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1
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Frenette C, Mendiratta-Lala M, Salgia R, Wong RJ, Sauer BG, Pillai A. ACG Clinical Guideline: Focal Liver Lesions. Am J Gastroenterol 2024; 119:1235-1271. [PMID: 38958301 DOI: 10.14309/ajg.0000000000002857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 04/25/2024] [Indexed: 07/04/2024]
Abstract
Focal liver lesions (FLLs) have become an increasingly common finding on abdominal imaging, especially asymptomatic and incidental liver lesions. Gastroenterologists and hepatologists often see these patients in consultation and make recommendations for management of multiple types of liver lesions, including hepatocellular adenoma, focal nodular hyperplasia, hemangioma, and hepatic cystic lesions including polycystic liver disease. Malignancy is important to consider in the differential diagnosis of FLLs, and healthcare providers must be familiar with the diagnosis and management of FLLs. This American College of Gastroenterology practice guideline uses the best evidence available to make diagnosis and management recommendations for the most common FLLs.
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Affiliation(s)
| | | | - Reena Salgia
- Department of Gastroenterology/Hepatology, Henry Ford Health, Detroit, Michigan, USA
| | - Robert J Wong
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System and Stanford University School of Medicine, Palo Alto, California, USA
| | - Bryan G Sauer
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA
| | - Anjana Pillai
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Chicago Medical Center, University of Chicago, Chicago, Illinois, USA
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2
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Yokoi A, Ishizuka K, Motohashi I, Hiwatari M, Asakura T, Ie K. Giant Hepatic Cyst. Am J Med 2024; 137:e103-e104. [PMID: 38479609 DOI: 10.1016/j.amjmed.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 04/07/2024]
Affiliation(s)
- Ai Yokoi
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan; Department of General Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
| | - Kosuke Ishizuka
- Department of General Medicine, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
| | - Iori Motohashi
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan; Department of General Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masaki Hiwatari
- Department of Gastroenterological and General Surgery, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
| | - Takeshi Asakura
- Department of Gastroenterological and General Surgery, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
| | - Kenya Ie
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan; Department of General Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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3
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Takayama S, Banba T, Hyodo T. Endoscopic observation of a lumen of a large hepatic cyst with aspiration and ethanol sclerotherapy: Case report and literature review. Int J Surg Case Rep 2023; 112:109001. [PMID: 39491855 PMCID: PMC10667867 DOI: 10.1016/j.ijscr.2023.109001] [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: 10/12/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/05/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE A large hepatic cyst cause abdominal bloating and other symptoms. Surgical deroofing or ethanol sclerosis has been reported as the treatment options. We have treated patients surgically. However, an experience with postoperative bile leakage prompted us to reexamine our treatment options. It has been reported that the cause of bile leakage is the connection between the hepatic cyst and the bile duct. Therefore, we planned to observe the lumen of the hepatic cyst by endoscopy to evaluate the bile duct connection. CASE PRESENTATION An 82-year-old woman presented to our hospital for abdominal bloating. An abdominal computed tomography (CT) scan revealed a large hepatic cyst. Respiratory function was decreased due to diaphragmatic compression caused by the cyst. Endoscopic observation of the cyst was performed to evaluate the bile duct connection. There were no obvious abnormalities in her cyst. The patient was discharged 7 days after this procedure. CLINICAL DISCUSSION Laparoscopic deroofing is recommended for the treatment of a large hepatic cyst when a patient can take surgery. However, deroofing has the potential for postoperative bile leakage. Careful consideration should be given to the treatment approach for each patient. Ethanol sclerotherapy has the potential for recurrence, but in this case, we confirmed the absence of bile duct connection. The ethanol sclerosis was effective, and there was no postoperative bile leakage. CONCLUSION Endoscopic observation during puncture of the hepatic cyst allowed the evaluation of bile duct connection and search for malignant disease. Ethanol sclerotherapy was also effective.
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Affiliation(s)
- Shoryu Takayama
- Department of Surgery, Haibara General Hospital, Hosoe 2887-1, Makinohara, Shizuoka 421-0421, Japan.
| | - Takuya Banba
- Department of Surgery, Haibara General Hospital, Hosoe 2887-1, Makinohara, Shizuoka 421-0421, Japan
| | - Takahumi Hyodo
- Department of Gastroenterology, Haibara General Hospital, Hosoe 2887-1, Makinohara, Shizuoka 421-0421, Japan
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4
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Maeda H, Fujita Y, Amagai T. Using temporal changes in MR images to determine treatment options for complex liver cysts. Radiol Case Rep 2023; 18:3122-3126. [PMID: 37388529 PMCID: PMC10302169 DOI: 10.1016/j.radcr.2023.05.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/07/2023] [Accepted: 05/28/2023] [Indexed: 07/01/2023] Open
Abstract
The prevalence of hepatic cyst (HC) ranges from 2.5 to 4.7%. Among them, HCs with with symptoms occur in 15%. Extrahepatic rupture of HCs with hemorrhagic shock and death may occur. Early detection of intracystic hemorrhage is necessary to prevent lifethreatening complications. In this case, a 77-year-old woman underwent regular checkups. Her ultrasound (US) showed multiple hepatic cysts (HCs). The largest HC was 80 mm in diameter and located in segment 8 of the right lobe. Her prognostic nutritional index (PNI) was 41.7, indicating high surgical morbidity and mortality after surgery. Multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) were added to identify intra- and extra-cystic anatomy. Compared to MDCT, MRI was able to identify intra-cystic heterogeneous low and high intensity. These findings were interpreted to indicate acute to chronic intra-cystic hemorrhage. As a complication of the rupture and death, an anterior segmentectomy with segmentectomy with cholecystectomy was planned and performed. Her postoperative course was uneventful and she was discharged on day 16. The life-threatening complex HCs include intra-cystic hemorrhage, rupture, hemorrhagic shock and death. To prevent these, we would like to emphasize that MRI appears to be superior to US or CT in providing accurate information on the time course of intra-cystic hemorrhage from hemoglobin to hemosiderin changes to guide urgent surgical intervention of hepatectomy to prevent HC rupture and prevent HC rupture and death.
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Affiliation(s)
- Hiroyuki Maeda
- Department of Surgery, Kagoshima Tokushukai General Hospital, Kagoshima, Japan
| | - Yasuhiko Fujita
- Department of Radiology, Kagoshima Tokushukai General Hospital, Kagoshima, Japan
| | - Teruyoshi Amagai
- Faculty of Health Care Sciences, Department of Clinical Engineering, Jikei University of Health Care Sciences, 1-2-8, Miyahara, Yodogawa-Ku, Osaka, 532-0003, Japan
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5
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Kinoshita S, Nishizawa T, Tojo M, Hirai Y, Nakazato Y, Miyanaga R, Fujimoto A, Inoue K, Ebinuma H, Suzuki H, Kikuchi M. Simple drainage versus drainage with minocycline infusion for symptomatic hepatic cysts. J Clin Biochem Nutr 2023; 72:89-91. [PMID: 36777076 PMCID: PMC9899919 DOI: 10.3164/jcbn.22-89] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/20/2022] [Indexed: 11/11/2022] Open
Abstract
Percutaneous treatment of symptomatic hepatic cysts includes simple drainage and drainage with sclerosing agents. We compared the efficacy of simple drainage with that of drainage with minocycline infusion for treating symptomatic hepatic cysts. We retrospectively evaluated 11 patients who underwent percutaneous drainage of symptomatic hepatic cysts. In seven cases, minocycline infusion was added at the discretion of the clinician. Cyst volume was evaluated before drainage, immediately after drainage, and after long-term follow-up. Cyst volume was calculated before treatment by multiplying the orthogonal diameters using the ellipsoid formula. Relapse was defined as the regrowth of the cyst with symptoms. Cyst volume immediately after drainage and after long-term follow-up was significantly less than that before treatment for the drainage with minocycline infusion group (p<0.05) but not for the simple drainage group. The relapse rates were 25% (1/4) for the simple drainage group and 0% for the drainage with minocycline infusion group. Drainage with minocycline infusion could be a promising option for treating symptomatic hepatic cysts, although simple drainage was not reliable.
