Biliary Cystadenoma Research Articles

Predictive Factors for Preoperative Diagnosis and Management of Cystic Liver Lesions: A Six Years Single Centre Experience

Introduction: Surgical management differs for different cystic lesions of liver. Various clinical, biochemical and radiological features are specific to a particular cystic liver lesion pathology and it’s associated complications. Preoperative diagnosis helps to select appropriate surgical approach and tailoring appropriate management. Aim: To evaluate the clinical, biochemical, radiological predictive factors to differentiate between hydatid diseases, simple cyst of liver and biliary cystadenoma. Also to evaluate appropriate management for hydatid disease with cystobiliary communication. Materials and Methods: A retrospective study was conducted at Institute of Surgical Gastroenterology, Madras Medical College, Chennai, Tamil Nadu, India. Data were collected from 65 patients including 44 patients of hydatid disease, 13 patients of simple cyst, and 8 patients of biliary cystadenoma using a maintained database from January 2014 to December 2019 with a follow up period up to December 2020 (mean follow up of 47.06±24.37 months). Various parameters like presence of cholangitis, deranged liver function test, number of cystic lesion, presence of calcification, presence of septation with or without enhancement were assessed. Data were statistically analysed using Analysis of Variance (ANOVA) and Chi-square test. Results: There were 44 (67.69%) females and 21 (32.31%) males in this study with mean age of 50.44±12.23 years. Though multiseptation was associated with 27 (61.36%) of hydatid cysts and 1 (7.69%) of atypical simple cyst, it was more specifically present in biliary cystadenoma 8 (100%). Presence of daughter cyst (n=24, 54.55%) in hydatid disease and multilobulated appearance (n=5, 62.5%) in biliary cystadenoma were strong predictors of diagnosis. Radical surgery was associated with significantly less postoperative bile leak than conservative surgery in patients of hydatid disease with cystobiliary communication. Conclusion: Predictive factors can help to make preoperative diagnosis correctly. Radical surgery reduces postoperative bile leak in patients of hydatid disease with cystobiliary communication.

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.

A RARE CASE OF MUCINOUS CYSTADENOCARCINOMA OF LIVER PRESENTING AS HYDATID CYST

Hepatobiliary cystadenocarcinoma is a very rare cystic tumor that arises in the liver or, less frequently, in the extrahepatic biliary system mostly seen in elderly patients. It has been shown to arise in congenital liver cysts, bile ducts, biliary cystadenoma, in the context of bro- polycystic disease and in the hepatoduodenal ligament. In the present case report, we describe a case of rare entity of hepatobiliary cystadenocarcinoma presented in a 36 year old male patient presented to opd with complaints of pain abdomen in right side of upper abdomen since 2 months. Main concern of this case report is preoperative imaging is imprecise and frequently misdiagnosed as benign cystic lesions and delays in treatment.

Giant biliary mucinous cystadenoma mimicking mesenchymal hamartoma of the liver in a child: A case report.

IntroductionBiliary cystadenomas (BCAs) are rare benign tumors with malignant potential. They are most commonly found in middle-aged women and are quite infrequently reported in children. Even with advanced imaging, diagnosing and distinguishing BCA from other cystic liver lesions remain challenging.Case presentationA 5-year-old boy was brought in by his parents to our hospital with abdominal swelling that had been persistent for a year, along with loss of appetite and weight loss. On examination, the abdomen was distended and dull on percussion. We considered mesenchymal hamartoma of the liver (MHL) as the top differential after an abdominal CT scan with contrast showed a multi-loculated cystic tumour. For both definitive diagnosis and therapy, the patient underwent exploratory laparotomy with excision of the cystic mass. Surprisingly, histopathology examination of the resected specimen revealed biliary mucinous cystadenoma (BCA).ConclusionSince conservative methods are associated with high recurrence rates, biliary mucinous cystic neoplasms require a high index of suspicion and should be handled with total surgical resection. In the post-operative phase, periodic surveillance imaging is recommended due to the risk of recurrence and malignant transformation.

