Simple Hepatic Cysts Research Articles

Percutaneous aspiration and sclerotherapy of a giant simple hepatic cyst causing obstructive jaundice: A case report and review of literature

BACKGROUNDGiant simple hepatic cysts causing intrahepatic duct dilatation and obstructive jaundice are uncommon. A variety of measures with different clinical efficacies and invasiveness have been developed. Nonsurgical management, such as percutaneous aspiration and sclerotherapy, is often applied. CASE SUMMARYThe case is a 39-year-old female with a 5-mo history of cutaneous and scleral icterus, loss of appetite, and dark urine. Lab tests showed jaundice and liver function abnormalities. Imaging revealed a giant simple hepatic cyst obstructing the intrahepatic bile ducts. A combination of percutaneous catheter aspiration and lauromacrogol sclerotherapy was successfully performed and the effects were satisfactory with the size of cyst decreasing from 13.7 cm × 13.1 cm to 3.0 cm × 3.0 cm. Further literature review presented the challenges of managing giant simple hepatic cysts that cause obstructive jaundice and compared the safety and efficacy of a combination of percutaneous aspiration and lauromacrogol sclerotherapy with other management strategies.CONCLUSIONGiant simple hepatic cysts can cause obstructive jaundice, and a combination of percutaneous catheter aspiration and sclerotherapy with lauromacrogol are suggested to treat such cases.

Comparison of the Efficacy and Safety of Single-Session OK-432 and Multiple-Session 99% Ethanol Sclerotherapy for Symptomatic Simple Hepatic Cysts

PurposeThis retrospective study aimed to compare the efficacy and safety of single-session OK-432 and multiple-session 99% ethanol sclerotherapy for symptomatic simple hepatic cysts.MethodsWe reviewed patients who received aspiration sclerotherapy with OK-432 (group A) or 99% ethanol (group B) for symptomatic simple hepatic cysts at Guangdong Provincial People's Hospital from January 2013 to November 2019.ResultsWe included 42 patients in group A and 39 patients in group B. No significant difference was found in the mean volume of hepatic cysts between the two groups. The overall success rates were 92.9% (39 of 42 patients) in group A and 79.5% (31 of 39 patients) in group B (P = 0.08). The treatment success for cyst volumes <200 ml, 200–500 ml, and >500 ml was 100, 93.3, and 88.2% in group A, and 100, 84.6, and 57.1% in group B, respectively. The symptomatic relief rate in group A was higher than that in group B for cysts ≥500 ml (P = 0.049) and cysts <500 ml. For treatment-related complications, the incidence of pain at the injection site in group A was lower than that in group B.ConclusionSingle-session OK-432 sclerotherapy was safer and more effective than multiple-session 99% ethanol sclerotherapy for treating large cysts, although both treatments had similar effects on small cysts.

Pediatric Hepatic Cystic Lesions: Differential Diagnosis and Multimodality Imaging Approach.

When a pediatric hepatic cystic lesion is identified at imaging, the differential diagnosis may be broad, including developmental, infectious, neoplastic, and posttraumatic or iatrogenic causes. The location of a cystic lesion and its number, size, composition, and relationship to the biliary system are features that help in narrowing the differential diagnosis. An incidentally detected simple hepatic cyst is the most commonly encountered. Ciliated foregut cysts are typically located in hepatic segment IVa. The presence of multiple cysts should raise suspicion for fibropolycystic liver disease, a group of related lesions-including biliary hamartoma and choledochal cyst-caused by abnormal embryologic development of the ductal plate. Communication of the cystic lesion with the biliary tree can confirm the diagnosis of choledochal cyst. In a neonate with jaundice, a cystic lesion at the porta hepatis should raise suspicion for choledochal cyst versus cystic biliary atresia. Hepatic abscess can appear cystlike, though typically with internal contents. In an immunocompromised child, multiple cystlike lesions should raise concern for fungal microabscesses. A complex cystic mass in a young child should raise suspicion for mesenchymal hamartoma, which can evolve into undifferentiated embryonal sarcoma if untreated. Hepatic hematoma and biloma can appear cystlike in children with a history of trauma or recent intervention. In neonates with an umbilical vein catheter (UVC), an intrahepatic cyst along the course of the UVC should raise concern for infusate extravasation. Familiarity with imaging findings and clinical features is essential for achieving accurate diagnosis of pediatric hepatic cystic lesions, which in turn can guide appropriate clinical management. Online supplemental material is available for this article. ©RSNA, 2022.

