Biliary Cystadenocarcinoma Research Articles

Hemorrhagic Hepatic Cyst Mimicking a Cystic Neoplasm: Case Report

Background: Intracystic hemorrhage is an extremely rare complication of simple hepatic cysts. Clinical symptomatology is non-specific, and imaging frequently mimics a biliary cystadenoma or cystadenocarcinoma, which makes it challenging from a diagnostic point of view to an appropriate therapeutic approach. In this report, we present a case of a simple hemorrhagic hepatic cyst mimicking a cystic neoplasm. Case Report: 48-year-old men was referred to our hospital for periumbilical abdominal pain with asthenia and 11 kg weight loss. His physical examination and laboratory findings were unremarkable. Carcinoembryonic antigen concentration was three times higher than normal. Abdominal ultrasonography demonstrated an impure cystic mass measuring 120 x 96 x 108 mm on hepatic segments VI and VII. Abdominal CT showed a cystic mass at the liver possibly related to a cystadenocarcinoma. Abdominal MRI revealed a cystic mass with lobulated contours, located in segments VII, VIII and part of VI, measuring 11.8 x11.4 cm long axis, heterogeneous signal with intense fluid towards the top in T1 and T2 and intense fluid towards the decline in T2 and T1, with the appearance of a small inferior septum slightly enhanced after injection. These findings did not exclude the possibility of malignant cystic tumor, such as biliary cystadenocarcinoma. Therefore, endoscopic ultrasound showed a cystic lesion developing in the liver, with a thickened wall in places, mainly adjacent to an intracystic nodule of 25 mm, this nodule continued with the wall. Biopsy performed using a 22G ultrasound. Aspiration of liquid: string test negative. Pathological examination confirmed a hemorrhagic biliary cyst and there was no tumor tissue. We observed a significant improvement in symptoms and reduction in cyst size after needle aspiration and we decided to adopt a conservative approach. The patient was followed and one year later, the patient remained in good condition without any complaints. ................

Clinicopathological features and management of biliary cystic tumors of the liver: a single-center experience

BackgroundBiliary cystic neoplasms (BCNs) of the liver are rare pathologies encountered in hepatobiliary surgeries. Till now, there is a lack of definitive criteria used to differentiate biliary cystadenoma (BCA) from biliary cystadenocarcinoma (BCAC).MethodsIn the period between 2005 and 2018, the data of consecutive patients diagnosed with BCA and BCAC were retrospectively reviewed.ResultsA total of 62 patients underwent surgical management for BCNs. BCA was diagnosed in 50 patients while 12 patients had BCAC. Old age, male gender, smoking, and abdominal pain were strongly associated with BCAC. Left lobe location, small size, with the presence of mural nodule, and solid component were significantly noticed with BCAC. A novel pre-operative score was developed to predict the susceptibility for BCAC and help us to identify the optimal surgical strategy. Blood loss, operative time, and complications were comparable between the two study groups.ConclusionMural nodules or solid components are suggestive of BCAC. Complete surgical resection of cystic tumors of the liver is mandatory due to malignant potential of the lesion and for prolonged survival.

Differential Diagnosis Difficulty between Biliary Cystadenoma and Cystaadenocarcinoma of the Liver: A Case Report

Biliary cystadenoma is a multilocular cystic benign tumor which arises in the intrahepatic biliary system. Diagnosis is often difficult and based on imaging, however histology remains the only argument for diagnosis certainty. We report a case of biliary cystadenoma in a 69-year-old female. Observation: it was a 69-year-old female with history of RHUPUS syndrome (Lupus + Rheumatoid arthritis) under low-dose corticosteroid therapy. She presented with pain in the right hypochondrium with permanent moderate intensity for 3 months associated to altered performance status. Physical examination showed a hepatomegaly, cervical subluxation, and pulmonary condensation syndrome. Hepatobiliary ultrasound showed presence of multiple septate cystic formations occupying segments 1, 7, 8, 5 of the left liver. Abdominal CT scan and hepatic MRI were in favor of biliary cystadenoma but could not rule out biliary cystadenocarcinoma with certainty. Conclusion: biliary cystadenoma is a benign cystic tumor of the liver. The differential diagnosis with cystadenocarcinoma is most often difficult and usually requires histological analysis for diagnostic certainty.