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.

Biliary cystadenoma a case report

Biliary cystadenoma (BCA) is a rare cystic neoplasm of liver with malignant potential and female predominance, mostly asymptomatic that will lead to late identification. BCAs are mostly do not communicate with Biliary tract but communication was reported in some studies, BCA has higher rate of recurrence after incomplete removal so the standard management is complete resection or partial hepatectomy. We report a case of BCA in 72-year aged female with ECOG score 3. Computed tomography showed BCA involving segment II, III, IV and VIII of liver without any malignant features, which was treated with laparoscopic deroofing with omentopexy and no recurrence at 1 year follow up. We used indocyanine green-fluorescent image to look for biliary communication. This study aims to report that minimal accesses surgery with deroofing and omentopexy can be alternative treatment for BCA without any malignant features in a poor performance status and use of Indocyanine green-fluorescent image to avoid biliary injury and rule out communication.

Giant hepatic cystadenoma mimicking a hydatid cyst: A challenging preoperative diagnosis

Biliary cystadenoma is a rare cystic tumor of the liver. It has a high recurrence rate and malignant transformation risk in middle-aged women. Pre-operative diagnosis is difficult because of the lack of clinical, biological and radiological specificity. The confirmation of the diagnosis is made by the histopathological examination. Complete surgical resection is preferred because of the high risk of malignant transformation and recurrence.

Feasibility of laparoscopic liver lobectomy in dogs.

To determine the feasibility of laparoscopic liver lobectomy (LLL) in dogs by using canine cadavers and to describe the clinical application in dogs with liver disease. Ex vivo experiment and descriptive case series. Twelve canine cadavers and six client-owned dogs. Cadavers underwent LLL with an endoscopic stapler. The percentage of liver lobe resected was determined by volume. The distance from the staple line to hilus was measured. Medical records of dogs undergoing LLL were reviewed. In cadavers ≤15 kg, left lateral lobectomy completeness was 87.3% (84.6%-96.6%), and remaining median (interquartile range) hilar length was 1 cm (0.25-1.75). Left medial lobectomy completeness was 72.5% (66.7%-80%), and remaining hilar length was 1.6 cm (0.47-1.75). Central division resection completeness was 68.3% (60%-92.9%), and remaining hilar length was 2.7 cm (0.8-5). Laparoscopic liver lobectomy was not feasible for right division lobes and in cadavers >15 kg. Five dogs with peripheral quadrate or left lateral lobe masses underwent stapled, partial laparoscopic lobectomy (30%-90%). One dog underwent stapled, left lateral lobectomy (90%) after open procedure conversion. Histopathological diagnoses included hepatocellular carcinoma (3), nodular hyperplasia (1), biliary cyst adenoma (1), and fibrosis (1). Laparoscopic liver lobectomy of the left and central divisions is feasible in cadavers ≤15 kg with an endoscopic stapler. Partial LLL of the left and central divisions is feasible in select dogs with liver disease. Laparoscopic liver lobectomy may be a viable alternative to laparotomy in small-to-medium size dogs with peripheral liver masses of the left and central divisions.

Should radiology reporting change surgeon's indication for surgery in cases of hepatic cyst?

Presenter: Aman Kumar MD | University of North Carolina at Chapel Hill Background: Simple liver cyst is a benign condition with virtually no malignant potential. Patients either present with symptoms or they are discovered incidentally due to increasing utilization of abdominal imaging. Historically management is driven by symptoms of pain; however, with increasing reporting of ‘rule out biliary cystadenoma’, patients and surgeons are even more likely to pursue surgical option. Aim of the study is to correlate radiology reports and histology by conducting a retrospective analysis of patients referred to a tertiary hospital. Methods: We analyzed the clinical, radiologic and histopathologic data for patients operated on with a diagnosis of a cystic lesion in the liver in between January 2018 - December 2020. Results: Twenty patients are 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. 10 (50%) patients had CT scans and 10 (50%) had MRI done for evaluation. All imaging was reported by an attending in radiology and the cases were discussed in a multidisciplinary hepatobiliary meeting. 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. There was a single patient who was reported as simple hepatic cyst on imaging 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 who were asymptomatic. 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. Based on this series it may be time to revisit the radiologic reporting on hepatic cysts.