Laparoscopic complete excision of an enormous simple hepatic cyst occupying the entire abdomen in a child: a case report and literature review.

BackgroundSimple hepatic cysts are common lesions in adults, but rare in children. Because of their benign nature, simple hepatic cysts may not be detected until they grow too large to be diagnosed and resected in a minimally invasive manner.Case presentationAn 18-month-old girl presented with an enormous cyst occupying the entire abdomen. The beak sign on computed tomography revealed the hepatic origin of the cyst. The cyst was decompressed through the umbilicus, which was opened by the three-triangular-skin-flap technique, thus creating a working space that enabled laparoscopic surgery. The cyst was excised en bloc together with the attached hepatic parenchyma.ConclusionsGiant simple hepatic cysts occupying the entire abdomen are rare in children. Of 14 reported cases, only 1 underwent laparoscopic treatment. We have herein reported another case of a giant simple hepatic cyst in which the beak sign on imaging and the three-triangular-skin-flap umbilical opening technique were useful for its diagnosis and laparoscopic excision, respectively. Complete excision is desirable because there is a possibility of recurrence or other diseases that require total removal, including hydatid cysts and mesenchymal hamartomas.

Ultrasound-guided polidocanol foam sclerotherapy for symptomatic giant hepatic cyst: A single-center experience.

Simple hepatic cysts are typically benign; however, when they are large and symptomatic, therapeutic intervention is required. We previously reported our initial experience with ultrasound (US)-guided polidocanol foam sclerotherapy in three patients with symptomatic giant hepatic cysts. In the present study, we examined the efficacy and safety of polidocanol foam sclerotherapy in a larger number of patients with long-term follow-up. Between May 2016 and April 2021, 15 patients with symptomatic giant hepatic cysts were referred to our hospital. All patients were prospectively included in the study and underwent US-guided polidocanol foam sclerotherapy. The mean maximum diameter and estimated cyst volume were 128.4mm (77-223mm) and 922.3ml (123.2-2797ml), respectively. Polidocanol foam was successfully administered through an 8.5-Fr pigtail catheter in all patients. The percentages of cyst diameter/volume after 1-3months, 3-6months, 6months-1 year, 1-2years, and 2-4years of sclerotherapy were 66.8%/36.5%, 48.1%/14.8%, 34.1%/6.9%, 28.2%/3.7%, and 26.2%/3.1%, respectively. During the follow-up period, there were no cases of symptom recurrence or need for additional treatment due to cyst re-growth. Six patients (40%) had fever, one had nausea, and one had right-sided chest pain, but none of these adverse events required prolonged hospitalization or readmission. US-guided polidocanol foam sclerotherapy may be an effective and safe method for the treatment of symptomatic giant hepatic cysts.

Management of Simple Hepatic Cyst.

