% after resection for BCAC. Recurrence after fenestration/marsupialization varied from 81.6% to 100% for both BCA as BCAC. Mortality rate was 0 in patients with BCA and 24% in BCAC. CONCLUSION Due to the difficulty in accurately diagnosing these biliary cystic lesions and the availability of different surgical approaches, patients with suspected BCA or BCAC should be treated in a center specialized in liver surgery with state-of-the-art imaging and all surgical techniques to prevent mismanagement of this rare disease.
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Affiliation(s)
- Anne J Klompenhouwer
- Erasmus MC, University Medical Center Rotterdam, Department of Surgery, Rotterdam, the Netherlands.
| | - David W G Ten Cate
- Erasmus MC, University Medical Center Rotterdam, Department of Surgery, Rotterdam, the Netherlands
| | - Francois E J A Willemssen
- Erasmus MC, University Medical Center Rotterdam, Department of Radiology, Rotterdam, the Netherlands
| | - Wichor M Bramer
- Erasmus MC, University Medical Center Rotterdam, Medical Library, Rotterdam, the Netherlands
| | - Michael Doukas
- Erasmus MC, University Medical Center Rotterdam, Department of Pathology, Rotterdam, the Netherlands
| | - Robert A de Man
- Erasmus MC, University Medical Center Rotterdam, Department of Gastroenterology and Hepatology, Rotterdam, the Netherlands
| | - Jan N M Ijzermans
- Erasmus MC, University Medical Center Rotterdam, Department of Surgery, Rotterdam, the Netherlands.
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Hasebe T, Sawada K, Hayashi H, Nakajima S, Takahashi H, Hagiwara M, Imai K, Yuzawa S, Fujiya M, Furukawa H, Okumura T. Long-term growth of intrahepatic papillary neoplasms: A case report. World J Gastroenterol 2019; 25:5569-5577. [PMID: 31576101 PMCID: PMC6767986 DOI: 10.3748/wjg.v25.i36.5569] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/29/2019] [Accepted: 09/10/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intraductal papillary neoplasm of the bile duct (IPNB) is a type of tumor that presents in the intra- or extrahepatic bile ducts. Cystic-type intrahepatic IPNB often mimics simple liver cysts, making the diagnosis difficult. Because the growth of IPNB is slow, careful follow-up and timely therapeutic intervention is recommended. There are few reports with a follow-up period longer than a decade; thus, we report the case of a patient with an IPNB that grew for over 13 years.
CASE SUMMARY A 65-year-old man was diagnosed, 13 years prior with a cystic hepatic tumor with abnormal imaging findings. The targeted tumor biopsy results showed no malignancy. Biannual follow-up examinations were performed because of the potential for malignancy. The cystic lesions showed gradual enlargement over 11 years and a 4 mm papillary proliferation appeared on the cyst wall, which is compatible with IPNB. The tumor was observed for another 2 years because of the patient’s wishes. The imaging findings showed enlargement to 8 mm and a new 9 mm papillary proliferation of the cystic tumor. Contrast-enhanced ultrasonography showed hyperenhancement during the arterial phase in both cyst walls, indicating intraductal tumor progression in both tumors. Thus, liver segment 8 subsegmentectomy was performed. The pathological findings indicated that the tumors contained mucin, and high-grade atypia was observed in the papillary lesions, showing IPNB.
CONCLUSION The development of IPNB should be monitored in patients with cystic lesions and ultrasonography are useful tool for the evaluation.