Biliary cystadenoma: A typical radiological presentation

Biliary cystadenoma is a rare benign hepatobiliary cystic tumor, more common in middle-aged women. The clinical manifestation is variable. It can be asymptomatic or symptomatic presenting with abdominal pain, nausea, vomiting, or a palpable mass. We report a case of a 36-year-old female patient,

Results of Treatment of a Biliary Cystadenoma by Unroofing and Fulguration in a Female.

Results of Treatment of a Biliary Cystadenoma by Unroofing and Fulguration in a Female.

Contemporary Management of Hepatic Cyst Disease: Techniques and Outcomes at a Tertiary Hepatobiliary Center

BackgroundHepatic cyst disease is often asymptomatic, but treatment is warranted if patients experience symptoms. We describe our management approach to these patients and review the technical nuances of the laparoscopic approach. MethodsMedical records were reviewed for operative management of hepatic cysts from 2012 to 2019 at a single, tertiary academic medical center. ResultsFifty-three patients (39 female) met the inclusion criteria with median age at presentation of 65 years. Fifty cases (94.3%) were performed laparoscopically. Fourteen patients carried diagnosis of polycystic liver disease. Dominant cyst diameter was median 129 mm and located within the right lobe (30), left lobe (17), caudate (2), or was bilobar (4). Pre-operative concern for biliary cystadenoma/cystadenocarcinoma existed for 7 patients. Operative techniques included fenestration (40), fenestration with decapitation (7), decapitation alone (3), and excision (2). Partial hepatectomy was performed in conjunction with fenestration/decapitation for 15 cases: right sided (7), left sided (7), and central (1). One formal left hepatectomy was performed in a polycystic liver disease patient. Final pathology yielded simple cyst (52) and one biliary cystadenoma. Post-operative complications included bile leak (2), perihepatic fluid collection (1), pleural effusion (1), and ascites (1). At median 7.1-month follow-up, complete resolution of symptoms occurred for 34/49 patients (69.4%) who had symptoms preoperatively. Reintervention for cyst recurrence occurred for 5 cases (9.4%). ConclusionsOutcomes for hepatic cyst disease are described with predominantly laparoscopic approach, approach with minimal morbidity, and excellent clinical results.