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Affiliation(s)
- Satoshi Kinoshita
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo 152-8902, Japan
- Gastroenterology, Saitama Medical Center, Saitama 330-0074, Japan
| | - Toshihiro Nishizawa
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita, Chiba 286-8520, Japan
| | - Masaya Tojo
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo 152-8902, Japan
| | - Yuichiro Hirai
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo 152-8902, Japan
- Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Yoshihiro Nakazato
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo 152-8902, Japan
- Gastroenterology, Saitama Medical Center, Saitama 330-0074, Japan
| | - Ryoichi Miyanaga
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo 152-8902, Japan
| | - Ai Fujimoto
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo 152-8902, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Toho University, Tokyo 143-8541, Japan
| | - Kazuaki Inoue
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita, Chiba 286-8520, Japan
| | - Hirotoshi Ebinuma
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita, Chiba 286-8520, Japan
| | - Hidekazu Suzuki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Masahiro Kikuchi
- Gastroenterology, Clinic of a Wind, Komazawa, Tokyo 154-0011, Japan
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6
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Hutchens JA, Lopez KJ, Ceppa EP. Mucinous Cystic Neoplasms of the Liver: Epidemiology, Diagnosis, and Management. Hepat Med 2023; 15:33-41. [PMID: 37016682 PMCID: PMC10066895 DOI: 10.2147/hmer.s284842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/01/2023] [Indexed: 04/06/2023] Open
Abstract
Mucinous cystic neoplasms (MCNs) are rare tumors of the liver, occasionally seen in the biliary tree. Epidemiologic data are limited by their indolence and recent changes to diagnostic criteria. They are considered premalignant lesions capable of invasive behavior. While their etiology remains unknown, their female predominance, age of onset, and hormonally responsive ovarian-type stroma suggest ectopic organogenesis during embryologic development. MCNs can typically be recognized on imaging; yet, invasiveness is often indeterminate, and percutaneous tissue biopsy has shown limited value. Therefore, complete excision is recommended for all lesions as focal malignant transformation and metastatic disease has been reported.
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Affiliation(s)
- Jeffrey A Hutchens
- Department of Surgery, Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kevin J Lopez
- Department of Surgery, Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Eugene P Ceppa
- Department of Surgery, Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
- Correspondence: Eugene P Ceppa, Associate Professor of Surgery, Section Chief of HPB Surgery, Division of Surgical Oncology, Indiana University School of Medicine, 545 Barnhill Dr, EH 541, Indianapolis, IN, 46202, USA, Tel +1-317-944-5013, Fax +1-317-968-1031, Email
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7
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Pompili M, Ardito F, Brunetti E, Cabibbo G, Calliada F, Cillo U, de Sio I, Golfieri R, Grova M, Gruttadauria S, Guido M, Iavarone M, Manciulli T, Pagano D, Pettinari I, Santopaolo F, Soresi M, Colli A. Benign liver lesions 2022: Guideline for clinical practice of Associazione Italiana Studio del Fegato (AISF), Società Italiana di Radiologia Medica e Interventistica (SIRM), Società Italiana di Chirurgia (SIC), Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB), Associazione Italiana di Chirurgia Epatobilio-Pancreatica (AICEP), Società Italiana Trapianti d'Organo (SITO), Società Italiana di Anatomia Patologica e Citologia Diagnostica (SIAPEC-IAP) - Part I - Cystic lesions. Dig Liver Dis 2022; 54:1469-1478. [PMID: 36089525 DOI: 10.1016/j.dld.2022.08.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 12/29/2022]
Abstract
Benign liver lesions are increasingly diagnosed in daily clinical practice due to the growing use of imaging techniques for the study of the abdomen in patients who have non-specific symptoms and do not have an increased risk of hepatic malignancy. They include simple or parasitic cysts and solid benign tumors which differ widely in terms of prevalence, clinical relevance, symptoms and natural history and often lead to significant clinical problems relating to diagnosis and clinical management. Following the need to have updated guidelines on the management of benign focal liver lesions, the Scientific Societies mainly involved in their management have promoted the drafting of a new dedicated document. This document was drawn up according to the present Italian rules and methodologies necessary to produce clinical, diagnostic, and therapeutic guidelines based on evidence. Here we present the first part of the guideline, concerning the characterization of focal hepatic lesions detected by ultrasound, and the diagnosis and clinical management of simple and parasitic hepatic cysts, and of polycystic liver disease.
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Affiliation(s)
- Maurizio Pompili
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Roma 00168, Italy.
| | - Francesco Ardito
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Roma 00168, Italy
| | - Enrico Brunetti
- Dipartimento di Scienze Cliniche, Chirurgiche, Diagnostiche e Pediatriche, IRCCS Fondazione Ospedale San Matteo, Università di Pavia, Unità di Malattie Infettive e Immunologia, Pavia, Italy
| | - Giuseppe Cabibbo
- Sezione di Gastroenterologia e Epatologia, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) Università di Palermo, Italy
| | - Fabrizio Calliada
- Dipartimento di Radiologia, Fondazione Policlinico San Matteo IRCCS, Università di Pavia, Italy
| | - Umberto Cillo
- Chirurgia Epatobiliare e Trapianto di Fegato, Ospedale Universitario di Padova, Italy
| | - Ilario de Sio
- Epatogastroenterologia, Facoltà di Medicina e Chirurgia, Università della Campania Luigi Vanvitelli, Napoli, Italy
| | - Rita Golfieri
- Dipartimento di Radiologia, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Mauro Grova
- Sezione di Gastroenterologia e Epatologia, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) Università di Palermo, Italy
| | - Salvatore Gruttadauria
- Dipartimento per la cura e lo studio delle Patologie Addominali e dei Trapianti Addominali, IRCCS-ISMETT-UPMCI, Dipartimento di Chirurgia e Specialità Medico-Chirurgiche, Università di Catania, Palermo, Italy
| | - Maria Guido
- Dipartimento di Anatomia Patologica, Azienda ULSS2 Marca Trevigiana, Treviso, Italy; Dipartimento di Medicina - DIMED, Università di Padova, Italy
| | - Massimo Iavarone
- Divisione di Gastroenterologia ed Epatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Tommaso Manciulli
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi, Firenze, Italy
| | - Duilio Pagano
- Dipartimento per la cura e lo studio delle Patologie Addominali e dei Trapianti Addominali, IRCCS-ISMETT-UPMC, Palermo, Italy
| | - Irene Pettinari
- Dipartimento di Radiologia, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Francesco Santopaolo
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Roma 00168, Italy
| | - Maurizio Soresi
- Medicina Interna, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) Università di Palermo, Italy
| | - Agostino Colli
- Dipartimento di Medicina Trasfusionale ed Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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8
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Du CX, Lu CG, Li W, Tang WB. Congenital hepatic cyst: Eleven case reports. World J Clin Cases 2022; 10:9112-9120. [PMID: 36157675 PMCID: PMC9477023 DOI: 10.12998/wjcc.v10.i25.9112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/20/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Liver cysts in infants are uncommon. With modern diagnostic imaging, we can achieve an early diagnosis of congenital hepatic cysts. Our purpose was to investigate the clinical features, surgical treatment methods and prognosis of infants with congenital hepatic cysts. Herein, we report a case series of congenital hepatic cysts.
CASE SUMMARY Eleven infants with hepatic cysts were retrospectively analysed. Ten of them had simple hepatic cysts, and a girl with a large hepatic mass was diagnosed with a solitary intrahepatic biliary cyst accompanied by a choledochal cyst. Among the ten simple hepatic cysts, eight were solitary and two were multiple. A total of 87.5% (7 of 8) of infants with solitary hepatic cysts were detected before delivery, and 86% (6 of 7) of those cysts were located in the right lobe of the liver. Surgical intervention was required for symptomatic hepatic cysts. Cyst resection or unroofing with fulguration of the cyst bed was employed. No recurrence of cysts was observed in these infants.
CONCLUSION Congenital hepatic cyst is a condition with a narrow differential diagnosis. Accurate diagnosis is essential for appropriate management. Unroofing is the favoured treatment in infants with symptomatic cysts. Most infants with congenital hepatic cysts have a good prognosis.
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Affiliation(s)
- Chun-Xia Du
- Department of Paediatric Surgery, Children’s Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China
| | - Chang-Gui Lu
- Department of Paediatric Surgery, Children’s Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China
| | - Wei Li
- Department of Paediatric Surgery, Children’s Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China
| | - Wei-Bing Tang
- Department of Pediatric Surgery, Children’s Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China
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9
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Tsuruya K, Nishizaki Y, Tatemichi M, Mishima Y, Shimma Y, Arase Y, Hirose S, Shiraishi K, Kagawa T. The prevalence and natural history of hepatic cysts examined by ultrasound: a health checkup population retrospective cohort study. Sci Rep 2022; 12:12797. [PMID: 35896780 PMCID: PMC9329350 DOI: 10.1038/s41598-022-16875-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/18/2022] [Indexed: 01/14/2023] Open
Abstract
The prevalence of hepatic cysts in the general population and their natural history are largely unknown. This study aimed to assess the prevalence and natural history of hepatic cysts by investigating health checkup participants. Ultrasonographic data of health checkup participants (n = 38,842) were retrospectively evaluated to calculate its prevalence. In addition, we assessed the changes in the size and characteristics of hepatic cysts over 10 years (n = 7709). We found the prevalence of hepatic cysts was 21.9%. Older age, female sex, and presence of kidney cysts or pancreatic cysts were associated with the occurrence of hepatic cysts. Younger age, female sex, and the existence of multiple hepatic cysts were associated with cyst enlargement. Among 126 individuals who had hepatic cysts with a diameter of 30 mm or larger at the first visit, two (1.6%) required treatment. Remain 124 cases showed four patterns: 44 cases with enlargement, 47 stable, 11 regression after enlargement, and 22 regression. Hyperechoic fluid inside the cysts was observed in 54.5% (18 of 33), which was significantly higher than 6.6% (6 of 91) of the non-regression (OR = 17.0). The appearance of intracystic hyperechoic fluid by ultrasound may predict subsequent regression of the hepatic cyst.