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Affiliation(s)
- Takumu Hasebe
- Department of Medicine, Division of Gastroenterology and Hematology/Oncology, Asahikawa Medical University, Asahikawa 0788510, Hokkaido, Japan
| | - Koji Sawada
- Department of Medicine, Division of Gastroenterology and Hematology/Oncology, Asahikawa Medical University, Asahikawa 0788510, Hokkaido, Japan
| | - Hidemi Hayashi
- Department of Medicine, Division of Gastroenterology and Hematology/Oncology, Asahikawa Medical University, Asahikawa 0788510, Hokkaido, Japan
| | - Shunsuke Nakajima
- Department of Medicine, Division of Gastroenterology and Hematology/Oncology, Asahikawa Medical University, Asahikawa 0788510, Hokkaido, Japan
| | - Hiroyuki Takahashi
- Department of Surgery, Division of Gastroenterological and General Surgery, Asahikawa Medical University, Asahikawa 0788510, Hokkaido, Japan
| | - Masahiro Hagiwara
- Department of Surgery, Division of Gastroenterological and General Surgery, Asahikawa Medical University, Asahikawa 0788510, Hokkaido, Japan
| | - Koji Imai
- Department of Surgery, Division of Gastroenterological and General Surgery, Asahikawa Medical University, Asahikawa 0788510, Hokkaido, Japan
| | - Sayaka Yuzawa
- Department of Diagnostic Pathology, Asahikawa Medical University Hospital, Asahikawa 0788510, Hokkaido, Japan
| | - Mikihiro Fujiya
- Department of Medicine, Division of Gastroenterology and Hematology/Oncology, Asahikawa Medical University, Asahikawa 0788510, Hokkaido, Japan
| | - Hiroyuki Furukawa
- Department of Surgery, Division of Gastroenterological and General Surgery, Asahikawa Medical University, Asahikawa 0788510, Hokkaido, Japan
| | - Toshikatsu Okumura
- Department of Medicine, Division of Gastroenterology and Hematology/Oncology, Asahikawa Medical University, Asahikawa 0788510, Hokkaido, Japan
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Tholomier C, Wang Y, Aleynikova O, Vanounou T, Pelletier JS. Biliary mucinous cystic neoplasm mimicking a hydatid cyst: a case report and literature review. BMC Gastroenterol 2019; 19:103. [PMID: 31234803 PMCID: PMC6591873 DOI: 10.1186/s12876-019-1001-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 05/28/2019] [Indexed: 02/07/2023] Open
Abstract
Background Biliary mucinous cystic neoplasms are rare cystic lesions of the liver which carry pre-malignant potential. Given the scarcity of reports in the literature, they pose a considerable challenge to clinical management, particularly with regards to accurate pre-operative diagnosis. Case presentation We present the case of a 37-year-old Tunisian woman who presented with subacute right upper quadrant pain and a large multi-loculated cystic lesion, most consistent with a hydatid cyst. She underwent an open right hepatectomy, and pathology surprisingly revealed a biliary mucinous cystadenoma. Herein, we review the current literature on biliary mucinous cystic neoplasms, with a particular emphasis on diagnostic investigations, key radiological features and optimal treatment modalities. Conclusion Biliary mucinous cystic neoplasms require a high index of suspicion and should be managed with complete surgical resection, as conservative techniques are associated with high recurrence rates. Considering the potential for malignant transformation, periodical surveillance imaging is recommended in the post-operative period.
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Affiliation(s)
- Côme Tholomier
- Division of General Surgery, Jewish General Hospital, 3755 Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada.,Division of Urology, McGill University Health Center, Montréal, QC, Canada
| | - Yifan Wang
- Division of General Surgery, Jewish General Hospital, 3755 Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada
| | - Olga Aleynikova
- Department of Pathology, Jewish General Hospital, Montreal, QC, Canada
| | - Tsafrir Vanounou
- Division of General Surgery, Jewish General Hospital, 3755 Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada
| | - Jean-Sebastien Pelletier
- Division of General Surgery, Jewish General Hospital, 3755 Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada.
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Diagnostic and Therapeutic Challenges of Intrahepatic Biliary Cystadenoma and Cystadenocarcinoma: A Report of 10 Cases and Review of the Literature. Int Surg 2019; 100:1212-9. [PMID: 26595495 DOI: 10.9738/intsurg-d-15-00025.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The objective of this study was to present our experience with intrahepatic biliary cystadenomas and cystadenocarcinomas in 10 patients surgically managed in our department. Intrahepatic biliary cystadenomas and cystadenocarcinomas are rare cystic tumors that are often misdiagnosed preoperatively as simple cysts or hydatid cysts. They recur after incomplete resection and entail a risk of malignant transformation to cystadenocarcinoma. A retrospective review was conducted of patients with histologically confirmed intrahepatic biliary cystadenomas and cystadenocarcinomas between August 2004 and February 2013 who were surgically managed in our department. A total of 10 patients, 9 female and 1 male (mean age, 50 years), with cystic liver were reviewed. The size of the cysts ranged between 3.5 and 16 cm (mean, 10.6). Five patients had undergone previous interventions elsewhere and presented with recurrences. Liver resections included 6 hepatectomies, 2 bisegmentectomies, 1 extended right hepatectomy, and 1 enucleation due to the central position and the large size of the lesion. Pathology reports confirmed R0 resections in all cases. All patients were alive after a median follow-up of 6 years (range, 1-10 years), and no recurrence was detected. Intrahepatic biliary cystadenoma and cystadenocarcinoma should be considered in differential diagnosis in patients with liver cystic tumors. Because of the high recurrence rate and difficult accurate preoperative diagnosis, formal liver resection is mandatory. Enucleation with free margins is an option and is indicated where resection is impossible.
