Hepatic Cystic Lesions Research Articles

Sclerotherapy as a palliative treatment for spontaneous huge biloma

A 91-year-old man with a history of surgically cured nasal cancer and coronary artery disease presented to our emergency department (ED) due to epigastric discomfort and poor appetite lasting for 1 day. He denied any prior trauma, intra-abdominal surgery, or choledocholithiasis. There was no dizziness or exertional dyspnea, but icteric sclera was present. Laboratory testing revealed hyperbilirubinemia (3.67 mg/dl). An abdominal computed tomography (CT scan) showed one huge hepatic cystic lesion with biliary obstruction (Fig. 1a). The surgeon deemed surgical cystectomy or fenestration unsuitable owing to his advanced age and cardiac comorbidity. CT-guided pigtail insertion was done with bile-like fluid aspirated, but no bile duct connection was found. The diagnosis of biloma was favored. After 2 days of drainage, we instilled 70 ml povidone iodine solution into the cyst cavity for sclerotherapy. A non-contrast CT 1 week later showed significant shrinkage of the biloma (Fig. 1b). He was discharged uneventfully after jaundice subsided, with progressive biloma shrinkage during the follow-up months. Bilomas are localized encapsulated pseudotumors consisting of bile juice accumulation, mostly within the hepatic parenchyma and rarely in the peritoneum or abdominal wall [1]. Bilomas result from traumatic injury of intraor extra-hepatic bile duct, or a complication of hepatobiliary procedures (mostly within 6 months). Nontraumatic and non-iatrogenic ones are termed ‘‘spontaneous bilomas’’, as in this patient [2]. Typical presentations are upper abdominal pain, but obstructive jaundice is rather rare, since bilomas commonly harbor connections with bile ducts. The exact mechanism of spontaneous biloma formation is unclear, but spasm of the sphincter of Oddi or biliary diverticuli rupture has been purported as a plausible mechanism [3]. Small bilomas are usually asymptomatic and regress spontaneously within weeks. Large and symptomatic bilomas are often managed with surgical or percutaneous drainage [4]. We have not found any reports concerning sclerotherapy for biloma for those patients unfit for surgery, but it would be a safe alternative option.

A rare benign condition: Intrahepatic giant biliary cyst in an adult

Most hepatic cysts are found accidentally on imaging studies and have a tendency to present a favourable evolution. Differential diagnosis of an isolated hepatic cystic lesion mainly includes simple cyst, hydatid cyst, hepatobiliary cystic neoplasm, and biliary cyst. We report the case of a woman who presented a giant biliary cyst and had a successful outcome following partial hepatectomy.

Spectrum of Multilocular Cystic Hepatic Lesions: CT and MR Imaging Findings with Pathologic Correlation

A multilocular cystic hepatic lesion detected at computed tomography (CT) and magnetic resonance (MR) imaging is a common but nonspecific radiologic finding that can cause potential challenges for differential diagnosis. This imaging pattern may be observed in a wide spectrum of common and uncommon neoplastic or nonneoplastic entities. Neoplastic lesions include cystadenoma, cystadenocarcinoma, hepatocellular carcinoma (HCC), metastases, mesenchymal hamartoma, and inflammatory myofibroblastic tumor. Nonneoplastic lesions include hepatic abscess, echinococcal cyst, intrahepatic hematoma, and biloma. The multiple coalescent cysts seen in polycystic liver disease may exhibit an imaging pattern similar to that of a multilocular cystic lesion. Mural nodularity, irregular thickness of the septa, ragged inner surface, and typical enhancement pattern in the solid portion of the lesion are often indicative of malignancy, although multilocular primary or secondary malignant tumors are uncommon. Recognition of the more common necrosis or cystic change of HCC and metastases induced by locoregional or systemic treatment also is important. The nonenhanced cystic component may be composed of different types of fluids (eg, serous, mucinous, proteinaceous, hemorrhagic, bilious, or mixed) or spontaneous or treatment-related necrosis, whereas the septa may be formed by a wide range of tissues depending on the lesion type. An understanding of the CT and MR imaging findings of these lesions and their respective pathologic correlation aids in accurate diagnosis.