Diagnostic and Treatment Errors in Biliary Cystadenomas and Cystadenocarcinomas: Clinical Cases

Background. Biliary cystadenomas and cystadenocarcinomas are rare cystic tumors of the liver. Complicated differential diagnostics for simple cysts often leads to errors in surveillance of patients with these tumors. Cystadenoma and cystadenocarcinoma should be suspected upon detection of single or multilocular cystic neoplasms of the liver with septa and blood flow loci in the cyst wall, especially in middle-aged women. The localization of the tumor is critical. The most common localization is segment IV of the liver. Urgent intraoperative biopsy is required to determine the extent of surgery.Case description. Clinical observations with analysis of the examination and treatment data of two female patients aged 38 and 56 were presented. Both clinical observations illustrate the underestimation of the preoperative examination data that served as a ground for diagnosis of liver cysts with inadequate extent of surgery. In the first case, the resection was incomplete, and, as such, the biliary cystadenoma recurred in the resection area, the capsule of the neoplasm was ruptured and an encysted fluid collection was formed. In the second case, lack of histological examination of the excised neoplasm, due to confidence in its morphological verification as a cyst, resulted in cystadenoma recurrence in the resection zone with metastasis to the contralateral lobe of the liver.Conclusion. Hepatic cystadenomas and cystadenocarcinomas are often misdiagnosed as simple cysts. These tumors should be suspected in central localization of the tumor in the liver, especially in young women. The clinical and instrumental symptomatology and radiological semiotics of the disease require careful evaluation. The recurrence of a cystic lesion in the resection zone in a patient previously operated for a hepatic cyst serves as an additional signal for detecting biliary cystadenoma. Rational strategy for surgical management of cystic liver lesions should include hepatectomy within healthy tissues (both anatomical and atypical) with mandatory intraoperative ultrasound and urgent histological examinations.

An Unusual Case of Biliary Cystadenoma

Biliary cystadenomas (BCAs) are rare, benign, tumors associated with liver parenchyma, and infrequently, the extrahepatic bile ducts. There is potential for malignant transformation, and as such, complete resection is crucial. Removal of the cystic lesion helps differentiate it from other hepatic lesions, such as its malignant counterpart, biliary cystadenocarcinomas (BCACs). We present the case of a 47-year-old female with a recurrence of BCA and a review of the literature. The case outlines an unusual presentation of BCA. J Curr Surg. 2022;12(2):50-55 doi: https://doi.org/10.14740/jcs431

Biliary Cystadenocarcinoma Misdiagnosed as a Hydatic Cyst of the Liver: About a Case and Literature Review

Biliary cystadenocarcinomas are very rare malignant epithelial tumors of the liver. The preoperative diagnosis of this cystic tumor is difficult because its clinical and radiological presentation is non-specific. Complete surgical removal is the recommended treatment for hepatic cystadenocarcinoma. Incomplete resection is a source of tumor recurrence and metastatic dissemination, which is the case when it is wrongly diagnosed as another benign cystic lesion of the liver. We report a new case of biliary cystadenocarcinoma that has been diagnosed as a hepatic hydatic cyst, resulting in inadequate management.

Biliary Cystadenocarcinoma Misdiagnosed As a Hydatic Cyst of the Liver: About A Case and Literature Review

Biliary cystadenocarcinomas are very rare malignant epithelial tumours of the liver. The preoperative diagnosis of this cystic tumor is difficult because its clinical and radiological presentation is non-specific. Complete surgical removal is the recommended treatment for hepatic cystadenocarcinoma. Incomplete resection is a source of tumor recurrence and metastatic dissemination, which is the case when it is wrongly diagnosed as another benign cystic lesion of the liver. We report a new case of biliary cystadenocarcinoma that has been diagnosed as a hepatic hydatic cyst, resulting in inadequate management.

