Cystic Lesions Of Liver Research Articles

Multimodality Imaging of Common and Uncommon Cystic Focal Liver Lesions

Cystic lesions of the liver are frequently encountered in clinical practice. In general, they can be classified as developmental, neoplastic, infectious, inflammatory, or miscellaneous lesions. Most cystic focal liver lesions have specific sonographic, computed tomographic, and magnetic resonance imaging features. These features help narrow, in combination with critical clinical information, the differential diagnosis and negate the need for biopsy or further diagnostic investigations in many patients. The purposes of this essay are to illustrate the characteristic sonographic, computed tomographic, and magnetic resonance imaging appearances of a gamut of both common and uncommon cystic focal liver lesions, to correlate these imaging findings with gross and microscopic pathology features, and to emphasize the essential information that allows differentiating among cystic hepatic lesions. Among others, imaging features that are important to recognize include the size and shape of the cyst; the presence and thickness of a cyst wall; the presence of calcifications, mural nodularity, debris, and septations; the density and signal intensity spectrum along with the enhancement pattern; the presence of communication with the biliary tree; and the presence of pericystic changes in the hepatic parenchyma. Familiarity with the complete spectrum of cystic focal liver lesions and a thorough understanding of their classic imaging appearances will undoubtedly allow a more definitive diagnosis and shorten the diagnostic workup.

Diagnostic sensitivity of enzyme-linked immunosorbent assay for IgG in hydatid disease.

Hydatid disease in humans is most commonly caused by Echinococcus granulosus and results in development of cysts in various organs of body. The diagnosis is made by serology i.e. by estimation of antibody levels or on imaging studies. Enzyme-linked immunosorbent assay (ELISA) is widely used for serological confirmation of the disease. To study the sensitivity of ELISA for IgG antibodies against E. granulosus in detecting hydatid disease of liver or lung. A retrospective study of serology of all surgically confirmed cases of hydatid cysts of liver or lung in a tertiary level hospital. The levels of IgG antibodies against Echinococcus, measured by ELISA, in patients of cystic lesions of liver or lung, who underwent surgery for the same and confirmed as having hydatid disease, during surgery or on histopathological examination after surgery, were recorded and analysed. There were 28 such patients from January 2001 to 2007. Twenty-three patients with hydatid cysts in liver and 4 in lung were included. One patient with hydatid liver was excluded from the study due to heavily calcified cyst. Two types of kits were used; one using crude antigen and other using purified antigens. Among 23 patients with hydatid cysts of liver, 8 had positive serology while 15 had either equivocal or negative results. All 4 patients with hydatid of lung had positive serology. ELISA test is not sensitive enough to be relied upon for confirmation of hydatid disease and considering its high cost, an alternative more specific, sensitive, cheaper and easily available test needs to be evaluated for confirming hydatid disease.

Episodic biliary obstruction due to an intrahepatic biliary cystadenoma: a case report

IntroductionBiliary cystadenoma is a rare, benign neoplasm of the bile ducts with malignant potential. Symptoms, predominantly right hypochondrial pain and the feeling of a lump or fullness are usually due to the mass effect. Jaundice is rare. This is the fifth reported patient with an intrahepatic biliary cystadenoma giving rise to episodic biliary obstruction, which is usually caused by choledocholithiasis or periampullary carcinoma. Considering the mean age of previous similar patients (53.5, standard deviation 14.6 years), the early age of presentation is very unusual in our patient.Case presentationA 25-year-old Asian woman presented with right hypochondrial pain and episodic biliary obstruction. Contrast enhanced computed tomography revealed a cystic mass in segment 4B and protruding into and along the left hepatic duct. Laparotomy confirmed the contrast enhanced computed tomography findings and histology revealed an intrahepatic mucinous biliary cystadenoma.ConclusionBiliary cystadenoma should be considered as a differential diagnosis in patients with cystic liver lesions who present with episodic biliary obstruction. Due to the reported malignant potential, radical surgery such as wide local excision of the lesion or hepatic resection is needed to minimize the risk of local recurrence.

