Biliary Cystadenoma Research Articles

Unusual Case of Large Biliary Cystadenoma in a Two-Year Old Child-Diagnostics and Therapy

Unusual Case of Large Biliary Cystadenoma in a Two-Year Old Child-Diagnostics and Therapy

Intra- and interobserver agreement in computed tomography localization of primary nonhematopoietic hepatic masses and comparison with surgical and histopathological outcomes in 21 cats.

Computed tomography (CT) is commonly used in the staging of hepatic masses and for liver lobectomy planning. Mass location is an important factor in determining the feasibility of resection, including surgical technique and the likelihood of surgical complications. The objectives of this retrospective descriptive cross-sectional, observer agreement, method comparison study were to assess the reliability of CT in correctly determining the hepatic division and lobar site of origin of feline primary nonhematopoietic hepatic masses, compared with surgically confirmed locations. Furthermore, it provides an overview of the types and locations of liver masses found in a cohort of cats. Pre- and postcontrast CT images of 21 cats were independently and simultaneously reviewed by two observers. Intra- and interobserver agreements and descriptive statistics on demographic and histological diagnoses were calculated. Based on surgical assessment, it was found that masses most frequently originated from the left hepatic division (13/24, 54%). The most frequent lobar origins were the left lateral (8/24, 33%), left medial (5/24, 21%), and right medial lobes (5/24, 21%). No masses were found originating from the right lateral lobe. CT correctly determined hepatic division and lobar origin in 76% of cases, with good-to-excellent intra- and interobserver agreement. The hepatic division had higher agreements overall for both observers. Most of the masses were benign (17/21, 81%), and the most prevalent histological diagnoses were biliary cystadenoma (11/21, 52%) and hepatocellular adenoma (6/21, 29%). Findings suggest that postcontrast CT is a reliable method for correctly determining hepatic mass division and lobar origin in cats.

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. ................

The Muculent Bleb-Mucinous Cystic Neoplasm-Hepatobiliary Region

Mucinous cystic neoplasm configures as a cystic neoplasm incriminating the hepatic parenchyma. Tumour is constituted of multi-locular or cystic cavity layered with mucinous or biliary type epithelium encompassed within an ovarian type stroma. The cystic lesion appears non communicative with adjoining bile ducts. Additionally designated as hepatobiliary cystadenoma, biliary cystadenoma or cystadenoma with mesenchymal stroma, neoplasms associated with invasive carcinoma component may be denominated as hepatobiliary cystadenocarcinoma.

Intra-axial Hepatic Cerebrospinal Fluid Pseudocyst: An Unusual Complication of Ventriculoperitoneal Shunt Placement

Intra-abdominal Cerebrospinal Fluid (CSF) pseudocysts are a well-known and potentially serious complication of Ventriculoperitoneal (VP) shunt placement. These cysts are often found within the peritoneal cavity or along the serosal surface of solid organs. Here, we present an unusual case of an intrahepatic CSF pseudocyst in a 14-year-old female patient with a VP shunt placed three years ago, following the excision of a cerebellar pilocytic astrocytoma. The child presented with complaints of right hypochondriac pain and tenderness for one month. On ultrasound of the abdomen, the right lobe of the liver showed a complex anechoic cystic collection with multiple thick internal septations. A Contrast-enhanced Computed Tomography (CECT) examination revealed a well-defined hypodense collection in segments IV and V of the liver with a VP shunt tube within. Based on clinical and imaging features, differentials of intra-axial intrahepatic CSF pseudocyst, complex hepatic cyst, peri-shunt hemorrhagic cyst, and biliary cystadenoma were considered. Aspiration of the cyst revealed clear, colourless, non purulent, non sanguineous fluid which tested positive for beta-2-transferrin, confirming the collection to be a CSF pseudocyst. An elective laparoscopic cyst excision with shunt revision was performed with no recurrence on follow-up. The present case highlights the uncommon occurrence of intrahepatic CSF pseudocysts post-VP shunt, necessitating meticulous diagnostic evaluation. Successful laparoscopic excision and shunt revision underscore the efficacy of tailored interventions. This contribution enhances the understanding of atypical complications in VP shunt recipients, guiding clinicians and radiologists in both diagnosis and management.

