Benign Hepatic Lesions Research Articles

Predictive Factors of Canine Malignant Hepatic Diseases with Multifocal Hepatic Lesions Using Clinicopathology, Ultrasonography, and Hepatobiliary Ultrasound Scores

Multifocal hepatic lesions in dogs arise from various benign and malignant liver diseases. Diagnosing these lesions is challenging because clinical signs, hematological data, and serum biochemistry are not definitive indicators. Ultrasound is utilized as a diagnostic imaging tool to evaluate liver parenchyma and detect hepatic lesions. This study aims to investigate the predictive factors that differentiate between benign and malignant multifocal hepatic lesions by examining ultrasound characteristics, blood tests, and serum biochemistry. In total, 43 dogs with multifocal hepatic lesions were included in this study. All dogs were classified into benign hepatic diseases (n = 32) and malignant haptic diseases (n = 11). For all dogs, their liver characteristics, lesion characteristics, and hepatobiliary ultrasound score by ultrasound were evaluated and we collected individual clinicopathological data for analysis. The findings of the univariate analysis revealed significant differences in four hematological and blood chemical parameters (hematocrit, white blood cell count, aspartate transaminase (AST), and alkaline phosphatase (ALP)) and six ultrasonographic parameters (liver parenchymal echogenicity, lesion homogeneity, lesion echogenicity, maximum lesion dimension, average lesion dimension, and hepatobiliary ultrasound score). Using multivariate analysis, only two parameters, hepatobiliary ultrasound score and lesion homogeneity, showed significant differences (p-value < 0.001 and p-value = 0.011, respectively). Additionally, these parameters demonstrated high accuracy in predicting malignant multifocal liver lesions, with accuracy rates of 97.67% and 93.02%, respectively. Therefore, the hepatobiliary ultrasound score and lesion homogeneity are considered effective parameters for screening malignant multifocal liver lesions in dogs.

Gadoxetate disodium (Gd-EOB-DTPA) contrast-enhanced magnetic resonance imaging for differentiation between benign and malignant splenic lesions in dogs.

Malignant splenic lesions in dogs are common, with hemangiosarcoma diagnosed most frequently, and there have been no consistent clinicopathologic, gross, or imaging characteristics identified that differentiate malignant from benign splenic lesions. Histopathology is required for definitive diagnosis, and given the poor long-term prognosis of malignant splenic lesions, a noninvasive tool to aid in diagnosis would be valuable. This prospective cohort study utilized gadoxetate disodium, a liver-specific contrast agent (Gd-EOB-DPTA; Eovist), to identify the general lesion and pre- and postcontrast signal characteristics of benign and malignant splenic and hepatic lesions in dogs with naturally occurring disease. Twenty-five dogs were enrolled, Eovist-enhanced MRI was performed, and dogs were taken to surgery for splenectomy and other organ biopsy. All histopathology and MRI studies were evaluated by a single pathologist and a single radiologist, respectively. The associations between the tumor type and numerous variables defined on MRI were evaluated using Fisher's exact tests, and the significance was identified at a P-value of.05. Malignant splenic masses were identified in 11/25 (44%) dogs, and 5/11 malignancies represented hemangiosarcoma. The presence of abdominal effusion (P=.017) and the presence of hepatic nodules on MRI (P=.009) were associated with splenic malignancy. There were no benign T2 hyperintense and no malignant T2 hypointense lesions (P=.021). Utilization of the T2 W MRI sequence may aid in the identification of malignant splenic lesions, particularly when accompanied by abdominal effusion and hepatic lesions.