Simple hepatic cysts are typically saccular, thin-walled masses with fluid-filled epithelial lined cavities. They arise from aberrant bile duct cells that develop during embryonic development. With the development of diagnostic modalities such as ultrasonography (US), CT, and MRI, simple hepatic cysts are frequently detected in clinical examinations. US is the most useful and noninvasive tool for diagnosis of simple hepatic cysts and can usually differentiate simple hepatic cysts from abscesses, hemangiomas, and malignancies. Cysts with irregular walls, septations, calcifications, or daughter cysts on US should be evaluated with enhanced CT or MRI, to differentiate simple hepatic cysts from cystic neoplasms or hydatid cysts. Growth and compression of hepatic cysts cause abdominal discomfort, pain, distension, and dietary symptoms such as nausea, vomiting, a feeling of fullness, and early satiety. Complications of simple hepatic cysts include infection, spontaneous hemorrhage, rupture, and external compression of biliary tree or major vessels. Asymptomatic simple hepatic cysts do not require treatment. Treatment for symptomatic simple hepatic cysts includes percutaneous aspiration, aspiration followed by sclerotherapy, and surgery. The American College of Gastroenterology clinical guidelines recommend laparoscopic fenestration because of its high success rate and low invasiveness. Percutaneous procedures for treatment of simple hepatic cysts are particularly effective for immediate palliation of patient symptoms; however, they are not generally recommended because of the high rate of recurrence. Management of simple hepatic cysts requires correct differentiation from neoplasms and infections, and selection of a reliable treatment.

Spontaneous rupture of hemorrhagic hepatic cyst: two case reports

BackgroundSpontaneous rupture of a hemorrhagic hepatic cyst is extremely rare. There is no standard treatment recommended for this condition. We report two cases of hemorrhagic hepatic cysts that spontaneously ruptured and were successfully treated with laparoscopic deroofing. We review the literature and discuss the characteristic features of spontaneous rupture of hemorrhagic hepatic cysts and their treatment.Case presentationThe first patient was an 85-year-old man admitted for sudden-onset right hypochondralgia and fever. Computed tomography revealed a 13-cm hepatic cyst occupying the right lobe of the liver and spontaneous rupture of the cyst. Laparoscopic deroofing was performed and continuous oozing from the cystic wall was found. Histological examination revealed a simple hepatic cyst. The patient was discharged on postoperative day 6. In the second case, a 77-year-old woman who had been followed up for a simple hepatic cyst (13 cm) was admitted for sudden onset of right hypochondralgia. Computed tomography demonstrated a 9.9-cm hepatic cyst occupying segment 4 of the liver. Laparoscopic deroofing was performed and continuous oozing from the cystic wall was observed. Histological examination revealed a simple hepatic cyst. The patient was discharged on postoperative day 6.ConclusionLaparoscopic deroofing was performed in patients with spontaneous rupture of hemorrhagic nonparasitic hepatic cysts.

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.

Magnetic resonance imaging evaluation of incidentally detected hyperechoic liver lesions: comparison of two modalities in terms of detection, diagnosis, and morphological features.

This study aimed to investigate and compare the ultrasonography and contrast-enhanced magnetic resonance imaging characteristics of incidentally detected hyperechoic focal liver lesions. Seventy-four patients (29 males and 45 females) who had undergone a B-mode ultrasonography and contrast-enhanced magnetic resonance imaging examination were included in this study. A total of 91 hyperechoic lesions detected on ultrasonography were evaluated. The ultrasonography features of these hyperechoic lesions were recorded, and the results were compared with those acquired from contrast-enhanced magnetic resonance imaging. The results were compared statistically using the Shapiro-Wilk, McNemar, and Wilcoxon signed-rank tests. A corresponding lesion was found on contrast-enhanced magnetic resonance imaging in 72 of the 91 (79.1%) hyperechoic lesions detected on ultrasonography. Forty-one (56.9%) of the magnetic resonance imaging-defined lesions were typical hemangiomas, while 10 (13.9%) were focal steatosis areas and 4 (5.6%) were diagnosed with hepatocellular carcinoma. In contrast, 6 lesions (8.3%) were diagnosed as simple hepatic cysts, 4 (5.6%) as sclerosing hemangioma, 2 (2.8%) as thrombosed hemangioma, 1 (1.4%) as focal nodular hyperplasia, 1 (1.4%) as hamartoma, 2 (2.8%) as hydatid cysts, and 1 (1.4%) as hepatic lipoma. No statistically significant differences were found between ultrasonography and magnetic resonance imaging in terms of the segmental classification of the true positive lesions based on contour structures and lesion area measurements (p=0.558, p=0.375, and p=0.636, respectively). Incidentally detected hyperechoic zones may not necessarily be detected on magnetic resonance imaging. This may be secondary to focal hepatic steatosis or false interpretation of the radiologist. Lesions requiring therapy must be considered in the differential diagnosis.