Paediatric Mesenchymal Hamartoma of Liver-A Diagnostic Dilemma

Introduction and Importance: Benign tumors of the liver are relatively rare in children. Mesenchymal hamartoma (MH) is a benign tumor of the liver. It is the second most common benign pediatric hepatic tumor after infantile hemangioma. Mostly it is seen in children less than 2 years of age. The diagnosis of this tumor is difficult because of nonspecific clinical symptoms and lack of definitive laboratory studies. The precise diagnosis of mesenchymal hamartoma relies on histological evaluation of the tissue.We hereby present a rare case in a 2 year old child with mesenchymal hamartoma and its diagnostic challenges. Case presentation: A 2 year old previously healthy male was referred to our institution for evaluation of a liver mass. He complained of loss of apetite and abdominal distension since last 10 weeks. He had no complaints of fever/trauma. Clinical findings and Investigations: On per abdomen examination,there was a presence of large, non tender hepatomegaly with no shifting dullness present. On radiological evaluation, Ultrasound abdomen showed solitary right lobe mass. On further imaging, CT scan of the abdomen was done which showed a large multiloculated lesion in right lobe liver with arterial enhancing intervening septae within.The lesion was compressing and displacing right portal vein and right hepatic vein. At that time, laboratory evaluation showed normal liver function tests, serum AFP and other blood parameters. Differentials of liver cyst, hydatid cyst and biliary cystadenoma was made. Intervention and outcome: After discussion in multidisciplinary care, he was planned for surgery which would provide the exact histological diagnosis also in such cystic lesion of liver.He was optimized for surgery and subsequently underwent right hepatectomy with resection of the ~14× 12 cm mass. No major periperative complications developed and patient was discharged from hospital on POD6. The pathological review of the resected mass showed mixture of bile ducts, vessels, irregular liver cell plates and loose mesenchyme containing variable sized cysts consistent with a mesenchymal hamartoma. He is asymptomatic at the time of regular follow-up visits. Relevance and Impact: Benign tumors of the liver are relatively rare in children. The diagnosis of mesenchymal hamartoma still remains a challenge with non –specific complaints, normal laboratory findings and delay in diagnosis can lead to complications from local compression. Though advance imaging can diagnose this entity if index of suspicion is high but Differentiating it from other tumors such as an undifferentiated embryonal sarcoma is difficult on imaging alone. Hence surgical excision is the gold standard for diagnosing to reach the final histological diagnosis and treating these entities.

Mucinous Cystadenoma of the Cystic Duct

A rare clinical observation of a cystic formation of the biliary system — mucinous cystadenoma of the cystic duct is presented. This type of tumors is benign, but in 20 % of cases their malignancy is described. They are often detected incidentally during routine examination and require surgical treatment, regardless of clinical manifestations. Difficulties in differential diagnosis led to unreasonably long follow-up, ending with malignancy of cystadenomas, which reduces the possibility of radical surgical treatment. Therefore, timely detection and differentiation of biliary mucinous cystadenomas by examination are very important for treatment strategy.

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.

V-028 HYBRID (LAPAROSCOPIC AND OPEN) REPAIR WITH REVERSE TAR TO TREAT A LATERAL INCISIONAL HERNIA WITH DENERVATION OF THE RIGHT ABDOMINAL MUSCLES

