Hepatobiliary cystadenomas with and without biliary leak

Abstract

Background: The incidence of benign tumors such as biliary cystadenoma is very low, its finding is generally incidental. The definitive diagnosis is anatomopathological. Histologically, 3 types of cystadenomas are defined, the first with mesenchymal stroma similar to ovarian tissue, it is the most frequent in women. The second with absence of mesenchymal is more frequent in men. The third and rarer type also has no mesenchymal stroma and instead has eosinophilic epithelial cells. Despite the improvement in imaging tests, differential diagnosis is sometimes difficult and may be confused, as in the first case, with simple cysts or with hydatid cystst. Methods: Clinical Case 1 - Female, 41 years old. Multiple consultations for pain in HD, Fever, coluria in the last 8 months. Physical examination without particularities. Functional Hepatic: only the increase in Gammaglutamyltranspeptidase (GGT) stands out. Clinical case 2 - Female, 54 years old, recurrent vesicular colic, echo of abdomen: vesicular lithiasis, polylobulated cyst, segment VI. Tomography: segment VI well defined cystic lesion, with polylobulated contours, measures 31 x 41 x 41 mm. Results: Case 1: Ultrasound: Vesicle without lithiasis, no dilation of the bile duct. Tomography: right lobe, cystic image 60 mm, echogenic walls with sediment slope. Serology for positive hydatidosis. Initial diagnosis: hepatic echinococcosis The surgery: Cyst 5 - 6 cm. Sectors in communication with posterolateral bile duct. Walls 3-4 mm not calcified. Endothelium coating. Biliary purulent content + microlithiasis. Case 2: In its interior multiple septa that seem to converge towards its center, no nodular sectors or calcium are visualized inside. Fine bile way. Initial diagnosis: Symptomatic cystic tumor Surgery: Segmentectomy VI. In these two cases the pathological anatomy certifies: mucinous cystadenomas. Conclusion: The suspicion of hepatic cystadenoma is fundamental in the therapeutic, are infrequent tumors less than 5%, and its malignant potential makes this surgery indicated. Normality in tumor markers such as CA19-9 and carcinoembryonic antigen does not exclude the diagnosis. Rule out differential diagnoses as in our first case, hepatic echinococcosis. Major hepatectomies or lobectomies should be taken into consideration depending on the tumor location and resulting hepatic reserve. Not indicating another type of minor surgical treatment, such as drainage or unroofing of the lesion, due to the high probability of recurrence or to that it is a malignant lesion after the complete histological study of the piece.