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.

S3675 Azithromycin-Induced Acute Liver Injury

Introduction: Idiosyncratic drug-induced liver injury (DILI) is a subtype of drug-induced liver injury that is typically variable in presentation and independent of medication dose or duration. A great number of commonly used medications and herbal supplements have been associated with idiosyncratic drug-induced liver injury. DILI is of clinical significance due to the potential for progression to chronic liver disease or acute liver failure, and may be caused by drugs not commonly associated with liver injury. Case Description/Methods: A 60 year old female was admitted after presenting with sore throat, fever, cough, diarrhea, rash and generalized malaise for 4 days prior to admission. Her past medical history was significant for mixed connective tissue disease, rheumatoid arthritis, and a remote history of alcohol abuse. She was on day two of an outpatient Azithromycin course prescribed for community acquired pneumonia. Physical exam showed diffuse, blanching, maculopapular rash along chest wall and dorsum of her upper extremities. Hepatic panel showed AST 64, ALT 42, Total bilirubin 1.1, and alkaline phosphatase of 68. Liver chemistries peaked during admission to AST 607, ALT 936, Total Bilirubin 20.8, ALP 739. MRCP demonstrated gallbladder adenomyomatosis and multiple simple hepatic cysts. Azithromycin was discontinued, and patient was started on N-acetylcysteine infusion. Workup for viral hepatitis was negative, as were EBV, CMV, HSV and HIV serologies. Immunologic workup showed positive ANA with chromatin of 6.5, SMRNP >8, and RNP of 8. AMA and ASMA were < 1:20. Given rising liver chemistries and history of autoimmune disease, a liver biopsy was obtained and revealed mild chronic hepatitis with minimal periportal activity, moderate bile duct injury with marked cholestasis, pseudoxanthomatous degeneration, and mild anisonucleosis consistent with DILI. Liver chemistries began improving on day 11 of admission. Patient’s maculopapular rash was largely cleared prior to discharge. Discussion: Azithromycin is recognized as a common agent in DILI. In this case, Azithromycin was recognized early as a potential cause of the patient’s worsening liver chemistries. Cessation of the offending agent will resolve most cases of DILI. This case demonstrates how a commonly prescribed medication may cause DILI with risk of progression to acute liver failure. Medications not typically associated with hepatic injury should be assessed when considering DILI.Figure 1.: Portal area with reactive atypia in bile ducts consistent with cholestasis. Mixed inflammatory infiltrate surrounding portal area.

Time course of histopathological changes after bleomycin sclerotherapy in rabbit gallbladders as a model for simple hepatic cysts.