EVALUATION OF HEPATIC MASS LESIONS BY DIFFUSION WEIGHTED MAGNETIC RESONANCE IMAGING

Objectives: The purpose of this study was to compare apparent diffusion coefficient (ADC) values for benign and malignant neoplastic hepatic lesions and also for suspected infective hepatic masses in which histopathology may always not be indicated. Methods: This is a cross-sectional study conducted in the department of radio diagnosis and imaging, army hospital research and referral, Delhi Cantt. All the patients coming for magnetic resonance imaging (MRI) scans for focal liver lesions detected on other imaging modalities were included. The imaging was done at the 1.5 Tesla MAGNETOM AVANTO A Tim system (Siemens Ltd.). Various parameters of the morphology of lesions in conventional MRI and parameters in diffusion-weighted MRI were evaluated. Results: A total of 75 patients were included in the study. The mean age of the subjects was 52.57±15.28 years, with a male: female sex ratio of 0.5:1. Among the 75 subjects, 20 subjects with hepatic cysts had no restrictions, and 12 patients with hemangioma were hyperintense on both diffusion-weighted imaging (DWI) and ADC. The mean differences between benign and malignant lesion ADC values. The difference was statistically significant (p<0.001). In the present study, we get a cut-off for the ADC value of 1.581×10-3 mm2/s, which proved to be an optimal parameter for differentiation between benign and malignant lesions. Conclusion: DWI proved to be a very useful supplementary imaging technique in conjunction with conventional imaging sequences in the analysis of focal hepatic lesions and should be included in the imaging algorithm for such lesions.

Pitfalls and strategies of Sonazoid enhanced ultrasonography in differentiating metastatic and benign hepatic lesions.

This article aims to clarify pitfalls and find strategies for the detecting and diagnosing hyperechoic liver metastases (LMs) using Sonazoid-contrast enhanced ultrasonography (Sonazoid-CEUS). This study was a prospective self-controlled study. Patients with hepatic lesions suspected as LMs or benign lesions were included in the study. Baseline ultrasonography (BUS) and Sonazoid-CEUS were performed on every patient. Characteristics of LMs and benign nodules were compared by chi-square test and fisher test. Factors influenced the CEUS were demonstrated by univariate analysis and multivariate logistic regression analysis. 54 patients were included in this study. CEUS found additional 75 LMs from 19 patients in Kupffer phase. We found hyperechoic focal liver lesions and deep seated in liver are main confounding factors in CEUS diagnosis. Sensitivity would be improved from 16.67% to 78.57%, negative predictive value (NPV) would be improved from 28.57% to 76.92% and accuracy would be improved from 37.5% to 87.50% when using rapid "wash-in" and "wash-out" as main diagnostic criteria. Hyperechoic LMs especially deeply seated ones are usually not shown typical "black hole" sign in Kupffer phase. Quickly "wash-in and wash out" shows high accuracy in diagnosing malignant nodules. We highly recommend CEUS as a routing exam to detect and diagnose LMs.

Early detection and prognosis evaluation for hepatocellular carcinoma by circulating tumour DNA methylation: A multicentre cohort study.

Early diagnosis of hepatocellular carcinoma (HCC) can significantly improve patient survival. We aimed to develop a blood-based assay to aid in the diagnosis, detection and prognostic evaluation of HCC. A three-phase multicentre study was conducted to screen, optimise and validate HCC-specific differentially methylated regions (DMRs) using next-generation sequencing and quantitative methylation-specific PCR (qMSP). Genome-wide methylation profiling was conducted to identify DMRs distinguishing HCC tumours from peritumoural tissues and healthy plasmas. The twenty most effective DMRs were verified and incorporated into a multilocus qMSP assay (HepaAiQ). The HepaAiQ model was trained to separate 293 HCC patients (Barcelona Clinic Liver Cancer (BCLC) stage 0/A, 224) from 266 controls including chronic hepatitis B (CHB) or liver cirrhosis (LC) (CHB/LC, 96), benign hepatic lesions (BHL, 23), and healthy controls (HC, 147). The model achieved an area under the curve (AUC) of 0.944 with a sensitivity of 86.0% in HCC and a specificity of 92.1% in controls. Blind validation of the HepaAiQ model in a cohort of 523 participants resulted in an AUC of 0.940 with a sensitivity of 84.4% in 205 HCC cases (BCLC stage 0/A, 167) and a specificity of 90.3% in 318 controls (CHB/LC, 100; BHL, 102; HC, 116). When evaluated in an independent test set, the HepaAiQ model exhibited a sensitivity of 70.8% in 65 HCC patients at BCLC stage 0/A and a specificity of 89.5% in 124 patients with CHB/LC. Moreover, HepaAiQ model was assessed in paired pre- and postoperative plasma samples from 103 HCC patients and correlated with 2-year patient outcomes. Patients with high postoperative HepaAiQ score showed a higher recurrence risk (Hazard ratio, 3.33, p<.001). HepaAiQ, a noninvasive qMSP assay, was developed to accurately measure HCC-specific DMRs and shows great potential for the diagnosis, detection and prognosis of HCC, benefiting at-risk populations.