A cystic lesion encases the right coronary artery

Case report description: A 75-year-old man presented to our department with incidental finding of pericardial effusion. He suffered from general malaise and body weight loss in recent 3 months. He had chronic hepatitis B and an abdominal computed tomography (CT) disclosed a new soft tissue nodule 1.7x1.3 cm in size over the S7 of liver and pericardial effusion. A transthoracic echocardiography showed a cyst-like lesion about 2.6x2.9 cm over right atrioventricular (AV) groove and moderate pericardial effusion. (Panel A and B) The patient received subsegmentectomy of liver and the pathology was compatible with hepatocellular carcinoma. A follow-up echocardiography showed progression of the lesion one month later. A cardiac CT disclosed a soft tissue mass spreading along the right AV groove and encasing the right coronary artery (RCA). (Panel D) A positron emission tomography (PET) scan disclosed increase of radiolabeled 18F-2-fluoro-deoxy-D-glucose uptake along the right AV groove. (Panel C) Hence, video-assisted thoracoscopic biopsy was done and the pathology findings were compatible with diffuse large B cell lymphoma. (Panel D and E) The patient was diagnosed as primary cardiac lymphoma (PCL) and received chemotherapy. A follow-up echocardiography showed markedly decrease of the tumor size 3 months after chemotherapy. (Panel G and H) Conclusion: Our case presented as hepatic nodule and cystic lesion encasing RCA with pericardial effusion, and finally diagnosed as double cancers, namely hepatocellular carcinoma and PCL. This case reminds us that an aggressive work-up can help a patient with unexplained intra-cardiac mass and pericardial effusion. ![Figure][1] Figure 1 [1]: pending:yes

Evaluation of hepatic cystic lesions

Hepatic cysts are increasingly found as a mere coincidence on abdominal imaging techniques, such as ultrasonography (USG), computed tomography (CT) and magnetic resonance imaging (MRI). These cysts often present a diagnostic challenge. Therefore, we performed a review of the recent literature and developed an evidence-based diagnostic algorithm to guide clinicians in characterising these lesions. Simple cysts are the most common cystic liver disease, and diagnosis is based on typical USG characteristics. Serodiagnostic tests and microbubble contrast-enhanced ultrasound (CEUS) are invaluable in differentiating complicated cysts, echinococcosis and cystadenoma/cystadenocarcinoma when USG, CT and MRI show ambiguous findings. Therefore, serodiagnostic tests and CEUS reduce the need for invasive procedures. Polycystic liver disease (PLD) is arbitrarily defined as the presence of > 20 liver cysts and can present as two distinct genetic disorders: autosomal dominant polycystic kidney disease (ADPKD) and autosomal dominant polycystic liver disease (PCLD). Although genetic testing for ADPKD and PCLD is possible, it is rarely performed because it does not affect the therapeutic management of PLD. USG screening of the liver and both kidneys combined with extensive family history taking are the cornerstone of diagnostic decision making in PLD. In conclusion, an amalgamation of these recent advances results in a diagnostic algorithm that facilitates evidence-based clinical decision making.

Current management of noninfectious hepatic cystic lesions: A review of the literature

Nonparasitic hepatic cysts consist of a heterogeneous group of disorders, which differ in etiology, prevalence, and manifestations. With improving diagnostic techniques, hepatic cysts are becoming more common. Recent advancements in minimally invasive technology created a new Era in the management of hepatic cystic disease. Herein, the most current recommendations for management of noninfectious hepatic cysts are described, thereby discussing differential diagnosis, new therapeutic modalities and outcomes.

