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Introducción: El cistoadenocarcinoma biliar es un tumor quístico poco frecuente, que se origina a partir del epitelio hepatobiliar, cuyo crecimiento es lento y sus síntomas son variables e inespecíficos. Objetivo: Presentar el caso de un paciente portador de un cistoadenocarcinoma biliar. Presentación del caso: Se presenta el caso de una paciente femenina de 56 años de edad que acude a la institución por presentar dolor en el hipocondrio derecho, fiebre y pérdida de peso. Al examen físico se constata una masa palpable en dicha zona abdominal, de bordes lisos, no dolorosa, dura, de escasa movilidad y relacionada con el hígado. Conclusiones: El cistoadenocarcinoma biliar es una neoplasia quística maligna poco frecuente del hígado. La mayoría de los pacientes presentan dolor abdominal, masa palpable y pérdida de peso. El tratamiento quirúrgico es la norma y la resección con márgenes libres se considera la variante de tratamiento más empleada(AU)
Introduction: Biliary cystadenocarcinoma is a rare cystic tumor, which originates from the hepatobiliary epithelium, whose growth is slow, and whose symptoms are variable and nonspecific. Objective: To present the case of a patient with a biliary cystadenocarcinoma. Case presentation: The case is presented of a 56-year-old female patient who came to our institution with pain in the right hypochondrium, fever and weight loss. Physical examination revealed a palpable mass in such abdominal area, with smooth edges, nonpainful, hard, with low mobility and related to the liver. Conclusions: Biliary cystadenocarcinoma is a rare malignant cystic neoplasm of the liver. Most patients present with abdominal pain, a palpable mass and weight loss. Surgery is the standard treatment and margin-free resection is considered the most commonly employed treatment variant(AU)
Subject(s)
Humans , Female , Middle Aged , Cystadenocarcinoma/diagnostic imagingABSTRACT
Objective:To study the clinical features of intrahepatic biliary cystadenoma (BCA), with the aim to improve its treatment results.Methods:The clinical data and follow-up results of 86 patients with BCA treated at our department from March 2010 to January 2021 were retrospectively analyzed. Of 86 patients, there were 15 males and 71 females, with age of (48.4±13.1) years old. According to the surgical procedures carried out, 44 patients were divided into the minimally invasive group and 42 into the open group. Clinical data including imaging data, blood biochemistry, and tumor markers were collected. The follow-up data of these patients was collected in outpatient clinics or by telephone review.Results:Of 86 patients, 19(22.1%) patients had a monocystic lesion while 67(77.9%) patients had a multicystic lesion, 64 patients (74.4%) had intracapsular segregation, and 12(14.0%) patients had solid structures. Eighty-six patients with BCA were misdiagnosed as hepatic cysts in 9 patients (10.4%), hepatic echinococcosis in 2 patients (2.3%), biliary hamartoma in 1 patient (1.2%), and hepatic hemangioma in 1 patient (1.2%) before surgery. The tumor size [(6.5±3.2) vs. (9.0±4.0) cm], operative time [115(88, 185) vs. 195(160, 254) min], intraoperative blood loss [50(20, 162) vs. 300(200, 600) ml], and postoperative hospital stay [4(3, 6) vs. 8(7, 10) d] were significantly lower in the minimally invasive group than the open group. The differences were statistically significant ( P<0.05). In the 73 patients with complete follow-up, (median follow-up 63.5 months), 4 patients had developed tumor recurrence. Conclusion:Intrahepatic bile duct cystadenoma lacks specific clinical manifestations, and has a high rate of misdiagnosis and mistreatment. Early radical hepatectomy improved clinical outcomes.
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Intrahepatic biliary cystadenoma (IBC) is a rare benign cystic neoplasm of liver,with malignant potential to transform into intrahepatic biliary cystadenocarcinoma.IBC predominantly occurs in women up to 85％,showing no special clinical symptoms and a polycystic lesion inside the liver on image examination.It is difficult to differentially diagnose from other cystic lesions of the liver such as simple liver cyst,intraductal papillary neoplasm of the bile duct,etc.The missed diagnosis and misdiagnosis rate were rather high in IBC,which is accurately diagnosed by pathological examination.Complete surgical removal of the tumor is the best way to cure it,and also can bring a satisfactory outcome to patients.