Abstract Aim Lateral incisional hernias with denervation of the muscles of the abdominal wall are a problem difficult to solve. The repair of the defect does not guarantee a functionality of the abdominal muscles if the lack of force of the abdominal wall is not solved. With the technique we present there is a minimally invasive reinforcement of the mid lateral wall affected. Material and Method 54 yo female. Previous surgeries: biliary cystadenoma 2014 by Makuuchi laparotomy (2 surgeries), Ooforectomy 2011, Hysterectomy 2013, Mamoplasty 2001, 3 vertebral surgeries. Six months after the surgery she felt a growing lump in the right side of the incision. Physical exam: right lateral incisional hernia and small umbilical hernia. Asymmetry of the abdominal wall because of flaccidity of the right abdominal muscles. Ultrasound Voluminous incisional hernia in the right flank dependent of the right transverse sub-costal incision with a hernia ring of 20mm and hernia sac 60mm of diameter increasing with Vasalva maneuvers. Surgical technique Hybrid approach laparoscopic and lateral by e-TEP to dissect the retrorectal bilateral space and lateral preperitoneal approach with reverse TAR. A macroporous polipropilene preperitoneal mesh is placed from the right psoas to left semilunar line and from top to bottom of the abdominal wall. Result Discharged 2nd po. day without complications. 5 months after surgery she has a symmetric abdominal wall without recurrence. Conclusion Hybrid technique to repair lateral hernias with denervation allows a wide repair with low morbidity and good tolerance with excellent result in abdominal functionality.

COMPARATIVE STUDY OF FOCAL LIVER LESIONS ON CECT AND 3T MRI.

Background: Focal liver disease is a common diagnostic problem referred to radiologists for evaluation owing to its nonspecic clinical presentation [1]. The rst line of investigation is ultrasonography. Since ultrasonography is less specic, better modes of investigation are needed for better characterization and hence diagnosis of FLLs. The available options are computed tomography (CT) and magnetic resonance imaging (MRI) [5]. It is important to characterize these lesions to determine their nature and thus, plan further management. Material & methods: This is a prospective observational study performed in tertiary care hospital during year 2021-22 which had 54 patients referred for CECT and MRI Abdomen & Pelvis scans to department of radiology with diagnosed or suspected focal liver lesions or deranged liver function tests (LFTs). These patients were evaluated on a 128 slice CTscanner and 3T MRI scanner. Results: In this study 51.9% cases were benign and 48.1% were malignant. Of the benign cases, 50% cases were abscesses followed by hydatid disease, haemangioma, biliary cystadenoma, simple cyst and hepatic adenoma as 17.8%, 17.8%, 7.1%, 3.5% and 3.5% respectively and of the malignant cases, 65.3% cases were metastasis followed by HCC, IHCC, spindle cell neoplasm and lymphoma as 19.2%, 7.7%, 3.8% and 3.8% respectively. While CECT correctly diagnosed 43 cases, MRI was able to diagnose 45 cases correctly. Conclusion: 1) CECT and MRI were found to be comparable and highly accurate in the diagnoses of FLLs. However, CECT performed better for abscesses whereas MRI was better for metastatic lesions. 2) DWI sequence was found to be of great importance in the diagnosis of not only smaller lesions, but also helped in the distinction of malignant lesions from benign. 3) Contrast administration was found to be invaluable in the condent characterization of FLLs both with CTand MRI.

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.

Management of Biliary Cystadenomas – Do Different Surgical Approaches Affect Their Recurrence?

Management of Biliary Cystadenomas – Do Different Surgical Approaches Affect Their Recurrence?

Intrahepatic biliary cystadenoma with mesenchymal (ovarian) stroma in an elderly female: A rare entity

Intrahepatic biliary cystadenoma with mesenchymal (ovarian) stroma in an elderly female: A rare entity

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

Intrahepatic biliary cystadenoma: Confusion, experience, and lessons learned from our center.

