Diagnosis and treatment of hepatobiliary cystic neoplasms

Abstract

Objective To investigate the clinical diagnostic and treatment characteristic and efficacy of hepatobiliary cystic neoplasms. Methods Clinical data of 13 patients with hepatobiliary cystic neoplasms in Department of Hepatobiliary Surgery, the Affiliated Hospital of Medical College, Qingdao University from January 2001 to March 2013 were analyzed retrospectively. There were 1 male and 12 females with age from 45 to 75 years old and a median of 55 years old. The informed consents of all patients were obtained and the ethical committee approval was received. Results Nine patients were observed with a main symptom of abdominal pain in the right upper quadrant, 4 patients with discomfort upper abdominal fullness, 4 patients with elevated serum cancer antigen (CA) 19-9 and 3 patients with elevated serum carcinoembryonic antigen (CEA). All patients received ultrasonography and computed tomography (CT) examination and the diagnosis was confirmed. Two cases received left hemihepatectomy, 1 case received left hemihepatectomy+ hepatic partial resection of segment Ⅷ, 3 cases received hepatic left lateral lobectomy, 1 case received hepatic left medial lobar cystic neoplasms resection, 2 cases received hepatic resection of segment Ⅳ, 1 case received hepatic cystic neoplasms resection of segment Ⅳ, 1 case received right hemihepatectomy+choledochal cyst resection+ left hepatic duct-jejunum Roux-en-Y anastomosis, 1 case received hepatic cystic neoplasms resection of segment Ⅵ and Ⅶ, and 1 case received hepatic cystic neoplasms resection of segment Ⅴand Ⅷ. The tumor diameter of gross specimen of 13 patients was from 1 to 14 cm with a median of 9 cm. The cyst wall thickness was not uniform and the inner wall was not smooth. Obvious papillary protrusion was observed in 3 cases. Offwhite gel-like liquid was observed inside the cysts of 9 cases. Four cases were combined with intrahepatic cholelithiasis, and 3 cases were combined with chronic inflammation in bile duct wall. Postoperative pathology examination demonstrated 3 cases of mucinous cystadenoma, 9 cases of mucinous cystadenocarcinoma, and 1 case of partial borderline mucinous cystadenoma. No death was observed and all the 13 patients were followed up for 1 to 72 months with a median of 35 months. No recurrence was observed during the follow-up. Conclusions Hepatobiliary cystic neoplasms include mucinous cystadenoma and mucinous cystadenocarcinoma. No specific clinical manifestation is observed in these patients. The diagnosis mainly depends on pathological examinations. Once diagnosed with hepatobiliary cystic neoplasms, the patient should undergo surgery in early period to achieve a good prognosis. Key words: Bile ducts, intrahepatic; Bile duct neoplasms; Cystadenocarcinoma; Cystadenoma; Hepatectomy; Pathology, surgical