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Lee JE, Kim SH, Lee S, Choi SY, Hwang JA, Woo SY. Differentiating metastatic mucinous colorectal adenocarcinomas from simple cysts of the liver using contrast-enhanced and diffusion-weighted MRI. Br J Radiol 2018; 91:20180303. [PMID: 30040437 DOI: 10.1259/bjr.20180303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE: To determine the value of contrast-enhanced and diffusion-weighted (DW) MRI for differentiating metastatic mucinous colorectal adenocarcinomas from simple cysts of the liver. METHODS: 29 patients with 47 metastatic mucinous colorectal adenocarcinomas and/or 19 simple cysts of the liver who underwent contrast-enhanced and DW MRI were included in this retrospective study. Two radiologists assessed the MRI findings by consensus. Qualitative and quantitative analyses were conducted. Significant MRI findings on univariate and multivariate analyses were assessed, and their diagnostic performances for predicting metastatic mucinous colorectal adenocarcinomas were analyzed. RESULTS: The presence of rim enhancement (odds ratio, 28.43; p = 0.008) and intracystic enhancement (oddsratio, 180.15; p = 0.001) were independently significant factors for predicting metastatic mucinous colorectal adenocarcinomas. The sensitivity and specificity of rim enhancement, intracystic enhancement, and their combination for detecting metastatic mucinous colorectal adenocarcinomas were 83% (39/47) and 63.2% (12/19), 87.2% (41/47) and 89.5% (17/19), and 72.3% (34/47) and 94.7% (18/19), respectively. Compared to simple cysts, metastatic mucinous colorectal adenocarcinomas showed significantly lower mean apparent diffusion coefficient (1.92 ± 0.81 vs 2.99 ± 0.75 × 10-3 mm2 s-1; p = 0.001) and lesion-to-liver apparent diffusion coefficient ratio (1.66 ± 0.75 vs 2.44 ± 0.56 × 10-3 mm2 s-1; p = 0.004) and higher mean signal intensity (400.3 ± 216.3 vs 222.4 ± 99.3; p = 0.039) and lesion-to-liver signal intensity ratio on hepatobiliary-phase images (0.58 ± 0.16 vs 0.30 ± 0.14; p < 0.001). CONCLUSION: Contrast-enhanced and DW MRI may be helpful for differentiating metastatic mucinous colorectal adenocarcinomas from simple cysts of the liver. ADVANCES IN KNOWLEDGE: On contrast-enhanced and DW MRI, rim and intracystic enhancement can be helpful for differentiating metastatic mucinous colorectal adenocarcinomas from simple cysts of the liver.
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Affiliation(s)
- Ji Eun Lee
- 1 Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital , Bucheon , Republic of Korea
| | - Seong Hyun Kim
- 2 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea
| | - Sunyoung Lee
- 2 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea
| | - Seo-Youn Choi
- 1 Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital , Bucheon , Republic of Korea
| | - Jeong Ah Hwang
- 3 Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital , Cheonan , Republic of Korea
| | - Sook-Young Woo
- 4 Biostatics Unit, Samsung Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea
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Yamada S, Kato Y, Hada M, Kotake M, Oyama K, Hara T. A case of a mucin-producing bile duct tumor diagnosed over the course of 6 years. Clin J Gastroenterol 2017; 10:530-534. [PMID: 28913716 DOI: 10.1007/s12328-017-0775-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 09/01/2017] [Indexed: 02/06/2023]
Abstract
We report a case of a mucin-producing intraductal papillary neoplasm of the intrahepatic bile duct (M-IPNB) diagnosed over a period of 6 years. A 64-year-old man underwent follow-up evaluations for an abdominal aortic aneurysm at our hospital. In 2009, a computed tomography (CT) scan revealed a simple hepatic cyst in segment 3 of the liver. Annual CT scans initially showed almost no change in the size or shape of the cyst. The cystic lesion, which measured 5 cm in 2014, had increased to 11 cm by 2015, and a solid component was detected within the cyst. A biliary cystic tumor was suspected and we performed a left lateral hepatectomy. Pathological examination showed that the papillary lesion in the cyst included adenocarcinoma and adenoma components. We diagnosed M-IPNB in 2015. Identification of the solid component of the cyst, as well as an increase in cyst diameter in the image analyses, was critical for diagnosis of M-IPNB.