The added value of diffusion-weighted imaging to dynamic MRI in detecting and characterizing hepatic focal lesions

Background Noninvasive diagnostic methods of hepatic lesions are often accomplished using contrast material-enhanced computed tomography and magnetic resonance imaging. Diffusion-weighted imaging (DWI) has evolved as a standard technique in liver imaging. Aim The work aimed to evaluate the added value of DWI to magnetic resonance imaging in identifying and characterizing hepatic focal lesions. Patients and methods In all, 100 participants having the clinical criteria of hepatic focal lesions detected on ultrasound or computed tomography screening were involved in our research. Dynamic magnetic resonance imaging of the liver and DWI were done. Results Correlation between the nature of lesions, magnetic resonance imaging findings, and comorbidity of liver cirrhosis show a highly statistically significant difference between benign and malignant hepatic focal lesions according to DWI and apparent diffusion coefficient (ADC) values. Receiver-operating characteristic curve analysis between the nature of lesions and lesions’ ADC value shows that at a cutoff value less than or equal to 1.5 (×10-3mm/s), with a sensitivity of 61.76% and specificity of 90.32%. It can predict malignant lesions with an area under the curve of 0.745 and a significant P value of less than 0.001. Conclusion DWI could identify malignant and benign hepatic tumors through ADC values producing high sensitivity and specificity; moreover, it is possible to identify subgroups of hepatic lesions depending on such values.

Comparison of magnetic resonance elastography and diffusion-weighted imaging for differentiating benign and malignant liver lesions

BackgroundImaging is a crucial diagnostic tool in focal liver lesions (FLLs) diagnosis. Without the need for an intravenous contrast agent, two such MRI methods that can distinguish between benign and malignant FLLs are diffusion-weighted imaging (DWI) and magnetic resonance elastography (MRE). The purpose of this study was to assess the utility of diffusion-weighted magnetic resonance imaging and magnetic resonance elastography in the identification and differentiation of benign and malignant hepatic focal lesions.MethodsThis cross-sectional study was carried out on ninety patients (with mean age 52 years) with hepatic focal lesions (29 benign and 61 malignant). Both MRE and DWI were performed on the patients. A modified gradient-echo sequence was used for MRE, and respiratory-triggered fat-suppressed single-shot echoplanar DW imaging (b = 0.800) was used for DWI. Maps of the apparent diffusion coefficient (ADC) and stiffness were produced. Regions of interest were placed over the FLLs on stiffness and ADC maps to get FLL ADC values and mean stiffness. Receiver operating curve (ROC) analysis was used to compare the roles of MRE and DWI in the differentiation of benign and malignant FLL.ResultsThe ADC of FLLs and MRE stiffness exhibited strong negative correlation [(r: −0.559; p < 0.001)]. Compared to malignant FLLs, benign FLLs had much higher mean ADC values. However, compared to benign FLLs, malignant FLLs exhibited much greater mean stiffness. FNH has the lowest mean stiffness of all FLLs, at less than 2.22 kPa. Among FLLs, CCAs had the lowest mean ADC values and the highest mean stiffness. The results showed that the MRE and DWI cutoff values were > 4.23 and ≤ 1.43, respectively; the area under the curve (AUC) values were 0.991 and 0.894, and the sensitivity and specificity results were 96.7%, 93.1%, and 85.2%, 89.7%, respectively.ConclusionsMRE was found to be more sensitive method for identifying benign and malignant hepatic focal lesions than DWI.