Clinicopathologic Features and Outcomes of Biliary Cystic Carcinoma

Introduction: Biliary cystadenocarcinomas are very rare cystic tumors arising in the liver that remains poorly understood. There is a paucity of data regarding biliary cystadenocarcinoma in the literature. The aim of this study is to characterize the clinicopathologic features and outcomes of these rare cancers. Methods: Patients with biliary cystadenocarcinoma were identified using a national database from 2004 to 2015. Patient demographics, tumor characteristics, treatment, and overall survival were analyzed. Results: Of the 132 patients identified with biliary cystadenocarcinoma , 53% were female and 71% were White. A total of 44.5% were treated at community hospitals while 55.4% were treated at high volume academic centers. The median age was 67 years, and 25% of patients have a history of multiple primary cancers. The median tumor size was 44mm(IQR 26-80mm) with nodal involvement in 48% and distant metastases in 18.3% of patients. Among patients with resectable disease, 28.6% underwent segmentectomy while 71.4% required major hepatectomy. No adjuvant chemotherapy in 71% of patients after surgery, while 26% were treated with multi-drug systemic chemotherapy and 10.1% were treated with single agent chemotherapy. While nonoperative management translated into a 3-year survival of 11% and 5-year survival of 4.3%, patients who underwent complete resection had a 3-year survival of 71% following segmentectomy and 61.8%.with major hepatectomy. Conclusions: While few patients have resectable disease, surgical resection of biliary cystadenocarcinoma remain the treatment of choice when feasible. Further investigation is needed to assess the benefit of adjuvant chemotherapy and/or radiation for this rare histologic subtype.

Redo Surgery in Recurrent Biliary Cystadenocarcinoma at Common Bile Duct: A Case Report and Literature Review

Redo Surgery in Recurrent Biliary Cystadenocarcinoma at Common Bile Duct: A Case Report and Literature Review

S2613 Management and Outcomes of Complex Cystic Masses With Malignant Transformation

Introduction: Liver cysts are generally simple and benign; we describe the presentation and outcomes of 3 patients with rare complex cystic tumors that emphasize the broad differential diagnosis for this condition. Case Description/Methods: The records of 3 patients were reviewed with respect to presenting symptoms, their management and clinical outcomes. A 47 year old male with a history of pancreatic neuroendocrine tumor and liver metastases underwent a multivisceral transplant including the liver. Three years later he complained of postprandial right upper quadrant (RUQ) and chest pain. A new 13 cm cystic lesion was found in his liver. Surgical resection of the mass was performed revealing an angiosarcoma with epithelioid features. The patient’s condition rapidly deteriorated with weakness and muscle wasting. Given the aggressive nature of the tumor and patient debility, the patient was admitted to hospice. A 38 year old female presented with postprandial RUQ pain and CT showed a 2.5 cm complex cystic liver mass with growth compared to prior imaging. The mass was surgically removed. Pathology showed a mucinous cystic tumor with a few foci of high grade neoplasia. Follow-up imaging shows continued resolution of disease without need for adjuvant therapy. The third case, a 63 year old female, has a history of hypothyroidism and an asymptomatic 4 cm complex liver cyst for a decade until it rapidly started growing to 7.6 cm with RUQ pain. Laparoscopic marsupialization with fenestration revealed a biliary cystadenoma. Follow up imaging showed a 4 cm cystic area secondary to residual inflammation. Discussion: The majority of hepatic cysts are benign and less than 5 % are malignant. Imaging characteristics may provide insight into discerning benign epatic cysts from malignant ones. Complex cysts have many septations and contain hemorrhagic or proteinaceous fluid. Biliary cystadenoma, which is premalignant, and biliary cystadenocarcinoma usually present as complex cysts. Mucinous cystic neoplasms of the liver are very rare, usually complex, premalignant, yet definitive diagnosis is challenging. Primary hepatic angiosarcomas are seen in middle aged patients; these have a propensity for local recurrence and malignant change. These cases emphasize the importance of the follow up and an early intervention of incidentally found hepatic large complex cysts.