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Biliary cystadenoma are rare cystic lesions of liver. They accounts for less than 5% of nonparasitic cyst of liver. Hueter first reported biliary cystadenoma in 1887. It is an extremely rare benign hepatic tumor arising from von meyerberg complexes. It occurs frequently in middle age between 40 and 50 years with female preponderance. We, hereby, report a case of 70 year male, who presented with mass and pain in the right upper abdomen
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Un principio básico de la patología es que las neoplasias se diferencian según sus células de origen y en el hígado semejan sus constituyentes, sean las células hepáticas, del epitelio biliar, endoteliales, mesenquimales o una combinación de estas. Es importante recordar aquí que son las metástasis el tumor maligno más frecuente del hígado, con una relación de 30:1 en pacientes sin enfermedad hepática crónica o cirrosis subyacente; es rara la presencia de las mismas en hígados cirróticos. Las neoplasias gastrointestinales del colon, páncreas, vía biliar extrahepática, estómago, tumores neuroendocrinos y GIST, o extraintestinales del pulmón, mama, melanoma o tumores de cabeza y cuello, son las más frecuentes (1). En este artículo solo revisaremos las más frecuentes. Iniciaremos con las neoplasias benignas y las lesiones pseudotumorales haciendo especial énfasis en aquellas con dificultades diagnósticas, en la utilidad de estudios especiales de inmunohistoquímica o moleculares para su adecuada clasificación y diagnóstico diferencial.
A basic principle of pathology is that neoplasms differ according to their cells of origin. Neoplasms of the liver resemble its constituent liver, biliary, epithelial, endothelial, mesenchymal cells or some combination of these different types of cells. It is important to remember here that metastases are the most frequent malignant liver tumor occurring at ratio of 30: 1 in patients without underlying chronic liver disease or cirrhosis. Metastases are rare in cirrhotic livers. The most common primary sites are the colon, pancreas, common bile duct, stomach, neuroendocrine tumors and GIST, or extraintestinal tumors from the lung, breast, head, neck and skin (1). In this article we review only the most frequent benign neoplasms and tumor-like lesions with particular emphasis on diagnostic difficulties, special studies, and the usefulness of immunohistochemical or molecular studies for proper classification and differential diagnosis.
Subject(s)
Humans , Adenoma , Angiomyolipoma , Focal Nodular Hyperplasia , Hemangioma , Neoplasms , Cysts , HamartomaABSTRACT
To investigate the clinical characteristics,diagnosis and treatment of intrahepatic biliary cystadenoma,a total of 7 patients with intrahepatic biliary cystadenoma admitted in our department from January 2008 to June 2013 were enrolled and the clinical data (i.e.clinical manifestations,imaging features and surgical treatment) were analyzed retrospectively.All the 7 patients were female and diagnosed as intrahepatic biliary cystadenoma.Five cases complained right upper abdominal pain of various severities.Color Doppler ultrasound,CT and MRI confirmed the diagnosis in all patients.The surgery included irregular fight hepatectomy (n =2),left lateral lobe hepatectomy (n =3),and left hepatectomy (n =2).Patients with intrahepatic biliary cystadenoma usually manifest nonspecific clinical symptoms,and thus are prone to be misdiagnosed as simple hepatic cysts.For such patients,surgery is of first choice,and complete resection is the key to avoiding the recurrence and malignancy.
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Objective To analyze the clinical features of intrahepatic biliary cystadenoma and cystadenocarcinoma.Methods Sixteen patients from Dec.2008 to Dec.2013 were retrospectively reviewed to investigate their clinical manifestations,image features,treatment and prognosis.Results Intrahepatic biliary systadenoma and occured occurred primarily in middle-aged women with no typical clinical manifestations.Image examination is the key method in diagnosis.Surgery is the only method to cure the disease.The procedure depends on its location,and its prognosis is related to complete surgical resection.Conclusion Intrahepatic biliary cystadenoma and cystadeno-carcinoma is a rare tumor occuring mostly in middle-aged women.Image examination is the key method in diagnosis.Complete surgical resection contributes to its better prognosis.