ACCURACY OF SHEAR WAVE ELASTOGRAPHY IN THE DIAGNOSIS OF HEPATIC FOCAL LESIONS

This study aimed to evaluate the accuracy of Shear Wave Elastography (SWE) in diagnosing hepatic focal lesions using triphasic CT as the gold standard. The study was conducted prospectively at the Department of Radiology, Nishtar Medical Hospital, from January 2022 to January 2023. Patients with at least one hepatic focal lesion ranging from 1 to 5 cm in diameter were included in the study. All patients underwent SWE scanning and ultrasound examination. The segment of focal lesions was evaluated, and 5-8 measurements were taken for quantitative analysis of stiffness. In patients with multiple focal lesions, the pathology of all lesions was confirmed by MRI and CT, and the most accessible lesion was analyzed. The mean of all measurements was compared with the findings of triphasic CT and tumor markers to estimate SWE's accuracy, specificity, and sensitivity. The study was conducted on 100 patients, of which 85 were males and 17 were females. The mean stiffness in benign lesions was 10.4 ± 6.32 kPa, and in malignant lesions was 16.3 ± 9.24 kPa. This difference was statistically significant (P&lt;.002). A cutoff value 13.25 was used to differentiate between malignant and benign lesions. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SWE were 78.05%, 71.43%, 88.9%, 52.3%, and 64.3%, respectively. The mean tissue stiffness in focal fatty infiltration was 12.7 ± 8.9 kPa, and in hemangioma lesions was 9.6 ± 4.3 kPa. The mean stiffness in HCC was 15.5 ± 7.1 kPa, in cholangiocarcinoma was 32.6 ± 8.26 kPa, and in metastatic lesions was 22.2 ± 0.5 kPa. In conclusion, SWE has a high sensitivity, specificity, and accuracy for differentiating malignant and benign hepatic focal lesions. The study shows that the stiffness of benign and malignant lesions differs significantly.

Patient with a novel syndrome with multiple benign hepatic lesions and extrahepatic neoplasms.

Simultaneous occurrence of benign hepatic lesions of different types is a sporadic phenomenon.To the best of our knowledge, we report the first clinical case of a syndrome with simultaneous manifestations of three different entities of benign liver tumors (hepatocellular adenoma, focal nodular hyperplasia and hemangioma) with a novel mutation detected in the liver adenoma and in the presence of a number of further extrahepatic organ neoplasms. Furthermore, we describe for the first time the presence of liver epithelial cells of hepatocytic phenotype expressing cytokeratin 7 (CK7) at the border of the adenoma.These findings may be important for explaining pathogenesis of benign as well as malignant tumors based on genetic and histopathological features.

A technical review of percutaneous sclerotherapy with bleomycin for giant hepatic venous malformation

BackgroundHepatic venous malformation (HVM), traditionally called liver haemangioma, is considered the most common benign hepatic lesion. Treatment might be indicated in large and symptomatic HVMs. We aim to describe stepwise technical aspects of trans-hepatic percutaneous sclerotherapy of hepatic venous malformation (HVM).Main textPatients with symptomatic HVM larger than 5 cm are selected after discussion in hepatobiliary multidisciplinary team. After prophylactic antibiotic and corticosteroid administration, local anaesthesia and conscious sedation are applied. A 22-gauge spinal or Chiba needle is used to obtain percutaneous access to the HVM through normal liver parenchyma under ultrasound guidance. To ensure proper needle placement and to prevent accidental delivery of sclerosant into unintended areas, about 5–10 mL iodine contrast is injected under fluoroscopy. Then, 45–60 IU bleomycin is mixed with 10 mL distilled water and 10 mL lipiodol and is slowly injected under fluoroscopy over a period of 20–30 s. After the needle is removed, manual pressure is applied over the puncture site for a period of 5 min followed by placement of a sandbag. Patients are monitored for 6–8 h post-procedure.ConclusionIn this technical review, we described our institutional technique of percutaneous sclerotherapy, which could be regarded as an alternative to TAE in the management of HVM.

