Hepatic Mucinous Cystic Neoplasm Deceptive as Hydatid Cyst: Message Learned

Abstract

Purpose: Mucinous cystic neoplasms (MCN) are infrequent non-invasive lesion of the liver. The diagnosis of such lesions relies mainly on the histopathological findings. They are often misinterpreted as hydatid cysts clinically and on imaging leading to partial resection or deroofing. Case presentation: Case 1: A 32-year-lady presented with upper abdominal pain and on evaluation found to have well-defined cystic lesion with smooth wall and thin septae in segment III/IV of liver. Robotic deroofing of cyst wall was performed. Microscopic examination revealed it to be mucinous cystadenoma. In view of histopathology and raised fluid CEA and CA 19-9 levels, she was re-operated for complete excision of cystadenoma. Subsequent, histopathology reported mucinous cystadenoma with clear margins. Case 2: A 57-year-lady presented with complaint of awareness of lump in right hypochondrium. On evaluation, a large unilocular cystic mass lesion was noted in the segment IV/V of liver. Intraoperatively, ∼1 liter of cyst fluid was drained with de-roofing of cyst wall was performed. Her histopathology was suggestive of MCN of the liver with no features of high-grade dysplasia or malignancy. She was contacted but lost to follow up. However, after 2 years she again reported with complaints of pain in upper abdomen. CECT abdomen revealed a recurrent multilocuated cystic lesion in the remaining segment IVb of the liver. She was counselled and re-resection of residual lesion with gall bladder was performed. Histopathology examination again confirmed MCN. Now, both the patients are doing well after 1 year of re-do surgery and having no features of recurrence. Conclusion: MCN-L are rare with a wide clinical with radiological presentation and may be misdiagnosed pre-operatively. Complete excision, even if re-do surgery has to be done as it prevents future recurrence and malignant conversion.