Endotheliale Nebennierenzyste als Differenzialdiagnose zur zystischen Echinokokkose bei einer türkischen Patientin

Cystic liver lesions include hepatic echinococcosis as an important differential diagnosis, especially in patients from endemic countries. Serology might be false negative in a relevant percentage of the patients. Thus, modern clinical imaging techniques are the most important non-invasive means for making or excluding the diagnosis of hepatic echinococcosis. A 37-year-old Turkish woman was admitted to hospital because of abdominal pressure, lack of appetite and weight loss. The suspected radiological diagnosis of hepatic echinococcosis was made based on a septated, cystic liver process with calcifications seen in an already performed computered tomography. The physical examination and laboratory findings did not show any specific pathology. The serological tests for echinococcosis were negative. The MRI scan of the liver showed a 10 x 7.5 cm large, multi-segmented, cystic lesion between the right kidney and the right liver lobe. The cyst was discussed as possibly having an origin from the right adrenal gland and very unlikely from the liver or kidney. Ultrasonography (Siemens-Acuson Sequoia 512, Mountain View) showed a cystic lesion with septated structures and calcifications between the right kidney and the liver without a typical capsule. Contrast-enhanced ultrasound after fractionated injection of 4.8 mL Sonovue (Bracco, Milano) showed an intensive perfusion of the septa in the cyst. We admitted the patient for surgery. Interoperatively a right adrenalectomy and cystectomy was performed. Histology showed an epithelial adrenal cyst. The patient was asymptomatic twelve months after surgery. High-end-ultrasonography with microbubble contrast media of the second generation is the primary diagnostic tool for the differential diagnosis of cystic lesions of the liver and adrenal glands. MRI or CT scans might be additionally indicated in the case of poor ultrasound conditions in a patient or before planned surgery, but can also fail to correct determine the origin of a cyst.

Diagnostic performance of contrast-enhanced ultrasound for complex cystic focal liver lesions: blinded reader study

The study was aimed at evaluating the diagnostic performance of contrast-enhanced ultrasound (CEUS) in characterizing complex cystic focal liver lesions (FLLs). Sixty-seven complex cystic FLLs in 65 patients were examined with conventional ultrasound (US) and real-time CEUS. The US and CEUS images were reviewed by a resident radiologist and a staff radiologist independently. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic performance, and the interobserver agreement was analysed. The results showed that complete non-enhancement throughout three phases of CEUS or sustained enhancement in the portal and late phases were exhibited in most benign lesions. Conversely, hypo-enhancement in the late phase was seen in all malignancies. After ROC analysis, the areas (Az) under the ROC curve were 0.774 at US versus 0.922 at CEUS (P=0.047) by the resident radiologist, and 0.917 versus 0.935 (P=0.38) by the staff radiologist. A significant difference in Az between the resident and the staff radiologists was found for US (0.774 versus 0.917, P=0.044), whereas not found for CEUS (0.922 versus 0.935, P=0.42). Interobserver agreement was improved after CEUS (kappa=0.325 at US versus kappa=0.774 at CEUS). Real-time CEUS improves the capability of discrimination between benign and malignant complex cystic FLLs, especially for the resident radiologist.

Spontaneous external biliary fistula in a dog

A 10-year-old sexually intact female dog was examined because of a static, well-circumscribed subcutaneous mass and associated fistulous draining tract located along the right ventrolateral aspect of the thoracic body wall of 15 months' duration. Results of computed tomography and fistulography confirmed the presence of the fistulous tract. Computed tomography also revealed a focal, hypodense region in the right ventral portion of the liver that was adjacent to but not clearly associated with the fistulous tract. Surgical exploration of the tract revealed that it passed into the right hemithorax to the diaphragm; entered the right medial lobe of the liver; and terminated in a well-encapsulated, cystic liver lesion. The right medial liver lobe and all affected tissues were removed. Histologically, the liver lesion consisted of a fibrotic, dilated bile duct. The dilated bile duct and fistula were lined with biliary epithelium. On the basis of these findings, a diagnosis of spontaneous external biliary fistula was made. Five months after surgery, the dog was clinically normal. To the authors' knowledge, spontaneous external biliary fistula in a dog has not been reported in the veterinary medical literature. Despite the rarity of this condition, it should be considered in a dog with similar clinical findings. Clinical findings and results of appropriate diagnostic imaging procedures may provide valuable information in making this diagnosis and in planning surgical treatment.

