A CASE OF CYSTADENOCARCINOMA TRANFORMED AFTER LAPAROSCOPIC DEROOFING OPERATION IN DIAGNOSIS OF SIMPLE CYST OF THE LIVER

Abstract

It is most probable that hepatic cyst with high levels of both CA19-9 and CEA in the cystic fluid is cystadenocarcinoma. A 57-year-old woman was admitted to Chunichi hospital because of a cystic mass in the middle segment of the liver. At first, she was diagnosed as having a cystic mass of the liver, which was 5cm in diameter. In 10 months the size of the cyst increased to 10cm in diameter. Although the patient had undergone an injection of absolute ethanol into the cyst through a catheter after US-guided drainage before admission, the cyst continued to increase in size. A laparoscopic deroofing operation was therefore performed. No pathological finding of malignancy was found in the wall of the cyst. Six months later, another cystic lesion in the middle segment of the liver with high level of CA19-9 was noticed again by ultrasonography. She underwent a left lobectomy of the liver in Aichi Cancer Center hospital. The pathological diagnosis of the tumor was cystadenocarcinoma. The patient had high levels of CA19-9 and CEA in the cyst fluid and also had high level of CA19-9 in serum. From this clinical course, the patient is considered to have had biliary cystadenocarcinoma which was derived from the simple cyst through cystadenoma. This case may serve as a paradigm that suggests the importance of following such cysts and of indicating laparoscopic surgery precisely.