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Biliary cystic tumors (BCTs) are rare cystic tumors and are accounted for less than 5％ of liver cysts.BCTs are very common in middle-aged and elderly women,and depend on diagnosis of imaging including papillary projection or multilocular cystic liver mass.BCTs are frequently misdiagnosed due to the absence of specific diagnostic indicators,which should differentiate from diagnosis of hepatic cystic.Complete surgical resection is the first choice for BCTs with a good out-come,in addition to low recurrence.Once recurrence was identified in follow-up,BCTs can be treated by reoperation with a good outcome.
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A 6-year-old female nulliparous Dutch Rabbit (Oryctolagus cuniculus) was presented in shock status with a history of abdominal distention, inappetance, lethargy, polydipsia, diarrhea and weight loss since 2 weeks ago. There was no breeding history. Radiographic survey showed increased soft tissue opacity dorsal to the urinary bladder and ventral to the colon on the lateral view consistent with uteromegaly and severe intestinal distention resembling intussusceptions. Conservative treatment was failed and the animal died. In necropsy, ileocecal intussusception was noted as the main death factor. Thickened uterine endometrium in both horns was observed and the uterus was filled with mucoid fluid. Both ovaries were multilobulated and distended. On the other hand, a small cyst sized 1.5 × 2.5 cm was diagnosed on the liver surface. Several samples were obtained from lesions for histopathological evaluation. Histopathologically, dilated cystic glands of variable size lined by densely packed epithelium and hyperplasia of the endometrium resulting in irregular folds or papillar projection into the lumen were evident and the sections of ovaries revealed ovarian luteoma that composed of polyhedral cells with pale stained vacuolated cytoplasm, centrally located nuclei with distinct cytoplasmic borders and the cytoplasm of cells contain lipid droplet. The occurrence of biliary cyst adenoma was confirmed by microscopic examination of the mass that composed of multicystic space in different sizes lined by flattened to cuboidal biliary epithelium with papillary projections. These cysts were seperated by variable amount of connective tissue. The lack of postmortem investigations in aged rabbits reduced the incidence of neoplastic disease diagnosis in this species. Whereas uterine adenecarcinoma and lymphosarcoma were commonly reported in rabbits, luteoma and biliary cyst adenoma that are well described in this case report were uncommon in rabbit medicine.
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A 16-year old female presented to hospital with abdominal pain. Features on computed tomography raised the possibility of biliary cystadenoma or cystadenocarcinoma. She underwent a liver resection, and histopathology confirmed a serous biliary cystadenoma. This case is presented to highlight the radiological features of this uncommon pre-malignant condition as well as to summarize a management algorithm for cystic liver lesions.
Una mujer de 16 años de edad acudió al hospital con un dolor abdominal. Las características observadas con tomografía computarizada apuntaban a un cistoadenoma biliar o un cistoadenocarcinoma como diagnósticos diferenciales. La paciente fue sometida a una resección del hígado, y la histopatología confirmó un cistoadenoma biliar seroso. Presentamos este caso para resaltar los rasgos radiológicos de esta condición premaligna rara, así como para resumir un algoritmo de tratamiento para las lesiones císticas de hígado.
Subject(s)
Adolescent , Female , Humans , Biliary Tract Neoplasms , Cystadenoma, Serous , Tomography, X-Ray Computed , Algorithms , Cystadenoma, Serous/pathology , Diagnosis, Differential , Magnetic Resonance ImagingABSTRACT
Adrenal cysts are a rare disease, and its prevalence is reported to be 0.06~0.18%. Its frequency of being recognized is increasing due to the widespread use of ultrasonography and computed tomography (CT) scans. We report here on a case of adrenal cyst that was mistaken as biliary cystadenoma prio-ocation and features. Laparoscopic exploration was performed via the transabdominal approach and this revealed a right adrenal cystic mass in the retroperitoneum beneath the liver (segment IV). We present here a case of adrenal cyst with endothelial lining along with a review of the literature to address the clinical presentation, histology, imaging features and differential diagnosis of this interesting and rare entity.