Cystic Hepatic Lesions in c-Kit Negative Systemic Mastocytosis

Purpose: Systemic mastocytosis (SM) is a rare disorder characterized by infiltration of mast cells in visceral organs. We present a 70 year old male with a c-kit negative mutation and aggressive SM presenting as multiple cystic liver lesions and non-cirrhotic portal hypertension. He had presented with worsening dyspnea on exertion, increased abdominal girth and weight loss. He had no history of alcohol, tobacco, IV drug use, transfusion, tattoos or familial liver disease. On exam, he had a fluid wave and hepatomegaly. Labs showed a WBC 3.9 × 10(9)/L with 35% monocytes, hemoglobin 9.7 g/dL, platelets 110 × 10(9)/L, alkaline phosphatase 201 U/L and INR of 1.3. Electrophoresis revealed a polyclonal gammopathy. Viral and autoimmune etiologies were excluded. Ascitic fluid showed a SAAG of 1.6 with total protein of 5 g/L and 89 neutrophils. Cytology showed histiocytes and mesothelial cells. Serum tryptase level was 150 ng/dL (nl<11.5). Imaging showed splenomegaly, ascites, recanalization of the umbilical vein, innumerable cystic liver lesions without arterial enhancement and multiple lytic rib lesions. Bone marrow biopsy revealed hypercellular marrow with an infiltrate of atypical spindle cells, compromising 30-40% of the cellularity. Immunohistochemical staining of the atypical cells was positive for CD117, mast cell tryptase, and CD25. Liver biopsy showed a similar infiltrate of atypical spindle cells, involving the portal areas and dispersed through the sinusoids with associated focal fibrosis. He was treated with one cycle of cladribine with persistent pancytopenia and no response in his bone and hepatic involvement. Genomic analysis, following the initiation of chemotherapy, revealed the absence of the D816V KIT mutation. The patient was enrolled in a trial with midostaurin (PKC412). Discussion: In a majority of adult cases of mastocytosis, including cases with hepatic manifestations, the somatic mutation Asp816Val (D816V) has been described in the catalytic domain of the KIT proto-oncogene. As in our case, patients with negative KIT mutations do not respond to imatinib mesylate. In the progression of mastocytosis, the KIT mutant D816V may disappear as a result of the clonal selection and transformation of more malignant subclones derived from a primitive neoplastic stem cell population. In our patient, the loss of the D816V mutation is possibly explained by clonal selection subsequent to the chemotherapeutic induction. The radiologic findings of cystic liver lesions are uncommon but may be related to obstructed sinusoids from infiltrated mast cells leading to portal hypertension.

Pylephlebitis: A Rare Cause of Intrabdominal Sepsis

Purpose: Intra-abdominal infections can be associated with a variety of complications. We present an unusual case of an infection of the portal vein (pylephlebitis). A 72 year-old Caucasian male with hypertension presented with epigastric pain and fevers. Initial workup revealed leukocytosis (19 K/μL) as well as mildly elevated bilirubin (1.9 mg/dL). CT scan revealed an acute left portal vein thrombosis as well as concern for a fluid collection near the hilum of the liver, possibly consistent with a hepatic abscess. Treatment was initiated with intravenous heparin as well as broad-spectrum antibiotics. The patient subsequently developed hypotension requiring pressor support, progressive renal failure, and atrial fibrillation necessitating cardioversion. Blood cultures revealed gram negative bacteremia with Veillonella species. The patient then improved with the antibiotics and anticoagulation over the next 48 hours. It was unclear whether the hilar fluid collection represented a cystic hepatic lesion or a hepatic abscess through direct extension of the pylephlebitis. Given the patient's clinical improvement, drainage of this hilar lesion was not attempted. The patient received 6 weeks of intravenous antibiotic therapy as well as Coumadin therapy. At long-term follow-up, he had no further symptoms. Repeat CT scan showed a small complex hepatic cyst, and persistence of the left portal vein thrombosis. The plan was to continue at least 6 months of anticoagulation and repeat imaging studies 6 months later. Pylephlebitis, or septic portal vein thrombosis, can complicate any intra-abdominal infection including diverticulitis, appendicitis, biliary process or even inflammatory bowel disease. It is rarely associated with an underlying hypercoagulable condition. Given its significant mortality (up to 30% even with antibiotic therapy), pylephlebitis should be considered in any patient that presents with fevers, abdominal pain, and jaundice. Early intravenous antibiotic therapy remains the mainstay of treatment. The role of anticoagulation is controversial, but appears to have a beneficial role through improved vascular recanalization, which may result in improved mortality.