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Affiliation(s)
- Sho Yamada
- M-IPNB, Department of Surgery, Kouseiren Takaoka Hospital, 5-10, Eirakumachi, Takaoka, Toyama, 933-8555, Japan.
| | - Yosuke Kato
- M-IPNB, Department of Surgery, Kouseiren Takaoka Hospital, 5-10, Eirakumachi, Takaoka, Toyama, 933-8555, Japan
| | - Masahiro Hada
- M-IPNB, Department of Surgery, Kouseiren Takaoka Hospital, 5-10, Eirakumachi, Takaoka, Toyama, 933-8555, Japan
| | - Masanori Kotake
- M-IPNB, Department of Surgery, Kouseiren Takaoka Hospital, 5-10, Eirakumachi, Takaoka, Toyama, 933-8555, Japan
| | - Kaeko Oyama
- M-IPNB, Department of Surgery, Kouseiren Takaoka Hospital, 5-10, Eirakumachi, Takaoka, Toyama, 933-8555, Japan
| | - Takuo Hara
- M-IPNB, Department of Surgery, Kouseiren Takaoka Hospital, 5-10, Eirakumachi, Takaoka, Toyama, 933-8555, Japan
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Grazioli L, Ambrosini R, Frittoli B, Grazioli M, Morone M. Primary benign liver lesions. Eur J Radiol 2017; 95:378-398. [PMID: 28987695 DOI: 10.1016/j.ejrad.2017.08.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/28/2017] [Accepted: 08/28/2017] [Indexed: 11/17/2022]
Abstract
Benign focal liver lesions can origin from all kind of liver cells: hepatocytes, mesenchymal and cholangiocellular line. Their features at imaging may sometimes pose difficulties in differential diagnosis with malignant primary and secondary lesions. In particular, the use of MDCT and MRI with extracellular and hepatobiliary Contrast Agents may non invasively help in correct interpretation and definition of hepatocellular or mesenchymal and inflammatory nature, allowing to choose the best treatment option. The peculiarities of main benign liver lesions at US, CT and MRI are described, with special attention to differential diagnosis and diagnostic clues.
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Affiliation(s)
- Luigi Grazioli
- ASST "Spedali Civili", P.le Spedali Civili 1, 25123 Brescia, Italy.
| | | | - Barbara Frittoli
- ASST "Spedali Civili", P.le Spedali Civili 1, 25123 Brescia, Italy.
| | - Marco Grazioli
- ASST "Spedali Civili", P.le Spedali Civili 1, 25123 Brescia, Italy; University of Brescia, P.le Spedali Civili 1, 25123 Brescia, Italy.
| | - Mario Morone
- ASST "Spedali Civili", P.le Spedali Civili 1, 25123 Brescia, Italy.
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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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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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Intrahepatic biliary dilatation caused by a small simple hepatic cyst: report of a case. Int Surg 2014; 99:753-6. [PMID: 25437583 DOI: 10.9738/intsurg-d-13-00153.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Biliary obstruction caused by small simple cysts is very rare. We present a case of biliary dilatation caused by a simple cyst with a 4-cm diameter. The patient was a 75-year-old woman referred to our hospital for evaluation of a cystic tumor associated with peripheral biliary duct dilatation in the left segment of the liver. Computed tomography and magnetic resonance imaging showed that the cyst probably communicated with the intrahepatic bile duct. Malignant tumors, including intrahepatic papillary neoplasms of the bile duct, could not be ruled out; therefore, we performed surgery with the patient's consent. Histopathologic examination of the resected liver showed that the cystic lesion was a simple cyst. The finding that even small simple cysts can obstruct the biliary tract is important for the management of cystic lesions of the liver.
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Lamba R, Fananazapir G, Corwin MT, Khatri VP. Diagnostic Imaging of Hepatic Lesions in Adults. Surg Oncol Clin N Am 2014; 23:789-820. [DOI: 10.1016/j.soc.2014.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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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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Kim SW, Kim HC, Yang DM, Won KY, Kim BS. Cystic intraductal papillary adenocarcinoma of the bile duct of the caudate lobe initially manifesting as a simple cyst on CT. Jpn J Radiol 2014; 32:371-374. [PMID: 24682931 DOI: 10.1007/s11604-014-0309-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 03/13/2014] [Indexed: 12/23/2022]
Abstract
Cystic-form, intraductal papillary neoplasms of the bile ducts (IPNBs) usually manifest as a multilocular cystic mass or unilocular cystic mass with papillary mural nodules. To our knowledge, cystic IPNBs forming single, unilocular cystic lesions without a visible papillary tumor and mimicking a simple hepatic cyst or mucinous cystadenoma have never been reported. Here, we report a case of cystic IPNB that initially appeared as a simple cyst and subsequently became a unilocular cystic mass with a papillary mural nodule on follow-up CT.
