Diagnosis Of Biliary Cystadenoma Research Articles

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.

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 in a Female Patient with HCV-Related Liver Cirrhosis: A Case Report

Biliary cystadenoma (BCA) is a rare tumor which is difficult to diagnose before surgery. We present a case of 73 years old woman with a previous histological diagnosis of biliary cystadenoma occurred in 2009, surgically removed. In January 2018, abdomen Computerized Tomography scan (CTs) showed a 65 mm diameter cystic mass in the fifth hepatic segment. Even if the patient refused to undergo surgical resection due to her several comorbilities, imaging features and clinical history are suggestive for BCA recurrence.

Diagnosis of biliary cystadenoma by peroral video cholangioscopy

Diagnosis of biliary cystadenoma by peroral video cholangioscopy

Giant biliary cystadenoma complicated with polycystic liver: A case report

Biliary cystadenoma (BCA) is a rare hepatic neoplasm. Although considered a benign cystic tumor of the liver, BCA has a high risk of recurrence with incomplete excision and a potential risk for malignant degeneration. Correct diagnosis and complete tumor excision with negative margins are the mainstay of treatment. Unfortunately, due to the lack of presenting symptoms, and normal laboratory results in most patients, BCA is hard to distinguish from other cystic lesions of the liver such as biliary cystadenocarcinoma, hepatic cyst, hydatid cyst, Caroli disease, undifferentiated sarcoma, intraductal papillary mucinous tumor, and hepatocellular carcinoma. Ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) may be necessary. They demonstrate intrahepatic cystic lesions with features such as mural nodules, varying wall thickness, papillary projections, and internal septations. Nevertheless, surgery is still the only means of accurate diagnosis. Definitive diagnosis requires histological examination following formal resection. We describe a 57-year-old woman initially diagnosed with polycystic liver who was subsequently diagnosed with giant intrahepatic BCA in the left hepatic lobe. This indicates that both US physicians and hepatobiliary specialists should attach importance to hepatic cysts, and CT or MRI should be performed for further examination when a diagnosis of BCA is suspected.

Giant mesenchymal hamartoma of the liver in an adult

We report a case of hepatic mesenchymal hamartoma in an adult; this condition is extremely rare, with only 15 cases having been reported in the English-language literature worldwide. The patient was a 36-year-old woman who was seen at her local hospital for upper abdominal distension. A giant multilocular cystic tumor, which had almost entirely replaced the normal parenchyma of the right lobe of the liver, was diagnosed. She was referred to our hospital, where, with a diagnosis of biliary cystadenoma, the tumor was successfully removed by right hemihepatectomy. After an uneventful postoperative course, the patient was discharged from our hospital. On histological examination, the tumor consisted of numerous cystic lesions without epithelial lining cells; hepatocytes, bile duct, and vascular components, without either lobular structure or atypia, were observed in the pseudocyst wall, leading to a diagnosis of hepatic mesenchymal hamartoma. There have been a few previously reported cases of multifocal hepatic mesenchymal hamartoma reappearing in the remaining liver after hepatectomy, although these cases are considered to be extremely rare. Therefore, periodic follow-up will be necessary for the patient.

Assessment of MRI and MRCP in diagnosis of biliary cystadenoma and cystadenocarcinoma

Magnetic resonance imaging (MRI) and magnetic resonance cholangio-pancreatography (MRCP) features were analyzed in the diagnosis of seven surgically resected hepatobiliary cystic tumors with reference to histopathological data. Homogeneity, size, location, signal intensity, presence or absence of septa and/or nodules and MRCP features of the lesions were studied. Histological evidence demonstrated six biliary cystadenoma (BCA) including four pseudo-ovarian stroma (POS) and one biliary cystadenocarcinoma (BCAC). Cystic lesions (3-15 cm in diameter) were homogeneous in the six BCA, heterogeneous in the one BCAC, and were located in the left and right liver, respectively. On T2-weighted images all lesions were hyperintense. On T1-weighted images hypointensity was found in three BCA (all serous fluid, including one POS), isointensity was found in the three others (two mucinous and one hemorrhagic fluid, including three POS) and in the one BCAC (containing mucinous fluid). Septas were present in all cases and nodules only in the one BCAC. On MRCP a hyperintense cystic lesion was found in all cases and a bile ducts dilatation in two BCA and the one BCAC. Gadolinium-enhanced MRI in combination with MRCP is a valuable tool for the diagnosis of BCA or BCAC. However, no specific information is gained for POS detection.

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.