Bleomycin sclerotherapy is used in the treatment of cystic lesions; however, the histopathological changes are undefined. Present animal models of cystic diseases are not adequate for the study of sclerotherapy of hepatic cysts, primarily because the established cysts in these models are too small in size. The aim of the present study was to establish a new animal model of simple hepatic cysts, and assess the histopathological changes after bleomycin sclerotherapy. Rabbit gallbladder, with ligaturing of the cholecystic duct whilst preserving cholecystic vessels, was used as a model for simple hepatic cysts. Bleomycin (2 mg dissolved in 1 ml saline) was injected into the aspirated gallbladder, gallbladder tissue was harvested (after 1, 7, 14, 28, 42, 56 and 84 days) and histopathological changes were evaluated (n=4 per group). Additionally, control rabbit gallbladders were injected with 1 ml saline and sampled after 14 days (n=4). Histopathological changes were evaluated using hematoxylin-eosin and Masson's trichrome staining, and immunohistochemistry for CD20-, CD43- and CD68-positive cells was performed. The integrated optical density (IOD) of immunohistochemical staining and average positive stained area percentage (APSAP) of collagen were quantitatively analyzed. The results revealed gallbladders in the control group had regular epithelial cells with no visible inflammation or fibrosis. In the experimental group, epithelial cells were swollen and necrotic on the first day, and were replaced gradually by single-layer flat cells from day 56. Inflammatory infiltration was found in the submucosa, and the IOD of T cells, B cells and macrophages were highest on day 1, and these parameters declined gradually, eventually disappearing. The APSAP of collagen was highest on day 7, and gradually declined thereafter. The results suggest that histopathological changes after bleomycin sclerotherapy of a simple hepatic cyst model were characterized by sequential epithelial destruction, inflammatory cell infiltration, collagen proliferation and epithelial partial regeneration.

Simple Hepatic Cysts as Markers of Thoracic Aortic Disease

Objective: Thoracic Aortic Disease (TAD) is potentially lethal, yet difficult to detect as most patients are asymptomatic until the aneurysm dissects and becomes life threatening. Several clinical markers for TAD have been identified such as: bicuspid aortic valve, intracranial aortic aneurysm, bovine aortic arch, positive family history, and simple renal cysts. The aim of this study was to investigate the prevalence of Simple Hepatic Cysts (SHC) among individuals diagnosed with TAD in order to assess whether they can be used as a predictor of TAD. Methods: In this retrospective study, the prevalence of SHC for (n=1244) hospital patients treated for TAD was evaluated and compared to a control group of (n=809) patients. TAD patients were divided into four subgroups: ascending aneurysm (788; 63.3%; descending aneurysm (123; 9.9%); type A dissection (137; 11%); type B dissection (196; 15.8%). The presence of SHC was determined based on either computed tomography, magnetic resonance imaging, or ultrasound imaging of these patients. Results: Prevalence of SHC was 14.8%, 11.4%, 12.4%, and 14.8% in patients with ascending aneurysm, descending aneurysm, type A dissection, and type B dissection, respectively. Prevalence of SHC in the control group was 3.8% (p&lt;0.001). The prevalence of SHC was not significantly different between males and females among the TAD patients as well as the control population. Conclusion: Individuals with TAD have an increased prevalence of SHC compared to individuals without TAD. SHC can potentially be used as a clinical marker to detect patients at risk for TAD.

Giant simple hepatic cyst mimicking as hydatid cyst: diagnostic dilemma

Giant liver cysts are uncommon. Hepatic cysts are usually asymptomatic and are found incidentally but they can become symptomatic and cause bleeding, infection, mass effect to adjacent structures or rupture. We described two cases of symptomatic liver cysts described suspected clinically and radiologically reported as hydatid cyst but were revealed to be simple liver cysts following surgery. Two elderly men presented with an enlarging abdominal mass and abdominal pain for 1 week. Both patients on radiology had large cysts in the liver causing significant mass effect on adjacent structures and characteristics were suggestive of hydatid cyst. Diagnostic laparoscopy with drainage was done for both patients and revealed as simple hepatic cyst. Hence simple liver cyst can mimic as hydatid cyst attaining giant dimensions and should be considered as an important differential diagnosis.

Fetal abdominal tumors and cysts.