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Affiliation(s)
- Sang Won Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 149 Sangil-Dong, Gangdong-Gu, Seoul, 134-727, Korea,
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Chandrasinghe PC, Liyanage C, Deen KI, Wijesuriya SR. Obstructive jaundice caused by a biliary mucinous cystadenoma in a woman: a case report. J Med Case Rep 2013; 7:278. [PMID: 24378216 PMCID: PMC3891978 DOI: 10.1186/1752-1947-7-278] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 09/30/2013] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Mucinous cystadenoma of the liver is a rare (less than 5%) neoplasm. This condition is more common in young women and accounts for non-specific symptoms. Cyst adenomas commonly affect the intrahepatic system (90%) and are rarely found in the extrahepatic biliary system or affecting both the systems. CASE PRESENTATION A 39-year-old Sinhalese woman presented with features of obstructive jaundice and was found to have a biliary neoplasm on imaging. In the absence of a definitive diagnosis despite extensive imaging she underwent preoperative endoscopic biliary drainage followed by a left hemihepatectomy with Roux-en-Y hepaticojejunostomy. A pathological examination of the specimen revealed an obstruction of the bile duct caused by a biliary mucinous cystadenoma affecting both the intrahepatic and extrahepatic systems. CONCLUSIONS Biliary mucinous cystadenoma rarely present with obstructive jaundice affecting both intrahepatic and extrahepatic ducts. Exhaustive investigation might not help in the diagnosis and may need to be treated based on clinical judgment. The definitive treatment modality is surgery due to its malignant potential. The operative procedure is technically demanding and is best performed at specialist centers to minimize complications.
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Affiliation(s)
- Pramodh C Chandrasinghe
- Department of Surgery, University Surgical Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka.
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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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Abstract
A fit and well 4-year-old girl presented with a 1-year history of abdominal distension, pain and vomiting with signs of non-shifting dullness on the right side of the abdomen. An abdominal CT revealed a 19 cm epigastric cyst that did not appear to connect to any solid organ and was therefore thought to represent a mesenteric cyst. However, laparotomy revealed that the cyst was arising from the liver. The cyst was resected and subsequent histology revealed a simple hepatic cyst. The patient has been well post-operation. The case represents the largest described simple hepatic cyst in the 0-16 years paediatric age group in Europe to date. We outline the epidemiology, embryology, key investigations and management options for these lesions.
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Galvão BVT, Torres LR, Cardia PP, Nunes TF, Salvadori PS, D'Ippolito G. Prevalence of simple liver cysts and hemangiomas in cirrhotic and non-cirrhotic patients submitted to magnetic resonance imaging. Radiol Bras 2013. [DOI: 10.1590/s0100-39842013000400005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective To determine the prevalence of liver cysts and hemangiomas in the general population and in cirrhotic patients. Materials and Methods Retrospective, observational, and cross-sectional study selecting consecutive magnetic resonance imaging studies performed in the period from February to July 2011. A total of 303 patients (187 women and 116 men) with mean age of 53.3 years were included in the present study. Patients with previously known liver lesions were excluded. The images were consensually analyzed by two observers in the search for simple liver cysts and typical liver hemangiomas, according to universally accepted imaging criteria. Lesions prevalence, diameters and location were determined in both cirrhotic and non-cirrhotic individuals. Results The authors observed prevalence of 8.6% for hemangiomas and 14.5% for simple cysts. No statistically significant difference was observed in relation to prevalence of hemangiomas and cysts among cirrhotic and non-cirrhotic patients (p = 0.954; p = 0.472). Conclusion In the present study, the prevalence of cysts and hemangiomas was higher than the prevalence reported by autopsy series. No influence of cirrhosis was observed on the prevalence and appearance of such incidental lesions.
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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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Abstract
Biliary cystadenocarcinomas are rare tumors that are poorly understood. Preoperative imaging is imprecise and treatment is not standardized. We describe the presentation and treatment of one of these rare tumors and review the limited published literature.
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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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