Imaging of cystic liver lesions in the adult

Imaging of cystic liver lesions in the adult

Inflammatory pseudotumour of the liver: the residuum of a biliary cystadenoma?

Inflammatory pseudotumour is a rare form of a liver mass. We report the case of a 28-year-old man presenting with obstructive jaundice, in whom an inflammatory pseudotumour arose with the resolution of a mucus secreting cystic liver lesion. The initial features suggested an intrahepatic cystadenoma or cystadenocarcinoma, which on its involution left a solid mass. Histopathology showed an inflammatory pseudotumour with no evidence of malignancy. A similar case has been reported recently, with the development of an inflammatory pseudotumour following collapse of a liver cyst seen on imaging. These two cases may shed some light on the origins of these rare liver lesions.

Adenocarcinoma and infection in a solitary hepatic cyst: A case report

Solitary non-parasitic liver cysts are being increasingly diagnosed due to the increased use of abdominal sonography. The majority of solitary liver cysts are asymptomatic; however, there are some complications which include infection, perforation, spontaneous hemorrhage, obstructive jaundice and neoplastic degeneration. In some cases a cystic liver lesion may mimic a tumor and is difficult to differentiate with standard imaging studies or fine needle aspiration cytology. Here in, we report a case of adenocarcinoma arising in a solitary hepatic cyst complicated with Klebsiella pneumoniae infection. High levels of CEA in the cyst fluid levels suggested malignancy, which was confirmed by pathology of the resected specimen.

Malignant cystic and necrotic liver lesions: A pattern approach to discrimination

Malignant primary and metastatic lesions of the liver have a myriad of imaging appearances. Discriminating between the various lesions requires an understanding of the underlying pathophysiology and imaging characteristics that lead to their malignant appearances. A pattern approach of recognition by imaging with understanding of why particular lesions behave the way they do on sonography, CT, MRI, and nuclear scintigraphy can be developed. A broad selection of malignant cystic liver lesions will be displayed in a multimodality pictorial style including hepatocellular carcinoma, cholangiocarcinoma, cystic and necrotic hepatic metastases, biliary cystadenoma/cystadenocarcinoma, epitheloid hemangioendothelioma, hepatoblastoma, and cystic sarcomas. Characteristic imaging features, clinical symptoms, and prognosis will be discussed. Emphasis will be placed on consistent features of these malignant lesions that help to discriminate them from other hepatic disorders.

Surgical management of benign solid and cystic liver lesions

The aim is to evaluate the indications for and results of surgery in patients with benign solid and cystic liver lesions. Resection is the best method of management of symptomatic benign solid liver lesions. For cystic lesions fenestration or resection have been the most-used treatments. Recently, laparoscopy has changed the way we treat these lesions. We reviewed the clinical files of all patients with benign solid and cystic liver lesions operated-upon between May 1995 and May 2003. There were 64 patients included in the present analysis (57 female; 7 male); median age was 48 years (range 21–74 years); 32 (50%) with benign solid liver lesions of which 22 were cavernous haemangiomas; 23 (35.9%) with non-parasitic liver disease (NPLD) and 9 (14%) had polycystic liver disease (PLD). There were 54 patients (84.3%) who had symptoms. Thirty-nine patients had liver resections performed (16 major and 23 minor), 15 patients were treated by open fenestration and 10 were treated by laparoscopic fenestration. There were 10 patients (15.6%) who presented complications; operative mortality was zero. The presence of symptoms is the most common indication for treatment. Laparoscopic fenestration has become the first-line treatment tor symptomatic NPLD and selected patients with benign solid liver lesions and PLD. However, in our centre, a considerable proportion of patients is still operated-upon via the open approach. A careful selection of cases is necessary to ensure good outcomes.

限局性嚢胞状肝内胆管拡張部に発生した肝内胆管腺腫の1例

A 72-year-old man was found by computed tomogram (CT) to have a cystic liver lesion 3 cm in diameter. Magnetic resonance imaging (MRI) showed a tumor in the cystic liver lesion, not connected with the intrahepatic bile duct. Intraoperative ultrasonography (US) showed a papillary tumor arising from the intrahepatic bile duct wall with topically cystic dilation. We conducted partial hepatectomy. Histological findings showed tubulopapillary adenoma of the topically and cystically dilated liver bile duct. We should consider such disease in diagnosis of the cystic liver disease.