Diagnostic accuracy of contrast-enhanced ultrasound in differentiating benign and malignant hepatic lesion: A meta-analysis

Diagnostic accuracy of contrast-enhanced ultrasound in differentiating benign and malignant hepatic lesion: A meta-analysis

Minimally Invasive Image-Guided Procedures for Benign Liver Lesions

AbstractAs access to affordable high-resolution medical imaging has improved, so too has the identification of benign hepatic lesions. Advanced imaging techniques and applications often allow characterization of these lesions so as to differentiate benign and malignant lesions without the need for biopsy. Patients with benign liver lesions are usually asymptomatic; however, a palliative intervention may be indicated if a benign liver lesion is symptomatic. This article reviews the characteristic imaging features of benign liver lesions, the indications for minimally invasive intervention, and the specific procedures for minimally invasive, nonsurgical intervention, and the procedural expectations, effectiveness, and periprocedural care.

Role of compression sonoelastography in aiding differentiation of benign and malignant solid hepatic lesions

Role of compression sonoelastography in aiding differentiation of benign and malignant solid hepatic lesions

A Rare Case of Ectopic Liver Presenting as an Intraperitoneal Mass: A Case Report and a Concise Case Review

Abstract Introduction/Objective Ectopic liver is a rare developmental abnormality, in which liver tissue is localized outside the normal liver and has no connection to the native liver. The presence of ectopic liver tissue has been reported most commonly in the gall bladder. Intrathoracic cavity, kidney, abdominal wall, and esophagus are the other sites where it has been identified. But its presence in the intraperitoneal has rarely been reported previously. We report such a case in a young female. Methods/Case Report A 27-year-old female presented with shortness of breath and was diagnosed to have pulmonary embolism. On imaging, she incidentally was found to have a well circumscribed 4.4 x 4.8 cm enhancing mass in the left sub- diaphragmatic region wedged between splenic hilum and greater curvature of the stomach. Based on imaging diagnosis of accessory spleen was considered. She underwent a nuclear medicine scan that was not consistent with the accessory spleen. Esophagogastroduodenoscopy identified a mass that showed abutment of the mucosa of stomach. Cytology showed rare polygonal benign cells which were non-diagnostic. A robotic laparoscopic-assisted abdominal mass excision was performed, identifying a mass abutting, but not adherent, to the spleen, pancreas and stomach. Histopathological examination revealed benign liver tissue with several portal triads. Immunohistochemical staining showed positivity for Hepar 1 and arginase; reticulin stain; together supporting it to be a benign hepatic lesion. This was finally diagnosed as benign ectopic liver Results (if a Case Study enter NA) NA. Conclusion Ectopic liver is a rare condition, with an incidence between 0.24%-0.47%. It can be associated with other congenital anomalies but most crucial implication, is the development of malignancy. It is sometimes, difficult to identify ectopic liver on imaging modalities. It is important to be aware of such rare findings for optimal patient care.

PSMA Immunohistochemistry in Hepatic Neoplasms: A Promising Diagnostic Marker With Potential Theranostic Applications.

Accurate classification of well-differentiated hepatocellular neoplasms can be challenging especially in core biopsies. Prostate-specific membrane antigen (PSMA) has been shown to highlight tumor-associated neovasculature in many nonprostatic solid tumors including hepatocellular carcinoma (HCC). Archived 164 hepatectomies and explants with 68 HCCs, 31 hepatocellular adenoma (HA), 24 dysplastic nodules (DN), and 42 metastases were retrieved, and pathologic parameters were evaluated. Sensitivity, specificity, accuracy, positive, and negative predictive values for correct diagnosis of HCC were calculated for PSMA and CD34 immunostains in tissue sections and HCC tissue microarrays. PSMA positivity was defined as capillarized sinusoidal/tumor-associated vessel staining involving ≥5% of the tumor area. In all, 55/68 (80.9%) HCC and 37/42 (88.1%) of liver metastasis were PSMA positive. PSMA was negative in HA, DN, and background liver (100% specificity). CD34 had a 98.5% sensitivity but a 65.5% specificity in identifying HCC. PSMA sensitivity remained high in the HCC tissue microarray (89.7%). PSMA was more accurate than CD34 (95.5% vs. 69.7%) in distinguishing grade 1 HCC from HA and high-grade DN while retaining high sensitivity (80%). The degree of PSMA positivity in HCC was greater in older, male, and human immunodeficiency virus patients ( P <0.05). No associations were found between PSMA staining and other tumor parameters ( P >0.05). PSMA is a marker of neoangiogenesis with increased expression in both primary and metastatic hepatic malignancies. Neovascular PSMA expression is more specific and accurate than CD34 for differentiating HCC from benign and precursor hepatic lesions. Diagnostic and therapeutic utility of PSMA radioligands in malignant liver neoplasms warrant further clinical investigations.