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Affiliation(s)
- Kota Tsuruya
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan.
| | - Yasuhiro Nishizaki
- Department of Clinical Health Science, Tokai University School of Medicine, Isehara, Japan
| | - Masayuki Tatemichi
- Department of Preventive Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Yusuke Mishima
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Yoshimasa Shimma
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Yoshitaka Arase
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Shunji Hirose
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Koichi Shiraishi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Tatehiro Kagawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan
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10
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Dancs PT, Hoyer DP, Paul A. Einfache Leberzysten. Zentralbl Chir 2022; 147:129-131. [PMID: 35378549 DOI: 10.1055/a-1546-2684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Peter Tibor Dancs
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen
| | - Dieter Paul Hoyer
- Klinik für Allgemein-, Viszeral- Transplantationschirurgie, Universitätsklinikum Essen
| | - Andreas Paul
- Klinik für Allgemein-, Viszeral- Transplantationschirurgie, Universitätsklinikum Essen
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11
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Kumar A, Zendel A, Batres M, Gerber DA, Desai CS. Radiologic Reporting of Simple Hepatic Cyst Versus Biliary Cystadenoma May Lead to Unnecessary Surgery. Am Surg 2021:31348211054077. [PMID: 34806934 DOI: 10.1177/00031348211054077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Simple liver cyst (SHC) is a benign condition with no malignant potential. They are typically discovered incidentally due to the increased use of abdominal imaging, but some patients may present with abdominal pain. A radiologist's differential diagnosis in cases of SHC will often include "rule out biliary cystadenoma." Under these circumstances, patients and surgeons are more likely to pursue surgical options even in asymptomatic cases. The aim of this study is to conduct a retrospective analysis of presentation, radiologic reporting, management plan, and histopathology of patients referred to a tertiary hospital in order to determine the correlation between radiology and histology. METHODS We retrospectively analyzed the clinical, radiological, and histopathological data of 20 patients operated for a diagnosis of a cystic lesion in the liver. RESULT The CT/MRI of 6 (30%) patients was reported as a biliary cystadenoma, 13 (65%) were reported as a simple hepatic cyst and 1 patient (5%) had hepatocellular carcinoma (HCC) with the additional diagnosis of multiple hepatic cysts. The lesion reported as HCC on the scan was separate from the cystic lesions. The modality of imaging for these cysts was evenly split, 50% of patients had a CT scan, and 50% had an MRI performed. All imaging studies were interpreted by an attending radiologist and most of them were discussed in multidisciplinary meetings. Nineteen patients (95%) had an intraoperative diagnosis of a simple liver cyst based on its visual appearance and clear fluid within the cyst. These patients underwent cyst wall fenestration and de-roofing with the cyst wall sent for histopathology. One patient (5%) with HCC underwent a non-anatomical liver resection. Histopathology was conclusive for a benign hepatic cystic lesion from the cyst wall biopsy. All 20 patients in this study underwent surgery, either due to symptoms or due to radiologic diagnosis of BCA. Four of the 20 cases (20%) were asymptomatic and out of these four cases, 3 (75%) were diagnosed as cystadenoma on the preoperative imaging studies. All 19 cases were diagnosed as a simple liver cyst on pathology. CONCLUSION In summary, there is a growing trend of "ruling-out the diagnosis of biliary cystadenoma" in patients who present with liver cysts. Patients are appropriately more anxious after this preoperative diagnosis and the treating surgeons have medico-legal concerns regarding conservative management in asymptomatic patients diagnosed as BCA. This single center experience draws attention to the radiology criteria utilized for diagnosing a biliary cystadenoma and suggests that it is time to revisit the imaging interpretation and differential diagnosis.
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Affiliation(s)
- Aman Kumar
- Division of Abdominal Transplant, Department of Surgery, 2332University of North Carolina, Chapel Hill, NC, USA
| | - Alex Zendel
- Division of Abdominal Transplant, Department of Surgery, 2332University of North Carolina, Chapel Hill, NC, USA
| | - Michael Batres
- Division of Abdominal Transplant, Department of Surgery, 2332University of North Carolina, Chapel Hill, NC, USA
| | - David A Gerber
- Division of Abdominal Transplant, Department of Surgery, 2332University of North Carolina, Chapel Hill, NC, USA
| | - Chirag S Desai
- Division of Abdominal Transplant, Department of Surgery, 2332University of North Carolina, Chapel Hill, NC, USA
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Ishikawa S, Kuroda S, Chosa K, Okada K, Tanimine N, Tahara H, Ohira M, Ide K, Kobayashi T, Ohdan H. Treatment of multiple huge liver cysts in a hybrid operating room: a case report. Surg Case Rep 2021; 7:232. [PMID: 34714449 PMCID: PMC8556466 DOI: 10.1186/s40792-021-01320-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/21/2021] [Indexed: 11/19/2022] Open
Abstract
Background Liver cysts are common, with most cases being asymptomatic. In symptomatic cases, the disease is amenable to treatment. However, huge or multiple liver cysts with vascular narrowing and associated systemic symptoms are extremely rare. Furthermore, the performance of a reliable and effective surgery in such cases remains a major problem. Here, we report a case of multiple giant liver cysts with impaired blood flow surgically treated in a hybrid operating room. Case presentation A 73-year-old male presented to a previous doctor with leg edema and dyspnea on exertion; computed tomography revealed that the cause complaint was right lung and heart compression and inferior vena cava (IVC) stenosis due to huge liver cysts in the caudal lobe. The patient was referred to our hospital because of disease recurrence despite percutaneous aspiration of the cyst. Multiple liver cysts were observed in addition to the drained cysts, two of which were located on both sides of the IVC and caused IVC stenosis. We performed open surgery for the liver cysts and used the hybrid operating room for intraoperative IVC angiography and measuring the hepatic vein and portal vein (PV) pressure. We performed unroofing of the hepatic cyst and cauterization of the cyst wall on the hepatic side. Angiography was performed before and after unroofing of the liver cysts, and IVC stenosis release was confirmed. IVC pressure measured at the peripheral side of the stenosis and PV pressures were continuously measured during surgery and were confirmed to have decreased during the opening of the liver cysts. The patient had a good postoperative course and was discharged on the 10th postoperative day. No recurrence was observed 6 months postoperatively. Conclusions Cyst unroofing surgery using angiography in a hybrid operating room is a useful treatment for deep hepatic lesions in that vascular stenosis improvement can be intraoperatively confirmed. Moreover, in cases wherein the cyst compresses the vasculature, intraoperative monitoring of IVC and PV pressures can be used to prove that the liver cyst is hemodynamically involved.
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Affiliation(s)
- Sho Ishikawa
- Department of Surgery, Kure City Medical Association Hospital, 15-24, Asahimachi, Kure-City, Hiroshima, 737-0056, Japan
| | - Shintaro Kuroda
- Department of Gastroenterological Surgery, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Keigo Chosa
- Department of Diagnostic Radiology, Hiroshima University Hospital, Hiroshima, Japan
| | - Kenjiro Okada
- Department of Gastroenterological Surgery, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Naoki Tanimine
- Department of Gastroenterological Surgery, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hiroyuki Tahara
- Department of Gastroenterological Surgery, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Masahiro Ohira
- Department of Gastroenterological Surgery, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kentaro Ide
- Department of Gastroenterological Surgery, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological Surgery, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hideki Ohdan
- Department of Gastroenterological Surgery, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Shimizu T, Yoshioka M, Kaneya Y, Kanda T, Aoki Y, Kondo R, Takata H, Ueda J, Kawano Y, Hirakata A, Matsushita A, Taniai N, Mamada Y, Yoshida H. Management of simple hepatic cyst. J NIPPON MED SCH 2021; 89:2-8. [PMID: 34526451 DOI: 10.1272/jnms.jnms.2022_89-115] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Simple hepatic cysts are typically saccular, thin-walled masses with fluid-filled epithelial lined cavities that arise from aberrant bile duct cells during embryonic development. With the development of diagnostic modalities such as ultrasonography, computed tomography and magnetic resonance imaging, simple hepatic cysts are seen with relative frequency in daily clinical examination. US is the most useful and noninvasive tool for the diagnosis of simple hepatic cysts, and can generally differentiate simple hepatic cysts from abscesses, hemangiomas and malignancies. Cysts with irregular walls, septations, calcifications or daughter cysts on US should be evaluated with enhanced CT or MRI to differentiate simple hepatic cysts from cystic neoplasms or hydatid cysts.Growth and compression of hepatic cysts cause abdominal discomfort, pain, distension and dietary symptoms such as nausea, vomiting, a feeling of fullness and early satiety. Complications of simple hepatic cysts include infection, spontaneous hemorrhage, rupture, and external compression of biliary tree or major vessels.Asymptomatic simple hepatic cysts should be observed. Treatment for symptomatic simple hepatic cysts includes percutaneous aspiration, aspiration followed by sclerotherapy, and surgery. The American College of Gastroenterology clinical guidelines recommend laparoscopic fenestration based on its high success rate and low invasiveness. Percutaneous procedures for treatment of simple hepatic cysts are particularly effective for the immediate palliation of patient symptoms; however, they are not generally recommended because of the high rate of recurrence.Management of simple hepatic cysts requires correct differentiation from neoplasms and infections, and the selection of a reliable treatment.