The Variable Presentations and Broadening Geographic Distribution of Hepatic Fascioliasis

We report 2 unrelated cases of hepatic fascioliasis in travelers returning to the United States from Africa and the Middle East. The first case presented with acute infection. Prominent clinical features included abdominal pain, elevated liver transaminases, serpiginous hepatic lesions, pericapsular hematoma, and marked peripheral eosinophilia. The second case was diagnosed in the chronic stage of infection and presented with right upper quadrant abdominal pain, cystic hepatic lesions, and an adult fluke in the common bile duct. We review the life cycle of Fasciola species, the corresponding clinical features during the stages of human infection, diagnostic methods, and the evolving understanding of the epidemiology of human fascioliasis, particularly emphasizing fascioliasis in African countries.

Multiple Synchronous Tumors in a Patient: A Rare Entity

A 77-year-old man was admitted to our hospital due to melena with no other symptoms from the upper gastrointestinal tract mentioned. Past medical history included heterozygous βthalassemia, arterial hypertension, and cholecystectomy. Esophagogastroscopy showed a hiatal hernia and a large ulcerative lesion at the gastroesophageal junction. Biopsy revealed malignant adenocarcinoma. Colonoscopy had no pathologic findings. Laboratory tests were within normal values, except for slight anemia. CT scan of the abdomen demonstrated three small cystic hepatic lesions and a welldefined lesion in the upper pole of the left kidney which measured 6×6.8 cm with soft-tissue density. Chest and brain CT scans as well as bone scan demonstrated no metastatic lesions. Further investigation of the abdomen with MRI demonstrated a primary neoplasm in the upper lobe of the left kidney, without participation of the adrenal. It also revealed that the hepatic pathology represented simple cysts (Fig. 1). Although the creatinine level was normal, a dynamic kidney scan showed the participation of the right kidney in a percentage of 54%. Additionally, the dermatologists and the plastic surgeons examined the patient, and no skin lesion was found. Surgical treatment was decided. After preoperative evaluation, an esophagogastrectomy and a left radical nephrectomy through a left thoracoabdominal incision were performed, without complications. The histology report showed a poorly differentiated ulcerative adenocarcinoma of the gastroesophageal junction and the lower esophagus infiltrating the wall and the surrounding adipose tissue (TNM Classification of Malignant Tumours (TNM)/American Joint Committee on Cancer (AJCC) stage pT3N0), a chromophobe renal cell carcinoma of the left kidney with perforation of the renal capsule and infiltration of the perirenal fat (TNM/AJCC stage pT3aN0), four small renal oncocytomas with organoid configuration, solid and acinar structures, and thin fibrovascular stroma, multiple diminutive foci of renal papillary adenomas in the vicinity of the oncocytomas and throughout the renal parenchyma with psammoma microcalcifications, and a small angiomyolipoma (0.5 cm in the greatest diameter) located in the proximal perirenal fat. Immunohistochemistry confirmed the above P. Tsipas :G. Laoutides : C. Kotoulas (*) Department of Cardiothoracic Surgery, 401 General Military Hospital of Athens, Kifissias Ave 38, Ampelokipoi, Athens 11526, Greece e-mail: info@kotoulas.com

Embryonal Sarcoma of the Liver in an Adult Patient

Undifferentiated embryonal sarcomas (UESs) are uncommon tumours that are seen predominantly in late childhood. Cases in adults are rare and generally present once a large mass develops and may be mistaken for other tumours. A case of an UES of the liver with an isolated peritoneal metastasis is described. The patient presented with a palpable mass with imaging findings suggestive of a cystic tumour. She had complete surgical resection of the liver mass and isolated peritoneal metastasis. She was tumour-free on imaging at 6 months without adjuvant chemotherapy. An UES should be considered in the differential of large cystic hepatic lesions, with aggressive surgical resection considered when possible.