Intrahepatic biliary cystadenoma (IBC) is a rare benign cystic tumor of the liver. So far, it has not been comprehensively understood, which causes incorrect diagnosis, treatment confusion, and even inappropriate treatment. Here, we reviewed clinical data of IBC patients in our center, shared our experiences and lessons learned, and improved the level of diagnosis and treatment. The clinical data of 10 patients with pathologically diagnosed IBC, admitted to the Department of Hepatobiliary Surgery of the Affiliated Hospital of Guangdong Medical University from January, 2007, to January, 2022 were retrospectively analyzed. 10 patients underwent surgery and were discharged successfully. Cyst morphology: multiple cysts: 6 cases (6/10), monocular cyst: four cases(4/10). Six patients (6/10) were diagnosed as IBC preoperatively and received hepatectomy. Four patients with monocular cyst IBC underwent intraoperative frozen section examination, except one case showed IBC; the rest were misdiagnosed as simple liver cyst. In three misdiagnosed patients, one underwent open left hepatectomy seven days after the initial operation. The other patient refused to undergo reoperation and required follow-up observation. The last patient could not tolerate hepatectomy due to insufficient residual liver volume and chose follow-up observation. For IBC, especially monocular IBC, it is easy to be misdiagnosed as simple hepatic cyst, which brings great confusion to clinical treatment. We propose strengthening communication with pathologists to deepen understanding of IBC. Attention should be paid to the cyst wall's shape and the cyst fluid's properties during the operation to avoid the missed diagnosis, misdiagnosis, or even improper operation. For suspicious cases, directly choose hepatectomy to avoid reoperation after thoroughly evaluating the patient's condition.

Biliary cystadenoma in an 8-year-old Caucasian bitch

Biliary cystadenoma is reported in an 8-year-old female Caucasian dog diagnosed by gross and microscopic examination. The gross lesion observed during postmortem examination on the liver was a 3×2cm cream-coloured raised nodule that extended into the parenchyma and another 2×4cm cyst filled with mucoid fluid. Histopathology showed multiloculated cysts lined by columnar and occasionally flattened epithelial cells, with papillary projections into the lumens. These findings are discussed in the paper.

Hepatobiliary mucinous cystadenoma in a two year old

Mucinous cystadenomas of hepatobiliary (MCAHb) are rare and generally benign intrahepatic cystic neoplasms, only few pediatric cases were found in the literature. These lesions are clinical presentation differ significantly so they can mimic other liver lesions. In this case report, we discuss a 2-year-old girl who presented with abdominal pain and distended abdomen, for which she had an abdominal ultrasound (US) and Computerized tomography (CT) were objectived cystic lesion lobe multi-loculated with regular borders in the left hepatic, the diagnostic was a hydatid cyst.The histopathological exam, after a laparotomy, revealed a biliary mucinous cystadenoma. Herein, we review the current literature on biliary mucinous cystic neoplasms in pediatric population. The diagnosis of MCAHb is made on several parameters radiological, biochemical, serological and histological.

A case of hilar biliary cystadenoma with elevated IgG4 levels.

Cholangiocytic adenoma in the hilar bile duct is rare, and elevated IgG4 at the same time is extremely rare. This situation has not been reported in the literature. Nonetheless, the current case involved hilar biliary cystadenoma with elevated IgG4 levels. A 66-year-old man presented at this hospital with dark tea-colored urine. Preoperative imaging studies suggested hilar cholangiocarcinoma. This case demonstrates the difficulty of preoperative diagnosis of benign hilar lesions and the rarity of two combined benign lesions. A point of contention is whether this case should be treated with surgery or hormone therapy.

Biliary cystadenoma in a lion (Panthera leo)

Animals in human care often exceed the life expectancy of animals in the wild when they have veterinarian follow-ups, no competition for space or food, and continuous care. Advanced age favors the development of mutations that often trigger cancer, which sometimes causes death. There are reports in the literature on neoplasms in lions in the liver, which are one of the main organs affected. A 20-year-old lion specimen was received for necropsy at the Federal University of Paraná, Curitiba, Brazil. Multiple cystic dilations were observed in the liver. Histologically, they were internally covered by a simple cuboidal epithelium, similar to that observed in the bile ducts, without cellular atypia. The adjacent liver parenchyma presented with mild disorganization of the hepatocyte cords. Biliary cystadenomas are benign growths formed by a thin opaque capsule filled with a slightly yellowish translucent fluid compressing the adjacent liver parenchyma, as highlighted in this case. The epithelium of the cysts was positive for anti-cytokeratin (CK) (EIA/A3E) and anti-CK7, confirming histogenesis in the bile ducts. This study reports a case of biliary cystadenoma in a Panthera leo specimen.