Redo Surgery in Recurrent Biliary Cystadenocarcinoma at Common Bile Duct: A Case Report and Literature Review

Redo Surgery in Recurrent Biliary Cystadenocarcinoma at Common Bile Duct: A Case Report and Literature Review

"Biliary cystadenoma and cystadenocarcinoma in patients operated for liver hydatid cysts: a retrospective clinical study and literature review"

"Biliary cystadenoma and cystadenocarcinoma in patients operated for liver hydatid cysts: a retrospective clinical study and literature review"

Recurrent Giant Intrahepatic Biliary Cystadenoma: Case Report and Review of Literature

AbstractBiliary cystadenoma is a very rare cystic neoplasm of the liver that usually occurs almost exclusively in middle-aged women. These are slowly progressive tumours and cannot be safely differentiated from cystadenocarcinomas on preoperative imaging and hence should always be considered for resection. Historically these cystic tumors have been treated by a variety of techniques including aspiration, fenestration, internal drainage, partial resection resulting in high rates of recurrence. In addition biliary cystadenoma is a premalignant lesion and only surgical excision can differentiate it from its malignant counterpart, biliary cystadenocarcinoma.

Biliary Mucinous Cystadenoma: A Review of the Literature.

Biliary mucinous cystadenomas are cystic neoplasms commonly mistaken for simple cysts. They are rare and generally benign tumors, often incidentally found on imaging and during unrelated surgical interventions. They tend to be slow growing though may reach symptomatic dimensions. Misdiagnosis of biliary mucinous cystadenomas may have serious consequences secondary to their potential for malignant transformation into biliary mucinous cystadenocarcinomas. Here, we review the epidemiology, etiology, pathology, diagnostic modalities, histology, and available treatment methods for mucinous cystadenomas reported in current literature.

Laparoscopy-assisted extended right hepatectomy for giant hemorrhagic hepatic cyst mimicking biliary cystadenocarcinoma: a case report

BackgroundHemorrhagic hepatic cysts infrequently involve several iconographic changes requiring a differential diagnosis, primarily with a cystic malignancy. We herein report a case of laparoscopy-assisted extended right hepatectomy for a giant hemorrhagic hepatic cyst with an enhancing mural nodule that was clinically suspected of being biliary cystadenocarcinoma.Case presentationA 73-year-old woman was followed up for giant hepatic cyst occupying the right lobe of the liver. During the follow-up, an enhancing mural nodule was newly noted on computed tomography in 2016. Based on additional clinical examinations, biliary cystadenocarcinoma was undeniable, and laparoscopy-assisted extended right hepatectomy was performed for diagnostic and therapeutic purposes. She had no perioperative complications and was discharged on postoperative day 13. A histological examination of the mural nodule showed neovascularization within an organized hematoma.ConclusionWe herein report a rare case of giant hemorrhagic hepatic cyst mimicking biliary cystadenocarcinoma that was successfully treated with laparoscopy-assisted extended right hepatectomy. Laparoscopic surgery in our case was an effective procedure performed with the utmost care.

Advances in diagnosis and treatment of intrahepatic biliary cystadenoma

Intrahepatic biliary cystadenoma (IBC) is a rare benign cystic neoplasm of liver, with malignant potential to transform into intrahepatic biliary cystadenocarcinoma. IBC predominantly occurs in women up to 85%, showing no special clinical symptoms and a polycystic lesion inside the liver on image examination. It is difficult to differentially diagnose from other cystic lesions of the liver such as simple liver cyst, intraductal papillary neoplasm of the bile duct, etc. The missed diagnosis and misdiagnosis rate were rather high in IBC, which is accurately diagnosed by pathological examination. Complete surgical removal of the tumor is the best way to cure it, and also can bring a satisfactory outcome to patients. Key words: Intrahepatic biliary cystadenoma; Intrahepatic biliary cystadenocarcinoma; Liver mucinous cystic neoplasms; Etiology; Pathogenesis; Clinical manifestation; Therapy

Hepatic Sclerosing Hemangioma with Predominance of the Sclerosed Area Mimicking a Biliary Cystadenocarcinoma

We report here an extremely rare case of hepatic sclerosing hemangioma mimicking a biliary cystadenocarcinoma. A previously healthy 39-year-old woman was referred to our hospital because of a large tumor in the liver. Abdominal computed tomography revealed early peripheral ring enhancement in the arterial phase and slight internal heterogeneous enhancement in the delayed phase. Magnetic resonance imaging revealed a tumor with low intensity in the T1-weighted image and very high intensity in the fat-saturated T2-weighted image. The patient underwent hepatectomy for a possible malignant liver tumor. Grossly, the tumor appeared as a white, solid, and cystic mass (weighted 1.1 kg and measured 170×100×80 mm) that was elastic, soft, and homogeneous with a yellowish area. Histological examination showed that the tumor mostly consisted of fibrotic areas with hyalinization. The typical histology of cavernous hemangioma was confirmed in part, and the tumor was diagnosed as a sclerosing hemangioma with predominancy of the sclerosed area. A review of 20 cases reported previously revealed that only 2 (10%) patients were diagnosed as having sclerosing hemangioma preoperatively.