Subject(s)
Cystadenoma , Diagnosis, Differential , Laparoscopy , Liver , Prevalence , Rare Diseases , UltrasonographyABSTRACT
BACKGROUND/AIMS: Biliary cystadenoma (BCA) and biliary cystadenocarcinoma (BCACa) are rare cystic neoplasms that usually arise from the liver. We reviewed the clinicopathologic and radiologic findings of 13 cases of intrahepatic biliary cystic neoplasms. METHODS: Seven patients with BCA and 6 patients with BCACa which were pathologically proven within past 10 years were included in this retrospective study. RESULTS: BCA (7 of 7) was more common in female compared to BCACa (4 of 6). Mean age at diagnosis was 53.4 years (BCA) and 58.5 years (BCACa). Abdominal pain (54%) was the most common presenting symptom. Eleven patients (61.5%) exhibited normal liver function profiles and 5 patients (38%) showed elevated levels of serum CA19-9 levels (mean 894.2 U/mL, range: 78.7-2,080). Mean size of tumor was 11.7 cm (range: 5-15). Most frequent radiologic finding was a single cystic mass with septation. BCACa tended to have intracystic solid portion. The cut surface revealed a unilocular or multilocular cystic mass with mucinous contents. Complete surgical excision was done in 12 patients. After the complete resection, recurrence was observed in 1 case of BCACa. CONCLUSIONS: The possibility of biliary cystic neoplasm should be suspected when an intrahepatic cystic lesion with multiseptation or solid portion is noted on imaging study. In addition, complete excision for definite diagnosis and treatment need to be performed.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Bile Duct Neoplasms/pathology , Bile Ducts, Intrahepatic , Cystadenocarcinoma/pathology , Cystadenoma/pathology , Liver Neoplasms/pathologyABSTRACT
A biliary cystadenoma and a cystadenocarcinoma are rare intrahepatic cystic neoplasm. The clinical feature is not marked but abdominal fullness and mass are the most common symptoms. The tumor is commonly a large multilocular cystic mass which requires hepatectomy for cure. We experienced one case of biliary cystadenoma and two cases of biliary cystadenocarcinoma. The biliary cystadenoma case was a 58-year-old female with right upper quadrant discomfort for 5 months and a 17 cm sized multilocular cystic mass. The serum CA 125 level was elevated but returned to normal level after resection. A right hepatectomy was performed and the patient has had no recurrence for 14 months after the resection. One of the biliary cystadenocarcinoma cases was a 42-year-old man with a 12 cm sized multilocular cystic mass in the right upper quadrant of his abdomen. A right hepatectomy was performed and the patient has had no recurrence for 12 months after the resection. The other biliary cystadenocarcinoma case was a 70-year-old man with right upper quadrant pain and a 5 cm sized cystic mass. A left hepatecomy was performed and the patient has had no recurrence for 8 month after the resection. The treatment of choice for a biliary cystadenoma or cystadenocarcinoma is complete resection. We report three cases of biliary cystadenoma and cystadenocarcinoma with a review of the literature.
Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Abdomen , Cystadenocarcinoma , Cystadenoma , Hepatectomy , RecurrenceABSTRACT
Biliary cystadenomas are very rare cystic neoplasms usually arising from the intrahepatic bile ducts. The majority of patients are middle-aged women who present with abdominal discomfort and/or a palpable mass. The diagnosis was performed using several methods such as abdominal ultrasonography, computed tomography, percutaneous cholangiography or endoscopic retrograde cholangiopancreatography, and showed multiloculated cystic tumors with multiple internal septation. But confirmatory diagnosis was done by surgical pathology. Because the prognosis is comparatively better than after complete resection and the cystadenoma is warranted to avoid malignant change, early detection and surgical resection must be needed. We have experienced two cases, 30 and 50 year old females, which presented with nonspecific abdominal pain and dyspepsia. They were diagnosed as having intrahepatic biliary cystadenoma histopathologically which was confirmed after surgical resection. We report two cases of intrahepatic biliary cystadenoma with a review of literature.