Biliary Atresia in Neonates and Infants

HomeRadiologyVol. 261, No. 3 PreviousNext CommunicationsLetters to the EditorBiliary Atresia in Neonates and InfantsSatheesh Krishna, Vinayak Mittal, Akshay K. Saxena, Kushaljit S. SodhiSatheesh Krishna, Vinayak Mittal, Akshay K. Saxena, Kushaljit S. SodhiAuthor AffiliationsDepartment of Radio Diagnosis, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India e-mail: [email protected]Satheesh KrishnaVinayak MittalAkshay K. SaxenaKushaljit S. SodhiPublished Online:Dec 1 2011https://doi.org/10.1148/radiol.11110959MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Reference1 Lee MS, Kim MJ, Lee MJet al.. Biliary atresia: color Doppler US findings in neonates and infants. Radiology 2009;252(1):282–289. [Published correction appears in Radiology 2011;261(3):1003.] Link, Google ScholarArticle HistoryPublished online: Dec 2011Published in print: Dec 2011 FiguresReferencesRelatedDetailsRecommended Articles Percutaneous US-guided Cholecystocholangiography with Microbubbles for Assessment of Infants with US Findings Equivocal for Biliary Atresia and Gallbladder Longer than 1.5 cm: A Pilot StudyRadiology2017Volume: 286Issue: 3pp. 1033-1039Risk Estimation for Biliary Atresia in Patients with Neonatal Cholestasis: Development and Validation of a Risk ScoreRadiology2018Volume: 288Issue: 1pp. 262-269Hepatic Imaging in Neonates and Young Infants: State of the ArtRadiology2017Volume: 285Issue: 3pp. 763-777Pediatric Hepatic Cystic Lesions: Differential Diagnosis and Multimodality Imaging ApproachRadioGraphics2022Volume: 42Issue: 5pp. 1514-1531Insight into Bile Duct Reaction to Obstruction from a Three-dimensional Perspective Using ex Vivo Phase-Contrast CTRadiology2021Volume: 299Issue: 3pp. 597-610See More RSNA Education Exhibits Neonatal Jaundice: A Multimodality Imaging ApproachDigital Posters2018Pictorial Review of Biliary Disorders in Infants and ChildrenDigital Posters2019360 Degrees of Pediatric Biliary Disease: Multimodality Imaging ReviewDigital Posters2019 RSNA Case Collection Intrahepatic bilomaRSNA Case Collection2022Perihilar Cholangiocarcinoma RSNA Case Collection2021Perihilar CholangiocarcinomaRSNA Case Collection2021 Vol. 261, No. 3 Metrics Altmetric Score PDF download

Abstracts and Case Studies From the College of American Pathologists 2011 Annual Meeting (CAP '11)

Abstracts and Case Studies From the College of American Pathologists 2011 Annual Meeting (CAP '11)

Cystic Abdominal Lesions: A Case Report on Two Newborns

Mesenchymal hamartoma is a benign lesion that occurs primarily in young children. It is composed of large, serous fluid-filled cysts surrounded by loose mesenchymal tissue containing small bile ducts. We have found multiple, hepatic cystic lesions in two newborns. The patients presented with hepa-tomegaly and normal liver function tests. The tumor was cystic in imaging studies. First case: preterm born (28.GW) with hypoplasia of the lungs and hepatic cystic mass; in the prenatal ultrasound screening after the 12th week there was a SGA with abdominal mass. Second case: preterm born (34.GW); in the prenatal ultrasound screening in the 8th week we saw a cystic abdominal mass. Birth weight: 2215 g, birth length: 43.5 cm. Postnatal cystic lesions were seen in the ultrasound. If you see an enlarged cystic placenta along with normal or too small for gestation age by sonography, mesenchymal stem villous hyperplasia of the placenta should be considered and the fetus should be screened for any sign of intrauterine growth retardation, Beckwith-Wiedemann syndrome, omphalocele or cystic lesions in the abdomen.