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Affiliation(s)
- Tetsuya Shimizu
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Masato Yoshioka
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Yohei Kaneya
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Tomohiro Kanda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Yuto Aoki
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Ryota Kondo
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Hideyuki Takata
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Junji Ueda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Youichi Kawano
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Atsushi Hirakata
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Akira Matsushita
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Nobuhiko Taniai
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Yasuhiro Mamada
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
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Blum SFU, Ittermann T, Kromrey ML, Dreyer CM, Seppelt D, Hoffmann RT, Völzke H, Kühn JP. Long-term outcome of incidental cystic liver tumors in the general population. Sci Rep 2021; 11:11661. [PMID: 34083637 PMCID: PMC8175727 DOI: 10.1038/s41598-021-91140-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/20/2021] [Indexed: 11/29/2022] Open
Abstract
Aim of this study was to investigate frequency, incidence and risk factors of liver cysts in the general population in a longitudinal survey. Cyst frequency was investigated in 607 adult volunteers (288 women, 319 men, mean age 55 years) using strong T2-weighted magnetic resonance imaging. Risk factors were investigated for occurrence, frequency and size of cystic lesions at baseline. Incidence and physiological growing of the lesions were observed in a 5-years follow-up. At baseline, 431 volunteers had 1,479 cysts (71.0%). The mean number of cysts per person was 3.4 ± 9.0. The mean size of cysts was 13.1 ± 11.7 mm. Women had a higher number of cysts than men (p = 0.026). Older and male volunteers demonstrated a higher cyst frequency (p = 0.002 and p = 0.025). Per one-year increase in age the chance for a liver cyst increased by 2%. Four-hundred seventeen volunteers had cysts in the follow-up, in 24.6% new lesions had occurred. Lesion size significantly increased in follow-up (p < 0.001). Age and male sex were associated with the occurrence of at least one liver cyst. Women had a higher average number of cysts. Cystic lesion progression is a physiological phenomenon in the long-term follow-up.
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Affiliation(s)
- S F U Blum
- Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - T Ittermann
- Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - M L Kromrey
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - C M Dreyer
- Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - D Seppelt
- Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - R T Hoffmann
- Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - H Völzke
- Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - J P Kühn
- Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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15
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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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16
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Engler A, Shi R, Beer M, Schmidberger J, Kratzer W, Barth TFE, Grimm J, Hillenbrand A, Henne-Bruns D, Gruener B, Beer AJ, Graeter T. Simple liver cysts and cystoid lesions in hepatic alveolar echinococcosis: a retrospective cohort study with Hounsfield analysis. ACTA ACUST UNITED AC 2019; 26:54. [PMID: 31469072 PMCID: PMC6716343 DOI: 10.1051/parasite/2019057] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/15/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Alveolar echinococcosis (AE) is a rare zoonosis caused by the larval stage of the tapeworm Echinococcus multilocularis. AE lesions affect the liver in more than 98% of cases. AE lesions have various morphological characteristics that are described in the Echinococcus multilocularis Ulm classification for computed tomography (EMUC-CT). One of these characteristics is a cystoid portion. The aim of the study was to compare the density of simple hepatic cysts with cystoid portions of AE lesions classified on the basis of the EMUC-CT. RESULTS Hounsfield Unit (HU) measurements of the cystoid portions of all EMUC-CT type I-IV AE lesions (n = 155) gave a mean of 21.8 ± 17.6, which was significantly different from that of 2.9 ± 4.5 for the simple hepatic cysts (p < 0.0001). The difference between each of the individual AE types and simple hepatic cysts was also significant. In addition, the HU values of the cystoid portions in types I, II and IIIa/b and simple cysts were each significantly different from type IV (p < 0.0001). The HU measurements in type IV presented by far the highest mean. CONCLUSIONS The significantly higher density measured in the cystoid portions of hepatic AE lesions offers a good means of differentiation from simple hepatic cysts.
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Affiliation(s)
- Agata Engler
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Rong Shi
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Julian Schmidberger
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Thomas F E Barth
- Department of Pathology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Johannes Grimm
- Department of Pathology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Andreas Hillenbrand
- Department of General and Visceral Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Doris Henne-Bruns
- Department of General and Visceral Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Beate Gruener
- Department of Internal Medicine III, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Ambros J Beer
- Department of Nuclear Medicine, Ulm University Hospital, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Tilmann Graeter
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
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17
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Abstract
Cystic hepatic lesions are commonly encountered in daily practice. The diagnosis of these lesions ranges from benign lesions of no clinical significance to malignant and potentially lethal conditions. The prevalence of hepatic cyst (HC) has been reported to be as high as 15-18% in the United States. Imaging with conventional ultrasound, computed tomography, magnetic resonance imaging, or contrast-enhanced ultrasound can be used to characterize further and diagnose. The pre-test probability of a diagnosis is highly affected by the patient's comorbidities and the clinical and laboratory data; thus, imaging studies should be interpreted in the context of the other clinical information for that particular patient. Treatment modalities for hepatic cyst include fenestration, aspiration sclerotherapy, or surgical resection. In the current review, we discuss the pathophysiology, diagnosis, and treatment modalities for various cystic hepatic lesions.
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18
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Mavilia MG, Pakala T, Molina M, Wu GY. Differentiating Cystic Liver Lesions: A Review of Imaging Modalities, Diagnosis and Management. J Clin Transl Hepatol 2018; 6:208-216. [PMID: 29951366 PMCID: PMC6018306 DOI: 10.14218/jcth.2017.00069] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/14/2017] [Accepted: 11/20/2017] [Indexed: 12/25/2022] Open
Abstract
Hepatic cysts (HCs) are frequently discovered incidentally on abdominal imaging. The prevalence of HCs has been reported as high as 15-18% in the United States. Although most cysts are benign, some are malignant or premalignant. It is important to diagnose cystic lesions in order to properly manage them. Imaging with conventional ultrasound, computed tomography, magnetic resonance imaging, or contrast-enhanced ultrasound can be used to further characterize and diagnose HCs. Ultrasound is typically the first-line imaging modality, whereas more advanced imaging can help narrow down the specific lesion. Contrast-enhanced ultrasound is a newer modality, recently approved in the United States, which offers non-invasive evaluation in real-time. The first step in diagnosis is stratifying risk by differentiating simple and complex cysts. There are several features that can help identify HCs, including septae, mural consistency, calcifications, and quality of cystic fluid. Simple cysts are mainly congenital cysts, but also occur in polycystic liver disease. Complex cysts include mucinous neoplasms, echinococcal cysts, hemorrhagic cysts, cystic hepatocellular carcinoma and other rare lesions. Treatment is indicated in symptomatic cysts or those suspicious for malignant or premalignant features. Treatment modalities include fenestration, aspiration sclerotherapy, or surgical resection.
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Affiliation(s)
- Marianna G. Mavilia
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA
- *Correspondence to: Marianna G. Mavilia, Department of Medicine, University of Connecticut Health Center, 263 Farmington Ave, Farmington, CT 06032, USA. Tel: +1-860-679-2509, Fax: +1-860-679-6582, E-mail:
| | - Tina Pakala
- Department of Medicine, Division of Gastroenterology-Hepatology, New York Presbyterian Hospital, New York, NY, USA
| | - Marco Molina
- Department of Radiology, University of Connecticut Health Center, Farmington, CT, USA
| | - George Y. Wu
- Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA
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Moriyama T, Kakiuchi D, Grasso L, Hutto DL, Fernando D, Schweizer C. Farletuzumab, a monoclonal antibody directed against folate receptor alpha, shows no evidence of teratogenicity in cynomolgus monkeys. Reprod Toxicol 2018; 79:89-95. [PMID: 29928988 DOI: 10.1016/j.reprotox.2018.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/03/2018] [Accepted: 06/14/2018] [Indexed: 11/26/2022]
Abstract
Farletuzumab is a humanized monoclonal antibody targeting human folate receptor alpha, which is being developed as an anti-cancer drug. A non-human primate reproductive study was conducted to evaluate whether it could cause any embryonic or fetal abnormalities. Farletuzumab was administered intravenously to pregnant cynomolgus monkeys (n = 16/group) at doses of 0 or 67.5 mg/kg once weekly during gestation day (GD) 20 through 97. C-section was performed on GD100 ± 2, and fetuses were evaluated for morphologic (external, visceral and skeletal) effects. No farletuzumab-related changes were observed in maternal animals or fetuses, which are supported by the fact that farletuzumab has no effects on cellular uptake of folate. These data support the potential use of farletuzumab for oncologic indications during pregnancy.