RECURRENT PNEUMOTHORACES IN A YOUNG, NON-SMOKING WOMAN

SESSION TITLE: Medical Student/Resident Genetic and Developmental Disorders Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Alpha-1 antitrypsin deficiency (AATD) is known to affect the lungs and liver by causing the early development of emphysema and liver disease. We present a case of a non-smoker who developed emphysema in her early 40s. CASE PRESENTATION: 42 year old non-smoking female with a past medical history of multiple spontaneous pneumothoraces presented to her primary care physician (PCP) with complaints of right-sided chest pain and was found to have decreased breath sounds on the right side. She was sent for a 2-view chest x-ray and d-dimer. The posteroanterior and lateral chest x-ray showed a right side pneumothorax and she was instructed to go to the emergency department (ED) for chest tube placement. Examination in the ED revealed normal vital signs and no breath sounds on the right chest. D-dimer was unremarkable. She was seen by pulmonology who recommended further imaging. CT chest with contrast demonstrated small subpleural blebs along the medial aspect of the right lung apex, the suspected source of the spontaneous pneumothorax, and a lobulated lesion in the posterior segment of the right lobe of the liver. Given the liver findings, a MRI abdomen was done showing a mildly complex, septated cyst in the posterior right hepatic lobe measuring up to 4.4cm without enhancement consistent with a biliary cystadenoma. Serial chest x-rays were done to monitor the pneumothorax regression. The chest tube was removed three days later after absence of pneumothorax on water seal. She was discharged with a referral to thoracic surgery and had an office visit two weeks later for right-sided robotic-assisted thoracoscopic surgery with wedge excision of right apical bleb and mechanical pleurodesis. Pathology from the bleb tissue showed subpleural fibrosis and emphysematous change. AATD testing sent during her hospitalization was significant for alpha-1 antitrypsin (AAT) phenotype of SS, with an incidence of 0.1% and an AAT level of 105 mg/dL, the lower end of the normal range for her age. Pulmonary function testing did not reveal any obstructive findings. DISCUSSION: Our case demonstrates a rare presentation of the development emphysema in a non-smoker found to have the SS phenotype with low normal level of alpha-1 antitrypsin. This patient developed emphysema earlier than expected given the phenotype of AATD. Although our patient did not have classic liver manifestations, she was found to have a biliary cystadenoma. Patients with the SS phenotype are at risk to develop liver disease and early manifestations of emphysema; however they have a minimally increased risk of developing COPD, as the SS allele is related to a mild decrease in alpha-1 antitrypsin levels. CONCLUSIONS: Given the rarity of the SS phenotype, more research is needed in order to truly determine the incidence of developing lung and/or liver disease. It will be vital to help prognosticate and treat patients with alpha-1 antitrypsin deficiency. Reference #1: Fregonese L, Stolk J. Hereditary alpha-1-antitrypsin deficiency and its clinical consequences. Orphanet J Rare Dis. 2008;3:16. Reference #2: Parr DG, Stoel BC, Stolk J, Stockley RA. Pattern of Emphysema Distribution in alpha1-Antitrypsin Deficiency Influences Lung Function Impairment. Am J Respir Crit Care Med. 2004;170:1172-8. Reference #3: Kelly E, Greene CM, Carroll TP, McElvaney NG, O’Neill SJ. Alpha-1 antitrypsin deficiency. Respir Med. 2010;104:763-72. DISCLOSURES: No relevant relationships by Patrick Koo, source=Web Response No relevant relationships by Jetina Okereke, source=Web Response

Extrahepatic Mucinous Biliary Cystadenoma: A Case Report

Biliary cysts refer to cystic dilatation in the biliary ductal system that may be congenital or acquired. Extrahepatic biliary cysts constitute less than 10% of biliary cysts. Extrahepatic mucinous cystadenoma represents an extremely rare clinical condition with less than 100 cases reported in the English medical literature. Herein, we report the case of a middle-aged woman who presented with a clinical picture of cholestatic jaundice. Laboratory findings revealed elevated bilirubin and alkaline phosphatase. After a thorough investigation, she was found to have a cystic lesion in the common bile duct near the cystic duction site. The patient underwent exploratory laparotomy, which revealed a 2.0 × 2.0 cm cystic lesion in the common bile duct that is exerting an obstructive effect on the biliary ducts. Complete en-block excision of the cystic lesion was performed with Roux-en-Y hepaticojejunostomy reconstruction. Histopathological examination revealed mucinous biliary cystadenoma. Although very rare, biliary cystadenoma should be kept in mind as a differential diagnosis of cholestatic jaundice particularly in patients with no history of biliary stones or cholecystectomy.

"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"

Neoplasms and novel gammaherpesviruses in critically endangered captive European minks (Mustela lutreola).