Value of multi-phase enhanced MRI combined with histogram analysis of apparent diffusion coefficient in differential diagnosis of intrahepatic biliary cystadenoma and intrahepatic biliary cystadenocarcinoma

Objective To investigate the value of quantitative multi-phase enhanced MRI combined with histogram analysis of ADC in differential diagnosis of intrahepatic biliary cystadenoma (HBCA) and intrahepatic biliary cystadeno carcinoma (HBCAC). Methods Twenty-five patients with pathologically confirmed intrahepatic biliary cystic tumor (HBCT), including 16 cases of HBCA and 9 cases of HBCAC, were retrospectively analyzed. All the patients underwent upper abdominal MR plain scan and multi-phase enhanced scan. The MRI findings of the lesions were observed. The peak contrast enhancement ratio (pCER) of the lesions in the arterial phase, portal venous phase and delayed phase was calculated. ADC histogram analysis was performed and the quantitative parameters were acquired, including the average, standard deviation, median, kurtosis, skewness, and the 10th, 30th,70th, 90th percentile. Qualitative parameters were compared using Fisher exact test. The continuous variables with normal distribution and homogeneous variance were compared by independent sample t test. The continuous variables with skewed distribution were compared by Mann-Whitney U test. The ROC curve analysis was used to evaluate the differential diagnostic ability of the variables with significant differences between HBCA and HBCAC patients. Results There was a statistically significant difference between HBCA and HBCAC in terms of gender, age and whether there was bile duct dilatation or mural nodules (all P 0.05). The pCER of arterial phase, portal venous phase and delayed phase of HBCAC patients were higher than those of HBCA patients (all P<0.05).The standard deviation of ADC value of HBCAC group was higher than that of HBCA group, while the kurtosis and the 10th percentile were lower than those of HBCA group, and the differences were statistically significant between the two groups (all P<0.05). When the 10th percentile value of ADC histogram was ≤ 2.060×10-3 mm2/s, the area under the ROC curve of discriminating between HBCA and HBCAC was the largest (0.861), and the diagnostic accuracy, sensitivity and specificity were 84.0% and 77.8% and 87.5%, respectively. Conclusion Quantitative multi-phase enhanced MRI combined with histogram analysis of ADC had certain value for the differential diagnosis of HBCA and HBCAC, and the 10th percentile of the ADC histogram had the best diagnostic efficiency. Key words: Bile duct neoplasms; Magnetic resonance imaging; Diffusion weighted imaging; Histogram

Systemic Amyloidosis in an African Tiger Snake (Telescopus semiannulatus)

An adult male African tiger snake (Telescopus semiannulatus) was diagnosed with disseminated mycobacteriosis and a hepatic biliary cystadenocarcinoma. Histologically, the spleen was largely replaced by extracellular deposits of eosinophilic, fibrillar to hyaline material. Similar material was also present in the testicular interstitium and occasional blood vessel walls. This material was congophilic with strong green birefringence under polarized light and emitted fluorescence when bound to the luminescent-conjugated oligothiophene, h-FTAA, an amyloid binding probe. Ultrastructurally, deposits were composed of aggregates of haphazardly arranged, non-branching fibrils up to 8nm in diameter and of indeterminate length. These findings all supported a diagnosis of amyloidosis, most likely amyloid A (AA) type based on concurrent inflammatory disease in this snake. However, immunohistochemistry for serum amyloid A was negative. There are only rare previous reports of amyloidosis in reptiles and many have been incompletely characterized. This case presents a thorough investigation into an occurrence of systemic amyloidosis in a snake, including a novel use of luminescent-conjugated oligothiophene binding in a reptile to confirm the diagnosis.

Biliary Cystadenoma and Cystadenocarcinoma of the Gallbladder: A Clinical Review

Biliary Cystadenoma and Cystadenocarcinoma of the Gallbladder: A Clinical Review