This article reviews the contemporary diagnosis and management of the most common abdominal neoplasms and cystic lesions diagnosed in the fetus. Fetal tumors discussed include teratomas (sacrococcygeal, cervical or mediastinal), mesoblastic nephroma, nephroblastoma (Wilms’ tumor), neuroblastoma, and hepatoblastoma. Fetal abdominal cystic lesions discussed include ovarian cyst, choledochal cyst, intestinal duplication cyst, mesenteric cyst, simple hepatic cyst, and meconium pseudocyst. We discuss the rare indications for fetal intervention or fetal surgery and other perinatal management, including prenatal interventions and fetal surgery for sacrococcygeal teratoma. The lesions reviewed are detected by widespread use of screening ultrasonography during pregnancy. Work-up for these abnormalities may include fetal MRI which enhances the diagnostic accuracy of abdominal tumors and cystic lesions and can aid in characterization of the lesion in relationship to surrounding anatomic structures. Accurate prenatal diagnosis of such lesions permits recommendations for optimal location and timing of delivery, and inclusion of appropriate caregivers and expertise to facilitate postnatal management. Perinatal management of the fetus with a neoplasm requires consideration of the optimal timing and mode of delivery, and pediatric oncology and surgical specialty care. The majority of tumors diagnosed antenatally have good prognosis with current multimodality treatment.

Prevalence of Cystic Lesions in Parenchymal Abdominal Organs

Abstract Introduction: Abdominal cystic lesions can be localized either in parenchymal or non-parenchymal organs and can be acquired or congenital. Knowing the characteristic imaging features as well as demographic data and the prevalence of cystic lesions can help radiologists in establishing the correct diagnosis. In this article, we conducted a statistical study of congenital and acquired cystic lesions of the abdomen, diagnosed by CT scan in patients hospitalized in Emergency Clinical County Hospital of Constanţa in years 2019 - 2020. Material and methods: The retrospective study included 285 patients admitted to the hospital. In the case of each patient, we recorded the following variables: Age, Sex, Localization of the lesion, Types of cysts for each localization. Results: The average age of the patients is 61.53 years. Most of the cystic lesions were localized in the liver (182 cases) and they were represented by: hydatid cysts, simple hepatic cysts, hepatic abscess, hepato-renal polycystic disease and hepatic adenocarcinoma. Cystic lesions of the kidney (56 cases) were represented by: autosomal dominant polycystic kidney disease, renal carcinoma, simple renal cysts, acquired polycystic renal disease, tuberous sclerosis, clear cell renal carcinoma and von Hippel Lindau syndrome. Cystic lesions of pancreas (47 cases) were represented by: pancreatic cysts, pancreatic pseudocysts and pancreatic adenocarcinoma. Conclusions: CT examination is extremely useful in establishing the location, type, imaging characteristics of cystic lesions, echo over surrounding organs, possibility of malignant transformation. The prevalence of certain types of localizations and morphologies depending on the age and organ involved always helps to obtain a correct and rapid diagnosis.

Differentiation and management of hepatobiliary mucinous cystic neoplasms: a single centre experience for 8\xa0years

BackgroundHepatobiliary mucinous cystic neoplasms (H-MCNs) are relatively rare cystic neoplasms in the liver. The differential diagnosis of H-MCNs remains big challenging, and the management and prognosis between the hepatic simple cyst (HSC) and H-MCNs are quite different. This study aimed to present our experience in the management of H-MCNs and provide a preoperative H-MCNs risk prediction nomogram to differentiating H-MCNs from liver cystic lesions.Methods29 patients diagnosed with H-MCNs and 75 patients diagnosed with HSC between June 2011 and June 2019 at Zhejiang University School of medicine, Sir Run-Run Shaw Hospital were reviewed in this study. We analyzed the demographic and clinicopathological variables.ResultsUS, CT, and MRI could accurately diagnose only 3.4%, 46.1%, and 57.1% of H-MCNs, respectively. After univariate analysis and multivariate logistic regression analysis, the variables significantly associated with H-MCNs were enhancement after contrast (p = 0.009), tumour located in the left lobe (p = 0.02) and biliary ductal dilation (p = 0.027). An H-MCNs risk predictive nomogram was constructed, which showed excellent discrimination (areas under the receiver operating characteristic curve were 0.940) and consistent calibration between the predicted probability and actual probability.ConclusionAmong patients with H-MCNs, the location of the tumour, enhancement in CT scan, and biliary duct dilation are significantly independent risk factors. The appropriate treatment of H-MCNs is radical resection. Using our Nomogram could facilitate screening and identification of patients with liver cystic lesions.