The European mink (Mustela lutreola) is a riparian mustelid, considered one of the most endangered carnivores in the world. Alpha, beta and gammaherpesviruses described in mustelids have been occasionally associated with different pathological processes. However, there is no information about the herpesviruses species infecting European minks. In this study, 141 samples of swabs (oral, conjunctival, anal), faeces and tissues from 23 animals were analysed for herpesvirus (HV) using a pan-HV-PCR assay. Two different, potentially novel, gammaherpesvirus species were identified in 12 samples from four animals (17.3%), and tentatively named Mustelid gammaherpesvirus-2 (MUGHV-2) and MuGHV-3. Gross examination was performed on dead minks (n=11), while histopathology was performed using available samples from HV-positive individuals (n=2), identifying several neoplasms, including B-cell lymphoma (identified by immunohistochemistry) with intralesional syncytia and intranuclear inclusion bodies characteristic of HV (n=1), pulmonary adenocarcinoma (n=1), and biliary (n=1) and preputial (n=1) cystadenomas, as well as other lesions (e.g., axonal vacuolar degeneration [n=2] and neuritis [n=1]). Viral particles, consistent with HVs, were observed by electron microscopy in the mink with neural lymphoma and inclusion bodies. This is the first description of neoplasms and concurrent gammaherpesvirus infection in European minks. The pathological, ultrastructural and PCR findings (MuGHV-2) in the European mink with lymphoma strongly suggest a potential role for this novel gammaherpesvirus in its pathogenesis, as it has been reported in other HV-infected species with lymphoma. The occurrence of neural lymphoma with intralesional syncytia and herpesviral inclusions is, however, unique among mammals. Further research is warranted to elucidate the potential oncogenic properties of gammaherpesviruses in European mink and their epidemiology in the wild population.

Spontaneous Tumors and Non-Neoplastic Proliferative Lesions in Pet Degus (Octodon degus).

In recent years, degus (Octodon degus), rodents native to South America, have been becoming increasingly popular as pet animals. Data about neoplastic diseases in this species are still sparse and mainly limited to single-case reports. The aim of this study was to present neoplastic and non-neoplastic proliferative changes in 16/100 pet degus examined at the Veterinary Faculty University of Ljubljana from 2010 to 2015 and to describe the clinic-pathological features of these lesions. Twenty different lesions of the integumentary, musculoskeletal, genitourinary and gastrointestinal systems were diagnosed: amongst these were 13 malignant tumors, six benign tumors, and one non-neoplastic lesion. Cutaneous fibrosarcoma was the most common tumor (7/16 degus). It was detected more often in females (6/7 degus) and lesions were located mainly in hind limbs. The gastrointestinal tract was frequently affected, namely with two malignant neoplasms - an intestinal lymphoma and a mesenteric mesothelioma, four benign tumors – two biliary cystadenomas, an oral squamous papilloma and a hepatocellular adenoma, and a single non-neoplastic proliferative lesion. In one animal, two organic systems were involved in neoplastic lesions.

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.

Laparoscopic left hepatectomy exposing the middle hepatic vein

Presenter: Jaime Kruger MD | Hospital das Clinicas - University of Sao Paulo Background: Laparoscopic liver resections are being increasingly performed in tertiary specialized HPB centers. Lesions close to major vessels were considered a contraindication for minimally invasive operations, but with progressive technical development such operations can be performed safely offering patients the benefits of laparoscopic approach. Methods: Video describing technique for a totally laparoscopic left hepatectomy. A 65 years-old female patient presented with epigastric pain. Abdominal MRI revealed a complex cystic mass on the central portions of the left lobe suggesting a mucinous biliary neoplasia. The lesion had a close contact with the middle hepatic vein along most of its extension. Due to the importance of venous drainage on postoperative liver function a laparoscopic left hepatectomy preserving the middle hepatic vein was planned. Five ports were placed and a 10 mm 30 degree scope was employed. Transection was carried out with ultrasonic scalpel under pneumoperitoneum pressure of 12 mmHg. Results: Operative time was 150 minutes and estimated blood loss was 120 mL. Patient recovered uneventfully and was discharged from hospital on the 4th POD. Pathology report confirmed a benign mucinous biliary neoplasia (former biliary cystadenoma) without areas of suspected displasia or malignant transformation. Conclusion: Liver resection in large lesions located along major vessels is feasible and should be performed in centers with expertise in laparoscopic liver resection. Preserving adequate liver remnant venous drainage might result in better postoperative function reducing complications.