Analysis of the Role of Shear Wave Elastography in Diagnosing Focal Liver Lesions

Objective: Focal hepatic lesions are the second leading cause of death in men worldwide. However, shear wave elastography (SWE) has proved to help assess liver fibrosis. We aim to demonstrate the role of shear wave elastography in the diagnosis of focal liver lesions. Methods: A prospective study was conducted in the radiology department of CPEIC Multan from April 2021-April 2022. A total of 70 patients with 93 focal lesions were included. Shear wave elastography (SWE) was performed on all the patients, and local lesions and parenchyma stiffness values were calculated. Ten patients were excluded as they failed elastography acquisitions. Contrast-enhanced CT and MRI were performed on the remaining 60 patients. Thirty-two patients underwent liver biopsy. Benign focal lesions were confirmed by analyzing the results of ultrasound biopsy, CT, and MRI. Results: Cholangiocarcinoma was found to have the highest stiffness value (34.2kPa), hence the stiffest malignant lesion. Focal nodular hyperplasia had a stiffness value of 25.4kPa and was the most stiff benign lesion. The average stiffness value between malignant and benign lesions had a significant difference, the value of malignant lesions being significantly high ( p&lt;0.001). Conclusion: Shear wave elastography can efficiently differentiate between malignant and benign hepatic lesions and can individually characterize these lesions accurately. Keywords: Focal liver lesions, malignant, stiffness value, shear wave elastography, benign

The role of glypican 3, arginase 1, and CD34 in differentiation between benign and malignant primary hepatic lesions

Background and aim Benign hepatic nodular lesions mimicking hepatocellular carcinoma (HCC) may be categorized into hyperplastic nodular lesions, neoplastic nodular lesions, and miscellaneous nodular lesions. This study aimed to assess the role of glypican 3 (GPC3), arginase 1 (ARG-1), and CD34 in differentiation between benign and malignant primary hepatic lesions. Materials and methods This study included 48 cases, where 25 (52.08%) cases were diagnosed as primary HCC in the liver and 23 (47.92%) cases were diagnosed as benign hepatic lesions. Of the 48 patients, five (10.42%) cases were diagnosed as focal nodular hyperplasia, four (8.33%) cases were diagnosed as hepatic adenoma, eight (16.67%) cases were diagnosed as dysplastic nodule, and six (12.50%) cases were diagnosed as regenerative nodule. Results The sensitivity of GPC3 for differentiation between benign and malignant primary hepatic lesions was 80% and its specificity was 82.5%. The sensitivity of ARG-1 was 90%, and its specificity was 0.0%. The sensitivity of CD34 for HCC in the study group was 84% and its specificity was 91.3%. Conclusion There was high sensitivity and specificity of both GPC3 and CD34 immunostaining for distinction of primary HCC from benign hepatic mimicker lesions, whereas there was high sensitivity of ARG-1 in both benign and malignant primary hepatic lesions but with no specificity for differentiating the benign from malignant primary hepatic lesions.

Uncommon Benign Neoplasms and Pseudotumors of the Liver.

The most common benign hepatic mass-forming lesions often display fairly specific imaging characteristics, whereas less familiar, rarer benign neoplasms and pseudotumors may pose a diagnostic challenge in clinical, radiology, and pathology practice because of either their rarity or their unusual features. To review a selection of pseudotumors and unusual benign hepatic neoplasms encountered in consultation practices with a focus on nonepithelial tumors. Sources include English-language literature and personal experiences. Several benign conditions (namely, segmental atrophy, infections, immunoglobulin G4 [IgG4]-related sclerosing disease, angiomyolipoma, mesenchymal hamartoma, and various vascular lesions) can lead to formation of hepatic masses. Because of their rarity and underrecognition, such lesions are often diagnostically challenging. Awareness of hepatic pseudotumors and various rare hepatic neoplasms and their potential mimics can forestall misdiagnosis and inappropriate management.