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Affiliation(s)
| | - Dai Kakiuchi
- Eisai Co. Ltd., 5-1-3 Tokodai, Tsukuba, Ibaraki 300-2635, Japan
| | - Luigi Grasso
- Morphotek Inc., 210 Welsh Pool Rd., Exton, PA 19341, USA
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Ogasawara Y, Yamada S, Suzuki K, Obinata K, Hashizume A, Tomita S, Okazaki T. Laparoscopic treatment of a simple hepatic cyst using argon beam coagulation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2017.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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21
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Typical and atypical benign liver lesions: A review. Clin Imaging 2017; 44:79-91. [PMID: 28486156 DOI: 10.1016/j.clinimag.2017.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/10/2017] [Accepted: 05/01/2017] [Indexed: 02/06/2023]
Abstract
Focal liver lesions are routinely encountered by clinical radiologists and represent a wide spectrum of pathology. Majority of these lesions are likely to be benign in nature, especially in the absence of chronic liver disease or primary cancer. A radiologist must be aware of common and uncommon imaging features of benign lesions across the various imaging modalities. This review discusses pathognomonic imaging features of common benign focal liver lesions seen on ultrasound, computed tomography and magnetic resonance, and adds to existing knowledge with the recent updates to have emerged in this area.
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22
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Abstract
Purpose The aim of the study was to determine the sonographic prevalence of benign focal liver lesions on the basis of a population of hospital patients. Methods
The ultrasound results in a population of (n = 45,319) hospital patients over a period of 10 years were examined retrospectively and evaluated for the diagnosis of benign focal liver lesions [hepatic cysts, hepatic hemangioma, focal nodular hyperplasia (FNH), hepatic adenoma, and focal fatty sparing]. Results that were incomplete or ambiguous were excluded from this study. Results At least one of the lesions to be investigated was diagnosed in 15.1% (n = 6839) of the patients of the total population. The most commonly recorded lesion, with a total prevalence of 6.3% (n = 2839), was focal fatty sparing, followed by hepatic cysts with 5.8% (n = 2631). The prevalence of hepatic hemangioma was 3.3% (n = 1640), while that of FNH was 0.2% (n = 81) and that of hepatic adenoma was 0.04% (n = 19). An association between the occurrence of benign focal liver lesions and age was observed. Conclusions The calculated prevalence of benign focal liver lesions shows that on the fortuitous discovery of space-occupying lesions of the liver, first consideration should be given to focal fatty sparing, simple hepatic cysts and hemangiomas. The finding of a FNH or an adenoma is rarely a random discovery.
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23
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Percutaneous Treatment of Simple Hepatic Cysts: The Long-Term Results of PAIR and Catheterization Techniques as Single-Session Procedures. Cardiovasc Intervent Radiol 2015; 39:902-8. [PMID: 26714694 DOI: 10.1007/s00270-015-1283-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/29/2015] [Indexed: 02/08/2023]
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Abstract
Background Benign liver tumors are common. They do not spread to other areas of the body, and they usually do not pose a serious health risk. In fact, in most cases, benign liver tumors are not diagnosed because patients are asymptomatic. When they are detected, it’s usually because the person has had medical imaging tests, such as an ultrasound (US), computed tomography (CT) scan, or magnetic resonance imaging (MRI), for another condition. Materials and methods A search of the literature was made using cancer literature and the PubMed, Scopus, and Web of Science (WOS) database for the following keywords: “hepatic benign tumors”, “hepatic cystic tumors”, “polycystic liver disease”, “liver macroregenerative nodules”, “hepatic mesenchymal hamartoma”, “hepatic angiomyolipoma”, “biliary cystadenoma”, and “nodular regenerative hyperplasia”. Discussion and conclusion Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in some areas of the world; there is an increasing incidence worldwide. Approximately 750,000 new cases are reported per year. More than 75 % of cases occur in the Asia-Pacific region, largely in association with chronic hepatitis B virus (HBV) infection. The incidence of HCC is increasing in the USA and Europe because of the increased incidence of hepatitis C virus (HCV) infection. Unlike the liver HCC, benign tumors are less frequent. However, they represent a chapter always more interesting of liver disease. In fact, a careful differential diagnosis with the forms of malignant tumor is often required in such a way so as to direct the patient to the correct therapy. In conclusion, many of these tumors present with typical features in various imaging studies. On occasions, biopsies are required, and/or surgical removal is needed. In the majority of cases of benign hepatic tumors, no treatment is indicated. The main indication for treatment is the presence of significant clinical symptoms or suspicion of malignancy or fear of malignant transformation.
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25
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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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Celebi S, Kutluk G, Bestas CB, Kuzdan Ö, Sander S. Current diagnosis and management of simple hepatic cysts detected prenatally and postnatally. Pediatr Surg Int 2014; 30:599-604. [PMID: 24817430 DOI: 10.1007/s00383-014-3509-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE The optimal management of simple hepatic cysts (SHCs) remains controversial. A retrospective review was carried out to evaluate the clinical presentation and surgical consideration of children with SHCs and outcome of management at our institution. METHODS We performed a retrospective review of all patients diagnosed with SHCs between January 1993 and May 2013. Patient variables included prenatal findings, age, gender, presenting symptoms, signs and diagnostic modality. Operative management and nonoperative follow-up were abstracted. RESULTS The 67 patients comprised 42 females and 25 males: 16 had prenatally detected, and 51 had postnatally detected hepatic cysts with a mean follow-up of 3.2 years (10 months-12 years). The average age was 5.9 years (0-17 years). Ten patients (six females and four males) were treated surgically. Fifty-seven asymptomatic patients were observed. Of those 57 patients, 9 (17%) had enlarged cysts, and 1 (2%) had clinical signs. The average enlargement time was 36 months (6-67 months). The cysts occurred in the right lobe in 47 patients, in the left lobe in 17 patients and in both lobes in 3 patients. The median cyst size for the asymptomatic cases was 2.1 cm (1.5-6 cm) and 13.7 cm (8-25 cm) for the surgery group. A statistically significant difference in cyst size was found between these two groups (p < 0.05). Prenatally detected cysts (n = 5) were subjected to surgery postnatally at an average age of 1.5 months (1 week-6 months). The main indication was the compressive effect of the cyst on the surrounding area. There was one case of hepatomegaly found to be causing pressure symptoms, two cases of respiratory distress, one case of hydroureteronephrosis, and one case of jaundice due to compression of the biliary system. Five patients underwent surgery in the postnatally detected group, and the main indication was a complication of the cyst or progressive enlargement. Symptoms included abdominal discomfort and pain in all five patients: one case exhibited a hemorrhage within the cyst, one case displayed a rupture with possible peritonitis, one case had a 25-cm cyst leading to secondary infection, and two cases were admitted with progressive enlargement with clinical symptoms. CONCLUSION Conservative management of SHCs is practical. Surgical excision is recommended in patients with larger cysts, causing pressure symptoms, or if the cyst size does not seem to involute with intractable abdominal pain or becomes complicated in the follow-up period.
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Affiliation(s)
- Suleyman Celebi
- Department of Pediatric Surgery, Kanuni Sultan Suleyman Education and Research Hospital, Istanbul, Turkey,
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Martel G, Alsharif J, Aubin JM, Marginean C, Mimeault R, Fairfull-Smith RJ, Mohammad WM, Balaa FK. The management of hepatobiliary cystadenomas: lessons learned. HPB (Oxford) 2013; 15:617-22. [PMID: 23458638 PMCID: PMC3731583 DOI: 10.1111/hpb.12026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 10/28/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Mucinous cystic neoplasms of the liver (hepatobiliary cystadenomas) are rare neoplastic lesions. Such cysts are often incorrectly diagnosed and managed, and carry a risk of malignancy. The objective of this study was to review the surgical experience with these lesions over 15 years. METHODS A retrospective chart review identified consecutive patients undergoing surgery for liver cystadenomas from 1997-2011. Clinical data were collected and summarized. RESULTS Thirteen patients (mean age 51 years, 12/13 females) with cysts 4.6-18.1 cm were identified. Most cysts were located in the left lobe/centrally (11/12) and had septations (8/13). Mural nodularity was infrequent (3/13). Nine patients had liver resection/enucleation, whereas four had unroofing. Frozen section analysis had a high false-negative rate (4/6). All patients had cystadenomas, of which two had foci of invasive carcinoma (cystadenocarcinoma) within mural nodules. There was no 90-day mortality. All but one patient (myocardial infarction) were alive at a median follow-up of 23.1 months. No patient with unroofing has developed malignancy to date. CONCLUSIONS Non-invasive hepatobiliary cystadenomas present as large central/left-sided cysts in young or middle-aged women. Associated malignancy was relatively uncommon and found within mural nodules. Intra-operative frozen section analysis was ineffective at ruling out cystadenomas. Complete excision is recommended, but close follow-up might be considered in patients with a prohibitive technical or medical risk, in the absence of nodularity on high-quality imaging.
