A rare case of hepatobiliary cystadenoma

Abstract

Introduction Hepatobiliary cystadenoma is a rare cystic lesion of the liver. It histologically resembles the more commonly recognised mucinous cystic neoplasm of the pancreas. Similarly, the features include mucinous epithelium surrounded by ovarian-type stroma. We present a case of an infected hepatobiliary cystadenoma. Case report This 30-year-old woman presented with abdominal pain, fever, tachycardia and raised inflammatory markers. A CT scan showed a 19 cm multi-septate liver cyst and suprapubic collection. Attempted radiological-guided drainage of the cyst and collection were made without resolution of symptoms. A left hemi-hepatectomy was performed. Macroscopically there was a 90 cm multilocular cyst with fibrous septae, patchy haemorrhage and necrosis. Microscopic examination showed liver parenchyma containing a cyst with surrounding acute and chronic inflammation. The cyst was lined by columnar epithelium and an underlying ovarian-type stroma. The features were consistent with a hepatobiliary cystadenoma. Discussion The mean age of diagnosis of hepatobiliary cystadenoma is 45 years and greater than 85% occur in women. They are often misdiagnosed as simple hepatic cysts or hydatid cysts pre-operatively. Knowledge of this tumour and confirmation of diagnosis is essential due to the small risk of malignant transformation and high rate of recurrence. Current treatment recommendations suggest complete surgical resection.