Deletion ofSox9in the liver leads to hepatic cystogenesis in mice by transcriptionally downregulatingSec63

Hepatic cysts are found in heterogeneous disorders with different pathogeneses, of which simple hepatic cysts and polycystic liver diseases are two major types. The process of hepatic cytogenesis for these two diseases is caused by defects in remodelling of the ductal plate during biliary tract development, which is called ductal plate malformation. SOX9 is a transcription factor participating in the process of bile duct development, and thus, its dysregulation may play important roles in hepatic cystogenesis. SEC63 encodes an endoplasmic reticulum membrane protein that is mutated in human autosomal dominant polycystic liver disease. However, the transcriptional regulation of SEC63 is largely unknown. In the present study, a liver-specific Sox9 knockout (Sox9LKO ) mouse was generated to investigate the roles and underlying mechanism of SOX9 in hepatic cystogenesis. We found that hepatic cysts began to be observed in Sox9LKO mice at 6 months of age. The number and size of cysts increased with age in Sox9LKO mice. In addition, the characteristics of hepatic cytogenesis, including the activation of proliferation, absence of primary cilium, and disorder of polarity in biliary epithelial cells, were detected in the livers of Sox9LKO mice. RNAi silencing of SOX9 in human intrahepatic biliary epithelial cells (HIBEpic) resulted in increased proliferation and reduced formation of the primary cilium. Moreover, Sec63 was downregulated in primary biliary epithelial cells from Sox9LKO mice and SEC63 in HIBEpic transfected with siSOX9. Chromatin immunoprecipitation assays and luciferase reporter assays further demonstrated that SOX9 transcriptionally regulated the expression of SEC63 in biliary epithelial cells. Importantly, the overexpression of SEC63 in HIBEpic partially reversed the effects of SOX9 depletion on the formation of primary cilia and cell proliferation. These findings highlight the biological significance of SOX9 in hepatic cytogenesis and elucidate a novel molecular mechanism underlying hepatic cytogenesis. © 2021 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

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.

Laparoscopic Approach in a Rare Symptomatic Simple Hepatic Cyst: A Case Report

Purpose: Hepatic cysts are formations of liquid content with multiple histological types that differ from each other due to their etiology, symptoms, and clinical management. Specifically, simple cysts are commonly asymptomatic and only require clinical observation. In particular, jaundice is a very rare clinic in these patients. Our goal is to show a case of a simple hepatic cyst that caused jaundice and needed surgery in order to emphasize how infrequent the case is. Methods: We present a descriptive study based on a case of a simple liver cyst that required surgery through a laparoscopic approach. Results: A 79-year-old woman had consulted to the Emergency room due to jaundice for 15 days. The blood test that was carried out showed elevated total bilirubin (12mg/dL) and transaminases levels with a cholestatic pattern, without alterations in the hemogram or elevation of acute phase reactants. An abdominal computerized tomography (CT) and a cholangioresonance revealed dilation of the intrahepatic bile duct secondary to a large cystic lesion in the right lobe of the liver, which measured approximately 10 centimetres. She underwent laparoscopic surgery, unroofing the cyst and the following day the patient was discharged from hospital without jaundice or any surgery complication. Finally, the anatomopathological study demonstrated a simple hepatic cyst, so the woman did not require more periodic controls. Conclusion: Simple liver cysts rarely cause symptoms and only require clinical observation. However, it is very important to perform an adequate anamnesis and carry out the necessary complementary tests to confirm such a diagnosis, since they can be confused with other liver cysts. Some examples might be a hydatid cyst or even a cystadenoma, which has the capacity to become malignant and require more aggresive management. In these patients, if surgery is needed, laparoscopy is a suitable approach, as allows the total resection of the lesion and provides an early postoperatory recovery.