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Affiliation(s)
- Guillaume Martel
- Liver and Pancreas Unit, Division of General Surgery, Gastrointestinal Pathology Section, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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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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Lantinga MA, Gevers TJG, Drenth JPH. Evaluation of hepatic cystic lesions. World J Gastroenterol 2013; 19:3543-3554. [PMID: 23801855 PMCID: PMC3691048 DOI: 10.3748/wjg.v19.i23.3543] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 03/05/2013] [Accepted: 03/22/2013] [Indexed: 02/06/2023] Open
Abstract
Hepatic cysts are increasingly found as a mere coincidence on abdominal imaging techniques, such as ultrasonography (USG), computed tomography (CT) and magnetic resonance imaging (MRI). These cysts often present a diagnostic challenge. Therefore, we performed a review of the recent literature and developed an evidence-based diagnostic algorithm to guide clinicians in characterising these lesions. Simple cysts are the most common cystic liver disease, and diagnosis is based on typical USG characteristics. Serodiagnostic tests and microbubble contrast-enhanced ultrasound (CEUS) are invaluable in differentiating complicated cysts, echinococcosis and cystadenoma/cystadenocarcinoma when USG, CT and MRI show ambiguous findings. Therefore, serodiagnostic tests and CEUS reduce the need for invasive procedures. Polycystic liver disease (PLD) is arbitrarily defined as the presence of > 20 liver cysts and can present as two distinct genetic disorders: autosomal dominant polycystic kidney disease (ADPKD) and autosomal dominant polycystic liver disease (PCLD). Although genetic testing for ADPKD and PCLD is possible, it is rarely performed because it does not affect the therapeutic management of PLD. USG screening of the liver and both kidneys combined with extensive family history taking are the cornerstone of diagnostic decision making in PLD. In conclusion, an amalgamation of these recent advances results in a diagnostic algorithm that facilitates evidence-based clinical decision making.
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30
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Kim SR, Lee DS, Park IY. Managements of simple liver cysts: ablation therapy versus cyst unroofing. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2012; 16:134-7. [PMID: 26388923 PMCID: PMC4574997 DOI: 10.14701/kjhbps.2012.16.4.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 10/05/2012] [Accepted: 10/15/2012] [Indexed: 11/18/2022]
Abstract
Backgrounds/Aims Simple liver cysts were easily recognizable with the advanced imaging procedures, such as ultrasound and computed tomography scan. A large cyst or significant symptoms were indications for the treatments. Ablation therapy with sclerotic agents was effective, but there were several complications including severe pain. With the surgical cyst unroofing method introduced, we compared the cyst unroofing method and ablation therapy. Methods Between March 1997 and May 2011, we performed treatments of simple liver cysts in 27 patients. There were 23 women and 4 men (age range: 42-84 years; mean age: 64 years). The cyst unroofing was undergone with laparoscopic (n=13) and open technique (n=1). The ablation therapy was performed with ethanol (n=13) and acetic acid (n=1). Results The usual symptoms of the liver cysts were abdominal mass (n=7), indigestion (n=4), abdominal discomfort (n=3), and the increasing size of the cysts (n=4). The mean diameter of the cysts was 10.9 cm. The cyst unroofing method was performed effectively in 14 patients. One patient had bleeding during operation, and was converted to the open technique. One patient had a bile leak from the cyst, but it was successfully closed with the laparoscopic technique. Among the 14 cases with the ablation therapy, there were 4 complications: hematoma (n=1); cyst leaking during aspiration (n=2); acute renal failure (n=1); and death due to acetic acid intoxication (n=1). Conclusions Laparoscopic cyst unroofing was more effective and safer in management than the ablation therapy in simple liver cysts.
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Affiliation(s)
- Seong-Ryong Kim
- Department of Surgery, Bucheon St. Mary Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Do-Sang Lee
- Department of Surgery, Bucheon St. Mary Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Il-Young Park
- Department of Surgery, Bucheon St. Mary Hospital, The Catholic University of Korea, Bucheon, Korea
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Biologic and clinical features of benign solid and cystic lesions of the liver. Clin Gastroenterol Hepatol 2011; 9:547-62.e1-4. [PMID: 21397723 DOI: 10.1016/j.cgh.2011.03.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 02/24/2011] [Accepted: 03/02/2011] [Indexed: 02/07/2023]
Abstract
The widespread use of imaging analyses, either routinely or to evaluate symptomatic patients, has increased the detection of liver lesions (tumors and cysts) in otherwise healthy individuals. Although some of these incidentally discovered masses are malignant, most are benign and must be included in the differential diagnosis. The management of benign hepatic tumors ranges from conservative to aggressive, depending on the nature of the lesions. New imaging modalities, increased experience of radiologists, improved definition of radiologic characteristics, and a better understanding of the clinical features of these lesions have increased the accuracy of diagnoses and reduced the need for invasive diagnostic tests. These advances have led to constant adjustments in management approaches to benign hepatic lesions. We review the biologic and clinical features of some common hepatic lesions, to guide diagnosis and management strategies.
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32
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Abstract
Benign pathologies of the liver often include several cystic diseases, such as simple cysts, autosomal dominant polycystic liver disease, and Caroli's disease. The differential of hepatic cysts also includes infectious pathologies, such as pyogenic liver abscess, hydatid cysts, and parasitic infections if the appropriate clinic setting. Understanding of the various causes, clinical presentation, and treatment options is required to ensure the appropriate surgical management of these patients.
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Affiliation(s)
- Kaye M Reid-Lombardo
- Division of Gastroenterologic and General Surgery, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA.
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33
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Long-term results after surgical treatment of nonparasitic hepatic cysts. Am J Surg 2010; 200:23-31. [PMID: 20637333 DOI: 10.1016/j.amjsurg.2009.06.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Revised: 06/22/2009] [Accepted: 06/24/2009] [Indexed: 02/08/2023]
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Goodman MD, Mak GZ, Reynolds JP, Tevar AD, Pritts TA. Laparoscopic excision of a ciliated hepatic foregut cyst. JSLS 2009; 13:96-100. [PMID: 19366552 PMCID: PMC3015889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Ciliated hepatic foregut cysts are uncommon solitary cysts of the liver that originate from the embryologic foregut. Clinically and radiographically, these lesions can be difficult to distinguish from neoplasms. Recent reports have demonstrated that ciliated hepatic foregut cysts may undergo dysplastic progression, supporting the argument to excise these cysts when discovered. Fewer than 100 cases have been described in the literature since the first description of a ciliated hepatic foregut cyst in 1857. We present a patient who recently underwent laparoscopic excision of a ciliated hepatic foregut cyst, review the literature, and propose the rationale for attempting removal of these cysts via a laparoscopic approach.
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Affiliation(s)
| | - Grace Z. Mak
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jordan P. Reynolds
- Department of Pathology and Laboratory Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Amit D. Tevar
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
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35
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Gamblin TC, Holloway SE, Heckman JT, Geller DA. Laparoscopic resection of benign hepatic cysts: a new standard. J Am Coll Surg 2008; 207:731-6. [PMID: 18954786 DOI: 10.1016/j.jamcollsurg.2008.07.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 07/01/2008] [Accepted: 07/08/2008] [Indexed: 12/16/2022]
Abstract
BACKGROUND We sought to evaluate the feasibility and outcomes of laparoscopic resection of symptomatic hepatic cysts. STUDY DESIGN Fifty-one patients underwent laparoscopic resections for symptomatic hepatic cysts. Resection was accomplished laparoscopically with an Endo-GIA vascular stapler. Data were collected in a prospective database. RESULTS Median patient age was 60 years, with a median lesion diameter of 13 cm. Indication for surgical treatment was pain in 92% of patients. Laparoscopic resection was successful in 100% of patients. A pure laparoscopic approach was used in 58% of patients, the remaining used a hand port. Median operating time was 178 minutes. Preoperative diagnosis was polycystic liver in 88% and simple cyst in 12% diagnosed by preoperative imaging. Histologic examination showed 90% to be simple cysts and 10% cystadenomas. There were nine minor perioperative complications. Median hospital stay was 2 days. Relief of symptoms was achieved in all patients operated on for pain, with a median followup of 13 months. Two patients required reoperation for recurrence of the same cyst. CT or MRI was used for yearly followup. CONCLUSIONS Laparoscopic resection of symptomatic liver cysts is a feasible and effective method to relieve symptoms with minimal surgical trauma. This series represents the largest report of laparoscopic management for benign hepatic cysts and provides evidence for a routine laparoscopic approach to benign symptomatic cysts. Traditional surgical methods should be reserved for when a malignancy is expected, laparoscopy is contraindicated, or for recurrence after an initial laparoscopic approach.