Cystic focal liver lesions in the adult: differential CT and MR imaging features.

Cystic lesions of the liver in the adult can be classified as developmental, neoplastic, inflammatory, or miscellaneous. Although in some cases it is difficult to distinguish these entities with imaging criteria alone, certain cystic focal liver lesions have classic computed tomographic (CT) and magnetic resonance (MR) imaging features, which are important for the radiologist to understand and recognize. Lesions with such features include simple (bile duct) cyst, autosomal dominant polycystic liver disease, biliary hamartoma, Caroli disease, undifferentiated (embryonal) sarcoma, biliary cystadenoma and cystadenocarcinoma, cystic subtypes of primary liver neoplasms, cystic metastases, pyogenic and amebic abscesses, intrahepatic hydatid cyst, extrapancreatic pseudocyst, and intrahepatic hematoma and biloma. Specific CT and MR imaging findings that are important to recognize are the size of the lesion; the presence and thickness of a wall; the presence of septa, calcifications, or internal nodules; the enhancement pattern; the MR cholangiographic appearance; and the signal intensity spectrum. In addition, access to critical clinical information remains extremely important. The most important clinical parameters defined include age and gender, clinical history, and symptoms. An understanding of the classic CT and MR imaging appearances of cystic focal liver lesions will allow more definitive diagnosis and shorten the diagnostic work-up.

Mesenchymal hamartoma of the liver

We present a multiseptated mesenchymal hamartoma of the liver in a 10-year-old male patient, a rare benign tumor of childhood. The characteristic ultrasound and CT appearances of this unusual tumor are reviewed. A single septal calcification associated with this tumor was demonstrated, an association which has not previously been reported. The differential diagnosis for cystic liver lesions is discussed in detail.

Primary pelvic hydatid cyst

We report a case of hydatid cyst of the pelvis in a 36-year-old woman presented with right adnexal cystic mass with similar cystic lesions in the liver. Laparatomy revealed a right paraovarian cystic mass densely adhered to the uterus, to the pelvic side wall, and to the right fallopian tube. Histopathological examination of the cyst wall showed the cuticular layer of the cyst. Cystic liver lesion was later proved to be hepatic hemangioma by magnetic resonance imaging.

Hepatobiliary and pancreatic: Cystic liver lesion in a man with abdominal pain

Hepatobiliary and pancreatic: Cystic liver lesion in a man with abdominal pain

Ultrasonographic evaluation of biliary cystadenomas in cats.

The purpose of this study was to describe the ultrasonographic appearance of biliary cystadenomas in cats and compare the findings to a similar rare form of liver tumor in humans. Biliary cystadenomas are uncommon, benign liver tumors of older cats that may occur as focal or multifocal cystic lesions within the liver. The records of 10 cats which had abdominal ultrasonography and histologic diagnosis of biliary cystadenoma were reviewed. The average age of affected cats was 13.3 years (range 10-16 years). Eight cats were neutered males and two were neutered females. In three cats, the tumors were not seen ultrasonographically due to their small size or from being obscured by near-field reverberation echoes. The remaining seven cats had solitary (4 cats) or multifocal (3 cats) masses corresponding to variable ultrasonographic patterns: multilocular masses containing thin-walled cysts, hyperechoic masses with cystic components, or masses of mixed echogenicity with cystic components. The masses had variable ultrasonographic patterns when multifocal disease was present. Recognizable cysts were evident somewhere within the tumors seen ultrasonographically, although sometimes the cysts appeared very small. The biliary cystadenomas were thought to be clinically silent. Although liver enlargement or a cranial abdominal mass was palpable in 4 cats, no consistent trend of clinical signs, CBC or serum biochemical abnormalities could be directly attributed to biliary cystadenoma. The treatment of choice is surgical resection of the tumor, as continued growth may compress adjacent vital structures within the liver. The differential diagnosis of biliary cystadenomas from other cystic liver lesions such as hepatic cysts, hematomas, abscesses, parasitic cysts, or other liver tumors is discussed.