Recent trends in treatment of hepatic non parasitic cystic lesions: Outcome of laparoscopic management

Background: Hepatic cystic lesions of non parasitic origin are mostly benign single, multiple, or diffuse cysts which contain clear serous fluid. Asymptomatic patients usually need no active treatment apart from follow up. In some patients, the cysts become painful and symptomatic which necessitate surgical intervention in the form of surgical deroofing or fenestration. Open surgical techniques used to be the treatment of choice since there is no harm to establish a free communication between the cyst and the peritoneal cavity because the cystic fluid contains no bile or microorganisms and its composition is similar to plasma. Recently, laparoscopic surgery is the treatment of choice as it can give similar results with less morbidity, and shorter hospital stay. The aim of this study was to evaluate the postoperative morbidity and, the incidence of relapses in the laparoscopic treatment of non-parasitic hepatic cysts and with polycystic liver disease during one year of postoperative follow up. Patients and methods: From March 2005 to September 2009, twenty patients (18 patients with simple non-parasitic hepatic cysts and 2 patients with polycystic liver disease (PCLD) with few large cysts in the anterior hepatic segments) of a mean age of 42 years (range 23-62) and of both sexes (16 women and 4 men) underwent laparoscopic fenestration and deroofing at Ain Shams University Hospitals. Before embarking on surgery, routine investigations, US, CT and serological tests for hydatid disease were requested. Tumour markers and bacteriological, chemical and cytological examination of the cystic fluid aspirated under US-guidance were requested if needed. Results: Computed tomography with contrast enhancement revealed simple hepatic cysts in 18 cases with a mean diameter of 10 cm (range 5-14 cm). There were 8 in the left lobe (segment II and III) and 10 in the right hepatic lobe. Polycystic liver disease was seen in 2 cases with a mean cyst diameter of 8 cm (range 6-10 cm). The dominant cyst was in the right hepatic lobe in 1 case and in the left lobe in the other case. Serological test for hydatid was done and was negative for all cases. Laparoscopic deroofing was completed successfully in 16 cases and conversion was needed in 4 cases in which the cysts were deeply seated and inaccessible by the laparoscope. Open surgical deroofing was possible in 2 cases and left lateral segmentectomy was done in 2 cases. There was neither perisurgical mortality nor significant morbidity in this study. One year postoperative results showed recurrence of the cyst in two cases. Conclusion: Laparoscopy can be considered a safe and efficacious treatment for non-parasitic hepatic cysts and with polycystic liver disease.

Value of ultrasonography-guided fine needle aspiration cytology in the investigative sequence of hepatic lesions with an emphasis on hepatocellular carcinoma

Background:The evaluation and management of various hepatic lesions is a common clinical problem and their appropriate clinical management depends on accurate diagnoses.Aims:To study the cytomorphological features of distinctive non-neoplastic and neoplastic lesions of the liver and to evaluate the sensitivity, specificity and diagnostic accuracy of ultrasonography (USG)-guided fine needle aspiration cytology (FNAC) in the diagnosis of liver diseases.Materials and Methods:Seventy-two patients with evidence of liver diseases underwent USG-guided, percutaneous FNAC. Cytomorphological diagnoses were correlated with clinical, biochemical and radiological findings, histopathological diagnoses and follow-up information.Results:The age of the patients ranged from eight months to 90 years with 48 males (66.67%) and 24 females (33.33%). Of the 72 cases, the cytological diagnosis was rendered in 71 patients and smears were inadequate for interpretation in one case. Neoplastic lesions (68.06%) were more common than non-neoplastic lesions (30.56%). The majority of the neoplastic lesions were hepatocellular carcinomas (36.12%) followed by metastatic adenocarcinomas (19.45%). Among non-neoplastic lesions, cirrhosis was the commonest lesion (8.34%). The overall diagnostic accuracy of FNAC was 97.82% with a sensitivity and specificity of 96.87 and 100% respectively.Conclusion:USG-guided FNAC of the liver is a safe, simple, cost-effective and accurate method for cytological diagnosis of hepatic diffuse, focal/nodular and cystic lesions with good sensitivity and specificity.