Should Radiology Reporting Change Surgeon's Indication for Surgery in Cases of Hepatic Cyst?

Background: Aim of the study is to correlate radiology reports and histology by conducting a retrospective analysis of patients with hepatic cyst Methods: We analyzed the clinical, radiologic and histopathologic data of patients operated for cystic lesion in the liver between Jan'18-Dec'20. Results: 20 patients were included in the study. CT/MRI of 6(30%) patients were reported as biliary cystadenoma and 13(65%) were reported as simple hepatic cyst and 1(5%) had a diagnosis of cystic HCC. Out of the 6 cases reported as biliary cystadenoma, 5(83%) were reported on MRI and 1(16%) on CT scan. 18 out of 20 patients(90%) had intraoperative finding of a simple liver cyst and the patients underwent cyst wall fenestration demonstrative of clear fluid. 1(5%) had a finding of HCC, so non-anatomical liver resection was performed. Histopathology in 18 of all the operated cases was conclusive of benign hepatic cystic lesion from the cyst wall biopsy. Four of the 20 cases, (20%) were asymptomatic and out of these 4 cases, 3(75%) were initially reported as cystadenoma which ultimately turned out to be simple liver cyst on final pathology. One patient reported as simple cyst turned out to be cystadenoma on histopathology In this series the radiologic diagnosis of cystadenoma lead to unnecessary surgical intervention in 3 out of 4(75%) of patients with asymptomatic liver cyst. Conclusion: Increasingly utilized ‘rule out diagnosis of biliary cystadenoma’ in patients with a simple hepatic cyst creates anxiety for the patient and can lead to unnecessary surgery in asymptomatic patients.

Radiologic Reporting of Simple Hepatic Cyst Versus Biliary Cystadenoma May Lead to Unnecessary Surgery.

Simple liver cyst (SHC) is a benign condition with no malignant potential. They are typically discovered incidentally due to the increased use of abdominal imaging, but some patients may present with abdominal pain. A radiologist's differential diagnosis in cases of SHC will often include "rule out biliary cystadenoma." Under these circumstances, patients and surgeons are more likely to pursue surgical options even in asymptomatic cases. The aim of this study is to conduct a retrospective analysis of presentation, radiologic reporting, management plan, and histopathology of patients referred to a tertiary hospital in order to determine the correlation between radiology and histology. We retrospectively analyzed the clinical, radiological, and histopathological data of 20 patients operated for a diagnosis of a cystic lesion in the liver. The CT/MRI of 6 (30%) patients was reported as a biliary cystadenoma, 13 (65%) were reported as a simple hepatic cyst and 1 patient (5%) had hepatocellular carcinoma (HCC) with the additional diagnosis of multiple hepatic cysts. The lesion reported as HCC on the scan was separate from the cystic lesions. The modality of imaging for these cysts was evenly split, 50% of patients had a CT scan, and 50% had an MRI performed. All imaging studies were interpreted by an attending radiologist and most of them were discussed in multidisciplinary meetings. Nineteen patients (95%) had an intraoperative diagnosis of a simple liver cyst based on its visual appearance and clear fluid within the cyst. These patients underwent cyst wall fenestration and de-roofing with the cyst wall sent for histopathology. One patient (5%) with HCC underwent a non-anatomical liver resection. Histopathology was conclusive for a benign hepatic cystic lesion from the cyst wall biopsy. All 20 patients in this study underwent surgery, either due to symptoms or due to radiologic diagnosis of BCA. Four of the 20 cases (20%) were asymptomatic and out of these four cases, 3 (75%) were diagnosed as cystadenoma on the preoperative imaging studies. All 19 cases were diagnosed as a simple liver cyst on pathology. In summary, there is a growing trend of "ruling-out the diagnosis of biliary cystadenoma" in patients who present with liver cysts. Patients are appropriately more anxious after this preoperative diagnosis and the treating surgeons have medico-legal concerns regarding conservative management in asymptomatic patients diagnosed as BCA. This single center experience draws attention to the radiology criteria utilized for diagnosing a biliary cystadenoma and suggests that it is time to revisit the imaging interpretation and differential diagnosis.