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Affiliation(s)
- T Clark Gamblin
- Department of Surgery, Liver Cancer Center, University of Pittsburgh, Pittsburgh, PA 15213, USA
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36
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Rougemont AL, Sartelet H, Oligny LL, Bensoussan A, Yazbeck S, Fournet JC. Accessory liver lobe with mesothelial inclusion cysts in an omphalocele: a new malformative association. Pediatr Dev Pathol 2007; 10:224-8. [PMID: 17535091 DOI: 10.2350/06-08-0148.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Accepted: 11/27/2006] [Indexed: 12/27/2022]
Abstract
Mesothelial inclusion cysts represent benign lesions that have been reported in a wide variety of locations. Peritoneal cysts are observed and visceral involvement has been described, notably of intraperitoneal organs such as the spleen and the testis. We report the cases of 2 neonates who underwent surgical management of an omphalocele. The hernial sac contained an accessory liver lobe, displaying in both cases multilocular mesothelial inclusion cysts. The hobnail cells lining the cysts exhibited calretinin and cytokeratin immunohistochemical reactivity, as well as focal D2-40 reactivity. One of the cases occurred in the setting of a Beckwith-Wiedemann syndrome (MIM 130650), an overgrowth disorder notably associated with omphalocele and hepatic anomalies and tumors. However, no hepatic mesothelial cyst has been described in this syndrome. In the 2nd case the omphalocele and the hepatic cysts were the sole lesions observed in the neonate. To the best of our knowledge, these 2 cases represent the first description of such an association.
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Blonski WC, Campbell MS, Faust T, Metz DC. Successful aspiration and ethanol sclerosis of a large, symptomatic, simple liver cyst: Case presentation and review of the literature. World J Gastroenterol 2006; 12:2949-54. [PMID: 16718826 PMCID: PMC4087818 DOI: 10.3748/wjg.v12.i18.2949] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Simple liver cysts are congenital with a prevalence of 2.5%-4.25%. Imaging, whether by US, CT or MRI, is accurate in distinguishing simple cysts from other etiologies, including parasitic, neoplastic, duct-related, and traumatic cysts. Symptomatic simple liver cysts are rare, and the true frequency of symptoms is not known. Symptomatic simple liver cysts are predominantly large (> 4 cm), right-sided, and more common in women and older patients. The vast majority of simple hepatic cysts require no treatment or follow-up, though large cysts (> 4 cm) may be followed initially with serial imaging to ensure stability. Attribution of symptoms to a large simple cyst should be undertaken with caution, after alternative diagnoses have been excluded. Aspiration may be performed to test whether symptoms are due to the cyst; however, cyst recurrence should be expected. Limited experience with both laparoscopic deroofing and aspiration, followed by instillation of a sclerosing agent has demonstrated promising results for the treatment of symptomatic cysts. Here, we describe a patient with a large, symptomatic, simple liver cyst who experienced complete resolution of symptoms following cyst drainage and alcohol ablation, and we present a comprehensive review of the literature.
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Affiliation(s)
- Wojciech C Blonski
- Gastroenterology Division, University of Pennsylvania, Philadelphia, PA 19104, United States
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38
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Miyamoto M, Oka M, Izumiya T, Nagaoka T, Ishihara Y, Ueda K, Enomoto S, Yanaoka K, Arii K, Tamai H, Shimizu Y, Ichinose M. Nonparasitic solitary giant hepatic cyst causing obstructive jaundice was successfully treated with monoethanolamine oleate. Intern Med 2006; 45:621-5. [PMID: 16755093 DOI: 10.2169/internalmedicine.45.1408] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
A 77-year-old man hospitalized for epigastric pain showed jaundice of the skin and conjunctivae. Laboratory tests revealed elevated hepatobiliary enzymes and inflammatory markers, and imaging studies demonstrated a 12 cm hepatic cyst compressing the common bile duct. The diagnosis was a giant hepatic cyst causing obstructive jaundice. Cyst drainage and sclerotherapy with 5% monoethanolamine oleate was performed twice, resulting in almost complete disappearance of the cyst. Obstructive jaundice due to a hepatic cyst, as seen in this case, is relatively rare and this report includes a review of other similar cases in Japan.
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39
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De J, Rossman L, Kott MM, Deavers MT. Cytologic diagnosis of ciliated hepatic foregut cyst. Diagn Cytopathol 2006; 34:846-9. [PMID: 17183760 DOI: 10.1002/dc.20572] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Ciliated hepatic foregut cyst (CHFC) is a rare, benign, solitary cyst occurring most often in the left lobe of the liver. CHFCs are typically found incidentally during radiologic imaging, surgical exploration, or autopsy. Only six cases of CHFC diagnosed by fine needle aspiration have been reported in the literature. We describe a CHFC diagnosed by aspiration in a 70-yr-old woman who presented with a 2-yr history of abdominal discomfort. The radiologically benign-appearing lesion was located in the subcapsular area of segment IV of the liver. The aspirate contained benign ciliated columnar cells and goblet cells suspended in mucoid material. Sections from a cell block demonstrated pseudo-stratified bronchial-type epithelium with mucin secreting cells and an absence of cartilage, characteristic of CHFC. Mucin-containing goblet cells stained with alcian blue. The neuroendocrine cells within the bronchial-type epithelium stained for calcitonin and synaptophysin. On follow-up, a computed tomography (CT) demonstrated the cyst to be unchanged, but as the patient continued to have pain, sclerosis of the cyst was planned. The diagnosis of CHFC by fine needle aspiration and its distinction from other solitary cysts of the liver may prevent unnecessary surgical exploration and excision.
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Affiliation(s)
- Jitakshi De
- Department of Pathology and Laboratory Medicine, University of Texas Medical School, Houston, TX 77030, USA
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40
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Fabiani P, Mazza D, Toouli J, Bartels AM, Gugenheim J, Mouiel J. Laparoscopic fenestration of symptomatic non-parasitic cysts of the liver. Br J Surg 2005. [DOI: 10.1046/j.1365-2168.1997.02555.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Larssen TB, Rørvik J, Hoff SR, Horn A, Rosendahl K. The occurrence of asymptomatic and symptomatic simple hepatic cysts. A prospective, hospital-based study. Clin Radiol 2005; 60:1026-9. [PMID: 16124985 DOI: 10.1016/j.crad.2005.04.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2004] [Revised: 04/04/2005] [Accepted: 04/25/2005] [Indexed: 11/24/2022]
Abstract
AIM To examine the prevalence of asymptomatic and symptomatic liver cysts in a university hospital patient population using modern US equipment. METHODS Abdominal US scans of 1541 cases referred during the period 21 January to 11 November 2000 were examined for hepatic cysts. RESULTS Of 1541 cases, 174 (11.3%) were found to have hepatic cysts, i.e. 109 female (12.5%) and 65 (9.7%) male patients (9.7%). In 413 individuals younger than 40 years, no cysts were found. Above the age of 40 years, prevalence increased with age. CONCLUSION By using modern US equipment, we found a higher prevalence of hepatic cysts than that reported in previous studies. Patient selection and the prevalence of liver cysts in the population from which the patients were referred may have influenced our results.
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Affiliation(s)
- T B Larssen
- Department of Radiology, Haukeland University Hospital, Bergen, Norway.
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42
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Tan YM, Chung A, Mack P, Chow P, Khin LW, Ooi LL. Role of fenestration and resection for symptomatic solitary liver cysts. ANZ J Surg 2005; 75:577-80. [PMID: 15972051 DOI: 10.1111/j.1445-2197.2005.03432.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Symptomatic liver cysts can be managed surgically by fenestration or by hepatic resection. The present study was designed to investigate the current role of each surgical technique in the management of this benign condition. METHODS Forty consecutive patients with symptomatic liver cyst (non-parasitic and non-malignant) surgically treated by fenestration or resection were identified from a prospectively collected database. An analysis of primary outcome measures including operative parameters, morbidity and mortality rates, length of postoperative stay and recurrence rates in months was carried out. RESULTS The laparoscopic fenestration group had the best perioperative outcome. At median follow up of 20 months, there were no recurrences in the resection group but recurrence occurred in 6/27 (22%) in the fenestration group. Four of these recurrences were asymptomatic and were managed conservatively while two symptomatic recurrences required a resection. CONCLUSION Laparoscopic fenestration is the best treatment for symptomatic liver cysts as the primary operation. It is associated with the lowest blood loss, lowest morbidity and shortest hospital stay. Liver resection is best reserved for recurrent symptomatic cysts and cystic lesions suspicious of tumours where it can be safely performed and associated with a zero recurrence rate.
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Affiliation(s)
- Yu-Meng Tan
- Hepatobiliary Unit, Department of Surgery, Singapore General Hospital, Singapore.
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Kornprat P, Cerwenka H, Bacher H, El-Shabrawi A, Tillich M, Langner C, Mischinger HJ. Minimally invasive management of dysontogenetic hepatic cysts. Langenbecks Arch Surg 2004; 389:289-292. [PMID: 15232698 DOI: 10.1007/s00423-004-0506-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2004] [Accepted: 05/20/2004] [Indexed: 01/28/2023]
Abstract
BACKGROUND Liver cysts occur with a prevalence of 4%-7% in the general population. Laparoscopic surgery is effective for solitary cysts and in selected patients with polycystic liver disease (PLD). We present our experience in the laparoscopic management of dysontogenetic cysts. PATIENTS AND METHODS Between 1994 and 2002, 36 patients were referred to our centre for the management of dysontogenetic cystic liver disease. Management was laparoscopic in 16 cases. Indications were solitary giant cysts (n=9) and PLD (n=7). RESULTS Laparoscopic procedures were completed in 15 patients. Mean operating time was 90 min. There were no deaths. In one case there was an intraoperative complication: bleeding from a superficial hepatic vein necessitated conversion to an open procedure. There were two postoperative complications: one patient with biliary leakage, which was managed conservatively, and one patient with a pneumothorax caused by the cava catheter installed for anaesthesia. Median follow-up was 36 months. There was no symptomatic recurrence. CONCLUSION Laparoscopy can be recommended as the procedure of choice for symptomatic solitary giant cysts and PLD Gigot type I.