A CASE OF SMALL CYSTADENOCARCINOMA OF THE LIVER

A case of small cystadenocarcinoma of the liver is reported. A 34-year-old woman complaining of suddenonset upper abdominal pain was admitted to the hospital because abdominal ultrasonography (US) revealed a liver cyst 2×2.5cm in size with a papillary projection 0.8cm in diameter in its lumen in the medial segment (S4). The tumor was slightly enhanced on dynamic computed tomography in early phase. Though the lesion was small, cystadenocarcinoma of the liver was strongly suspected, and a partial excision (S4) was performed. Intraoperative US also revealed the tumor in the cyst without invasion and lymph node metastasis. The final pathological diagnosis was cystadenocarcinoma of the liver arising from cystadenoma. The tumor existed only in the cyst and no liver invasion was found. The patients is doing well 52 month after the operation without any signs of recurrence and metastasis. This is the smallest liver cystadenocarcinoma arising from cystadenoma among those have been operated on. Recent progress in imaging studies has facilitated the discovery of such small liver tumors including cysts. Even if a small nodule in a cystic liver lesion is found, we must bear possibility of cancer growing in mind.

Biliary cystadenoma: An ongoing diagnostic challenge

Biliary cystadenoma is a rare benign cystic liver lesion which may be difficult to diagnose by radiologic and histologic criteria. This review of eleven patients treated surgically between 1980 and 1997 illustrates the clinical, radiologic, and pathologic features which distinguish this tumor from other liver cysts. The patients were all women. Their mean age at presentation was 44 years (range: 24-68 years). Presenting complaints included mild chronic abdominal pain (4 patients), acute abdominal pain (1), and jaundice (I). Five patients were diagnosed incidentally during investigations for unrelated illnesses. Five patients were misdiagnosed initially as having simple cysts (4) or biliary duplication (I) by clinical and pathologic criteria between 1980 and 1994. These patients were treated with partial excision and all cysts progressed. A total of 17 operations were performed in these five patients until complete removal was accomplished by liver resection (3), cystectomy (1), or the disease was arrested with percutaneous, intracystic injection of 5-fluourouracil (1). There were no deaths but a total of ten complications were noted: intra-abdominal abcess (3), biliary fistula (2), wound infection (2), portal vein thrombosis (1), incisional hernia (1), and pulmonary edema (1). Six patients were correctly diagnosed with biliary cystadenomas based on clinical features and pre-operative imaging between 1987 and 1997. Radiologic characteristics included solid components in the cyst wall, septations, and multiple loculations with fluid of different densities. One stage excision was accomplished by liver resection (5) or cystectomy (1). There were no deaths and one complication, an incisional hemia, was noted in these six patients. The diagnoses were confirmed by one or more of the following histologic features: papillary projections, columnar epithelium, mucin production, spindle cell stroma, and immunohistochemical staining for CEA. No tumor recurrence has occurred in the ten patients having complete excision during a median follow-up of 30 months (range: 1-71 months). The diagnosis of biliary cystadenoma requires a high level of suspicion and understanding of the clinical, radiologic, and pathologic features of the disease. Complete removal by either cystectomy or liver resection is necessary to prevent tumor recurrence and its associated complications.

A case of gallbladder cancer associated with a common bile duct neuroma, and a cystic lesion of the liver with histologic findings similar to those of an inflammatory pseudotumor

We report a rare case of gallbladder cancer associated with a common bile duct neuroma, and a cystic liver lesion with histologic findings similar to an inflammatory pseudotumor, in a patient who had had no previous abdominal surgery. The patient was a 62-year-old man whose major complaint was fever. Ultrasonography and a computed tomography scan revealed gallstones, an elevated lesion in the gallbladder, and a cystic liver lesion. Endoscopic retrograde cholangiopancreatography demonstrated stenosis of the common bile duct. Cultures of the cystic fluid and gallbladder bile were positive for Staphylococcus aureus. The patient underwent hepatectomy (inferior S4, S5, and S6), cholecystectomy, resection of the common bile duct, and right hemicolectomy. The resected specimens revealed gallbladder cancer with the microscopic appearance of a papillary adenocarcinoma, and a 12 x 4.5 x 3.5 cm cystic liver lesion with a wall 7 mm thick. Histologic studies of the wall of the cystic liver lesion revealed infiltration by histiocytes and plasma cells, and the presence of fibrous connective tissue, which findings are characteristic of inflammatory pseudotumors. A 9 x 6 mm elevated lesion, with the microscopic appearance of a neuroma, was resected from the common bile duct.