Mucinous cystic neoplasms of the liver: Literature review and case series

Table 1 Radiological criteria for mucinous cystic neoplasms of the liver

Criterion	Diagnostic importance
Multiloculated cystic lesion	Common feature of MCN-L
Septations	If > 3 mm, considered a major feature for high suspicion
Internal nodules	Major feature for high suspicion
Calcifications	Present in 47%-63% of cases
Thickened, irregular cyst walls	Common feature of MCN-L
Mural nodules with enhancement	Highly suggestive of MCN-L
Predilection for the left hepatic lobe (segment IV)	Found in 69%-76% of cases
Biliary duct dilatation	Minor feature
Absence of communication with bile ducts	Helps differentiate from IPNB
Echogenic septations (on ultrasound)	Key ultrasonographic feature
Contrast enhancement (on MRI)	Highly sensitive feature on MRI

MCN-L: Mucinous cystic neoplasms of the liver; MRI: Magnetic resonance imaging; IPNB: Intraductal papillary neoplasm of the bile duct.

Table 2 Anatomopathological criteria and molecular features for mucinous cystic neoplasms of the liver

Criterion	Diagnostic importance
Ovarian-like subepithelial stroma	Essential for MCN-L diagnosis and for differential diagnosis
Cuboidal to columnar cells, with variable mucin content	Typical histological appearance of the inner surface of the cysts
Basally oriented nuclei	Common nuclear arrangement
Immunohistochemical positivity of ovarian-like stroma for ER, PR, WT1	Helps differentiate from other hepatic cystic lesions
Expression of SF-1, Inhibin-α, Calretinin in ovarian-like stroma	Suggests hormonal influence
Activation of Hedgehog and Wnt pathways	Associated with oncogenesis
Rarity or absence of KRAS and RNF43 mutations	Differentiates from pancreatic MCN
Shortening of telomers	Indicates progression to carcinoma

MCN-L: Mucinous cystic neoplasms of the liver; ER: Estrogen receptor; PR: Progesterone receptor; WT1: Wilms tumor 1; SF-1: Steroidogenic factor 1.

Table 3 General characteristics of patients undergoing surgery for hepatic cysts

Variable	N
Procedures	30
Patients	25
Sex (Male/Female)	13/17
Age (mean ± avg)	58.867 ± 15.126
BMI (mean ± avg)	24.568 ± 4.137
Symptoms (yes/no)	24/6
Imaging
CT	n = 12
MRI	n = 7
US only	n = 11
Size (cm)	10.607 ± 4.609
Growing volume (yes/no)	21/6
Septations (yes/no)	10/17
Calcifications (yes/no)	3/24
Mural nodules (yes/no)	4/23
Contrast enhancement (yes/no)	3/24
MCN-L on histological examination (yes/no)	11/19
Surgery
Fenestration with pericystectomy	n = 24
Resection	n = 6
Surgical approach (VLS/OPEN)	24/6
Operative time (min)	197.6 ± 105.565
Length of stay (days)	6.4 ± 4.304
N of Reinterventions	5

This table provides an overview of the demographic and clinical characteristics of all patients who underwent surgery for hepatic cysts at our center between January 2019 and March 2025. Patients who underwent multiple procedures are listed as separate entries. CT: Computed tomography; MRI: Magnetic Resonance Imaging; US: Ultrasound; MCN-L: Mucinous cystic neoplasms of the liver; VLS: Video-laparoscopic surgery.

Table 4 Clinical and histopathological characteristics of patients with mucinous cystic neoplasms of the liver

Variable	N
Patients	9
Sex (Male/Female)	1/8
Age (mean ± avg)	55.444 ± 16.622
BMI (mean ± avg)	22.989 ± 3.043
Symptoms (yes/no)	8/1
Size (cm)	8.078 ± 3.282
Growing volume (yes/no)	7/2
Septations (yes/no)	5/4
Calcifications (yes/no)	1/8
Mural nodules (yes/no)	2/7
Contrast enhancement (yes/no)	2/7
Original surgery
Fenestration with pericystectomy	n = 7
Resection	n = 2
Reinterventions	2
Surgery of the reinterventions	Resection

This table details the clinical presentation, imaging findings, type of surgery, histopathological features, and postoperative outcomes of the nine patients diagnosed with MCN-L. BMI: Body mass index.