Mucinous cystadenoma of the liver with ovarian-like stroma: the need for complete resection

Cystadenoma of the liver is a rare neoplasm. Although many cystadenomas are asymptomatic, symptoms can include abdominal pain, postprandial epigastric discomfort, and nausea. Dramatic changes in hepatic imaging techniques have been helpful for diagnosing cystic lesions of the liver, such as simple cyst, hydatid cyst, cystadenoma, cystadenocarcinoma, and metastatic neuroendocrine tumors. However, it remains difficult to differentiate cystadenoma from cystadenocarcinoma for multiseptated cystic hepatic lesions with papillary projection on computed tomography (CT) and magnetic resonance imaging (MRI). Here we report the case of a 47-year-old woman with several months of postprandial discomfort and abdominal fullness. CT and MRI revealed multiseptated cystic lesions with papillary excrescences. A left hemihepatectomy was performed. Histology showed a benign mucinous cystic tumor with ovarian-like stroma.

A case of thermal sink during liver Radiofrequency Thermal Ablation of an HCC adjacent to a large hepatic cystic lesion

A case of thermal sink during liver Radiofrequency Thermal Ablation of an HCC adjacent to a large hepatic cystic lesion

Giant and complicated variants of cystic bile duct hamartomas of the liver: MRI findings and pathological correlations

To describe a new category of liver cyst we propose calling "giant bile duct hamartoma (giant-BDH)" and to provide a more complete record of the magnetic resonance imaging (MRI) features of BDHs with potential for clinical impact. This study was Institutional Review Board (IRB)-approved and Health Insurance Portability and Accountability Act (HIPPA)-compliant. Fifteen patients were identified with surgical liver pathology in keeping with complicated BDH and MRI findings of giant cysts. In all, 14/15 patients presented with pain that resolved in 14/14 with surgery. Imaging features common to pretreatment cysts included sharply defined, lobulated margins with thin, smooth rim-enhancement. Treated symptomatic cysts measured 9.8 cm on average and 21.6 cm maximum. The 14/15 patients had coexistent <2.0 cm BDH. Elevated T1 signal corresponded with hemorrhagic cyst content (10/15 patients); cyst-wall rim-enhancement corresponded with histological findings of inflammation (15/15), fibrocystic changes (12/15), and smaller BDH in the adjacent liver (13/15). Histology of giant-BDH cyst walls corresponded with complicated BDH in 15/15. The incidence of symptomatic-treated BDH at our institution was 0.4%. BDH is a benign hepatic cystic lesion that may undergo cystic enlargement, internal hemorrhage, and clinically present with abdominal pain treatable by minimally invasive laparoscopic fenestration. Complicated giant-BDH coexists with smaller BDH and the MRI features of giant-BDH are characteristic.

Biliary cystadenocarcinoma with mesenchymal stroma

Hepatobiliary cystadenocarcinomas (BCACs) with mesenchymal stroma are a rare cystic lesion. This tumour needs to be distinguished from benign biliary cystadenoma, which is antecedent in most cases. The treatment of choice is radical excision of the mass. The diagnostic evaluation, surgical management, pathological characteristics, treatment and follow-up of one patient with hepatobiliary cystadenocarcinoma with ovarian stroma is described. Preoperative diagnosis of BCACs is often difficult, because their clinical manifestations are similar to those of other hepatic cystic lesions. MRI is suitable for accurate characterisation of cystic biliary lesions, but distinguishing between cystadenoma and cystadenocarcinoma remains difficult on the basis of imaging findings. Complete surgical excision gives a relatively good chance of long-term survival because of the slow growth rate of these tumours.