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Affiliation(s)
- Peter Kornprat
- Division of General Surgery, Department of Surgery, University Medical Centre, Auenbruggerplatz 29, 8036 Graz, Austria.
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Larssen TB, Rosendahl K, Horn A, Jensen DK, Rørvik J. Single-session alcohol sclerotherapy in symptomatic benign hepatic cysts performed with a time of exposure to alcohol of 10 min: initial results. Eur Radiol 2003; 13:2627-32. [PMID: 12955449 DOI: 10.1007/s00330-003-1923-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2002] [Revised: 10/15/2002] [Accepted: 03/03/2003] [Indexed: 11/25/2022]
Abstract
The aim of this study was to evaluate the 1-year results of single-session sclerotherapy of symptomatic benign non-parasitic liver cysts performed with maximum 10 min time of ethanol exposure. During the period 1995-1999, 15 symptomatic liver cysts in nine patients--eight women and one man--were treated with 10 min time of exposure to ethanol. Ultrasound-guided puncture combined with fluoroscopy was used for catheter placement. Alcohol sclerotherapy was performed with a maximum volume of ethanol 96% of 10% of the cyst volume, never exceeding 100 ml. At follow-up the patients were examined with liver function tests, ultrasound or CT examination, clinical examination, and interview by a gastrointestinal surgeon. Ten cysts in seven patients (six women and one man; age range 44-61 years, median age 58 years), who had a follow-up of at least 1 year, were included. The original cyst volumes were 30-4110 ml (median 392 ml). After a follow-up period of 12-47 months (median 23 months), cyst volumes were 0-523 ml (median 21.5 ml) with a reduction of the median cyst volume by 95% ( p<0,005). All patients experienced relief of their clinical symptoms. Except for pain, no complications were observed. Sclerotherapy using only one session and maximum 10 min time of exposure to ethanol represents an effective treatment of symptomatic liver cysts.
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Affiliation(s)
- Trond B Larssen
- Department of Radiology, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway.
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Carrim ZI, Murchison JT. The prevalence of simple renal and hepatic cysts detected by spiral computed tomography. Clin Radiol 2003; 58:626-9. [PMID: 12887956 DOI: 10.1016/s0009-9260(03)00165-x] [Citation(s) in RCA: 205] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM To provide a definitive evaluation of the prevalence of simple renal and hepatic cysts using spiral computed tomography (CT). PATIENTS AND METHODS Contrast-enhanced abdominal CT studies from 617 patients (295 women, 322 men) attending for investigations unrelated to renal or hepatic pathology were included. The number of renal cysts, their location and the diameter of the largest cyst were recorded. Hepatic cysts were recorded as being either present or absent. RESULTS Two hundred and fifty-four patients (41%) were found to have simple renal cysts and 110 patients were found to have simple hepatic cysts (18%). Both renal and hepatic cysts became more common with age. Renal cysts were significantly more common at all ages in men (p=0.001), and increased in both size (p=0.02) and number (p<0.05) with age. CONCLUSION A major discrepancy has, until now, existed between autopsy prevalence of renal cysts and prevalence as reported by in-vivo third-generation CT or sonography studies. Using newer spiral CT machines, we have generated prevalence data closer to post-mortem findings. We have also shown a significant, but age dependent, association between the presence of simple hepatic and simple renal cysts (p=0.001)
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Affiliation(s)
- Z I Carrim
- Department of Clinical Radiology, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
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Lermite E, Pessaux P, Jousset Y, Aubé C, Regenet N, Hennekinne-Mucci S, Arnaud JP. [Compression of the inferior vena cava with thrombus: a rare complication of solitary liver cyst]. ANNALES DE CHIRURGIE 2002; 127:776-8. [PMID: 12538099 DOI: 10.1016/s0003-3944(02)00878-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Because of the increase of ultrasonographic exams, nonparasitic cyst of the liver is frequently encountered. Some giant cysts have complications. The surgical treatment for complicated forms consists in resection of the protruding part. We report a case of a giant non parasitic cyst of the liver which was responsible of a compression of the inferior vena caval with thrombus. The resection of the thrombus was performed after a double control of the vena cava and a control of the aorta. The fenestration of the cyst was performed in a second time.
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Affiliation(s)
- E Lermite
- Service de chirurgie viscérale, CHU Angers, 4, rue Larrey, 49100 Angers, France
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Gigot JF, Metairie S, Etienne J, Horsmans Y, van Beers BE, Sempoux C, Deprez P, Materne R, Geubel A, Glineur D, Gianello P. The surgical management of congenital liver cysts. Surg Endosc 2001; 15:357-63. [PMID: 11395815 DOI: 10.1007/s004640090027] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2000] [Accepted: 09/13/2000] [Indexed: 12/16/2022]
Abstract
BACKGROUND Most series that report the results of surgical treatment for congenital liver cysts focus more on the technical aspects of the operation than on the late outcome of these patients. In this paper, we emphasize the importance of appropriate patient selection and adequate surgical technique for successful long-term outcome. METHODS Twenty-four consecutive patients with congenital liver cysts were selected for surgical treatment. According to our own classification, 13 patients had simple liver cysts, nine had multicystic liver disease, and two had type I polycystic liver disease. All of these patients were treated by the fenestration technique. An open approach was used for five patients (group 1) treated between 1984 and 1990. In 19 patients (group 2) treated since 1991, a laparoscopic approach was used. The incidence of complicated liver cysts was 40% in group 1 and 68% in group 2. RESULTS There were no treatment-related deaths in this series. The mean postoperative hospital stay was significantly shorter for patients who underwent successful laparoscopic fenestration (p < 0.05). In the open group (group 1), there were no postoperative complications, and all patients were alive and free of symptoms during a mean follow-up of 130 months, without any sign of cyst recurrence. In the laparoscopic group (group 2), four patients were converted to open surgery. One of these patients had an inaccessible posterior cyst; another had bile within the cystic cavity. A further two cases had complicated liver cysts with an uncertain diagnosis between congenital and neoplastic cysts. Four patients (21%) developed peri- or postoperative complications. During a mean follow-up time of 38.5 months, none of the patients with simple liver cysts incurred late symptoms or signs of cyst recurrence. In the six patients with multicystic liver disease, one developed disease-related cyst progression (17%) and required reoperation. One of the two patients with type I polycystic liver disease (50%) developed asymptomatic disease-related cyst progression. CONCLUSIONS When patients are carefully selected and a proper surgical technique is employed, excellent long-term results with a low morbidity rate can be achieved in patients with congenital liver cysts. Patients with multicystic liver disease or type I polycystic liver disease are more prone to late cyst recurrence. A tailored approach is thus indicated for patients with congenital liver cystic disease. However, the laparoscopic approach appears to be the gold standard for the treatment of highly symptomatic or complicated simple liver cysts.
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Affiliation(s)
- J F Gigot
- Department of Digestive Surgery, Saint-Luc University Hospital, Universite Catholique de Louvain (UCL), Hippocrate Avenue, 10, B-1200 Brussels, Belgium
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Hemming A, Gallinger S. Liver. Surgery 2001. [DOI: 10.1007/978-3-642-57282-1_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Affiliation(s)
- R A Cowles
- Department of Surgery, University of Michigan, Ann Arbor, USA
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Vick DJ, Goodman ZD, Deavers MT, Cain J, Ishak KG. Ciliated hepatic foregut cyst: a study of six cases and review of the literature. Am J Surg Pathol 1999; 23:671-7. [PMID: 10366149 DOI: 10.1097/00000478-199906000-00006] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Ciliated hepatic foregut cyst (CHFC) is a rare, benign, solitary cyst consisting of ciliated pseudostratified columnar epithelium, subepithelial connective tissue, a smooth muscle layer, and an outer fibrous capsule. We studied six previously unreported cases of CHFC and 50 cases from the literature. The literature search revealed that Friedreich first described the lesion in 1857 and hypothesized its congenital origin. The cyst generally is found incidentally on radiologic imaging or during surgical exploration, although one case presented with portal vein compression. It occurs more frequently in men and is found most commonly in the medial segment of the left hepatic lobe, unlike most other solitary cysts that show a female predominance and greater occurrence in the right hepatic lobe. Two of the 56 cases were multilocular. There has been an increase in the number of reports of CHFC during the past 15 years. This may reflect the increased availability and use of various radiologic imaging modalities. A large number of cases have been reported in the Japanese population, but the significance of this is unclear. CHFC should be considered in the differential diagnosis of other solitary liver cysts, including simple cysts, hepatobiliary cystadenomas, and parasitic cysts.
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Affiliation(s)
- D J Vick
- Department of Pathology and Area Laboratory Services, Walter Reed Army Medical Center, Washington, DC, USA
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