Abstract
BackgroundIntrahepatic biliary mucinous cystic neoplasms are rare hepatic tumors and account for less than 5% of intrahepatic cystic lesions. Accurate preoperative diagnosis is difficult and the outcome differs among various treatment modalities.The aim of this study is to investigate the clinico-radiological characteristics of intrahepatic biliary mucinous cystic neoplasms and to establish eligible diagnostic and treatment suggestions.MethodsNineteen patients with intrahepatic biliary cystadenomas and two patients with biliary cystadenocarcinomas were retrospectively reviewed. Their clinico-radiological variables and survival outcome were analyzed.ResultsOf the 19 patients with biliary cystadenoma, 16 (84.2 %) were female. 11 (57.9 %) patients had symptoms before operation with the most common presenting symptom being abdominal pain. Among the patients with available data, serum and cystic fluid CA 19–9 levels were invariably elevated and the CA 19–9 level in the cystic fluid was significantly higher than that in the serum. Loculations (84.2 %) and septations (63.2 %) were the most common radiologic findings. For treatment, 11 (57.9 %) patients received radical resection by either enucleation or hepatic resection, while the remaining 8 (42.1 %) patients underwent only fenestration of liver cysts. Radical resection provided a significantly better clinical outcome than fenestration in terms of tumor recurrence (p = 0.018). The only two male patients with biliary cystadenocarcinoma received radical hepatic resection and achieved a disease-free survival of 16.5 months and 33 months, respectively.ConclusionIntrahepatic biliary mucinous cystic neoplasms are rare and preoperative diagnosis is difficult. Internal septations and loculations on radiologic examinations should raise some suspicion of this diagnosis. Complete tumor excision is the standard treatment that may provide patients with better long term results after the operation.
Highlights
An accurate preoperative diagnosis for intrahepatic biliary mucinous cystic neoplasms remains difficult and controversy exists in regards to the appropriate treatment and follow-up
The purpose of this study is to share the experience in our institute and to investigate the clinicoradiological characteristics of intrahepatic biliary mucinous cystic neoplasms
Preoperative contrast-enhanced computed tomography (CE-CT) or contrast-enhanced magnetic resonance image (MRI) of liver was routinely performed and interpreted by radiologists experienced in the hepatobiliary system
Summary
Intrahepatic biliary mucinous cystic neoplasms are rare hepatic tumors and account for less than 5% of intrahepatic cystic lesions. Accurate preoperative diagnosis is difficult and the outcome differs among various treatment modalities.The aim of this study is to investigate the clinico-radiological characteristics of intrahepatic biliary mucinous cystic neoplasms and to establish eligible diagnostic and treatment suggestions. Cystic lesions of the liver are being discovered more frequently nowadays owing to advances in abdominal imaging including sonography and computed tomography. They are mostly benign and asymptomatic [1]. An accurate preoperative diagnosis for intrahepatic biliary mucinous cystic neoplasms remains difficult and controversy exists in regards to the appropriate treatment and follow-up. The purpose of this study is to share the experience in our institute and to investigate the clinicoradiological characteristics of intrahepatic biliary mucinous cystic neoplasms. Suggestions on the subject of preoperative diagnosis and treatment strategy will be provided
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