Subject(s)
Female , Humans , Middle Aged , Abdominal Pain , Bile Ducts, Intrahepatic , Cholangiography , Cholangiopancreatography, Endoscopic Retrograde , Cystadenoma , Diagnosis , Dyspepsia , Liver , Pathology, Surgical , Prognosis , UltrasonographyABSTRACT
PURPOSE: Cystic lesions of the liver are highly variable in respect to appearance and therapeutic approach. However, without cystectomy and hepatic resection, the patient is at risk for recurrent enlargement, infection, or progression of an unrecognized malignant neoplasm. The goal of this study was to discern the safest and most effective method, with special emphasis on a suitable therapeutic technique for various cystic lesions of the liver. METHODS: We reviwed the cystectomy and hepatic resection and outcome of patients with hepatic cysts from November, 1987 to April, 2000 at the Hanyang University Hospital. A retrospective study of 19 patients with various cystic lesions of the liver was performed. RESULTS: There were 8 simple cysts, 2 polycystic liver disease, 2 biliary cystadenoma, 4 biliary cystadenocarcinoma, 2 hydatid cysts, and 1 traumatic cyst. In examining the 6 cystectomies, 13 hepatic resections. (4 right lobectomies, 4 left lobectomies, 5 minor hepatic resections), there were no postoperative deaths in this series. Four patients (21.1%) developed operative complications. During the mean follow- up time of 78.2 months, symptomatic relief was complete and permanent in all of patients except the 1 biliary cystadenocarcinoma 1 of the 4 patients with biliary cystadenocarcinoma died of tumor recurrence (5.3%) approximately 27 months after hepatic resection. CONCLUSION: Cystectomy and hepatic resection is a more curative treatment for cystic lesions of the liver than other treatments. We recommend complete cystectomy and hepatic resection as the preferred therapy, particularly when the cyst is large, a malignancy cannot be ruled out, and a proper diagnosis is not confirmed.
Subject(s)
Humans , Cystadenocarcinoma , Cystadenoma , Cystectomy , Diagnosis , Echinococcosis , Liver Diseases , Liver , Recurrence , Retrospective StudiesABSTRACT
BACKGROUND/AIMS: With the advances in imaging modalities, the incidental diagnoses of solitary cystic lesions of the liver are increasing. The aim of this study is to establish the strategy of differential diagnosis and treatment in the patients with solitary cystic lesions of the liver METHODS: Forty three solitary cystic lesions of the liver treated surgically at Seoul National University Hospital from January 1981 to December 1998 were reviewed retrospectively. The clinicopathologic features, postoperative courses and their long-term results were analysed. RESULTS: There were fifteen congenital nonparasitic cysts (simple cysts), 3 Caroli's diseases, 4 hydatid cysts, 2 traumatic cysts, 1 cystic hamartoma, 10 biliary cystadenomas, and 8 biliary cystadenocarcinomas. Twenty six hepatic resections, 12 excisions, 3 marsupializations, 1 cystojejunostomy, and 1 cystic wall biopsy were performed. There were 4 biliary leakages and 2 intraabdominal abscesses after surgery, and three out of them resulted from the communications with the biliary trees. Cystic fluid analysis or radiologic study could not offer the accurate diagonosis. Two patients who had biliary cystadenoma and biliary cystadenocarcinoma, respectively, and underwent marsupializations with preoperative misdiagnosis of simple cyst resulted in death due to recurrent tumors. CONCLUSION: In exploring every case of solitary cystic lesion of the liver, presence of biliary communication and cystic malignancy should be considered unless simple cyst is highly suggested.
Subject(s)
Humans , Abscess , Biopsy , Bone Cysts , Cystadenocarcinoma , Cystadenoma , Diagnosis , Diagnosis, Differential , Diagnostic Errors , Echinococcosis , Hamartoma , Liver , Retrospective Studies , SeoulABSTRACT
Biliary cystadenoma is a rare tumor that arises in the liver or, less frequently, in the extrahepatic ducts. Jaundice in patients with biliary cyst adenoma is not uncomon, but it is very rare that the jaundice is caused by tumor compression of the bile duct. A 43-year-old woman who had a huge biliary cystadenoma occupying the left liver developed deep jaundice. Endoscopic retrograde cholangiopancreatograpy demontrated that this tumor compressed the common hepatic ducts extrinsically which caused the deep jaundice.
Subject(s)
Adult , Female , Humans , Adenoma , Bile Ducts , Cystadenoma , Hepatic Duct, Common , Jaundice , Jaundice, Obstructive , LiverABSTRACT
A biliary cystadenoma (BC) and a cystadenocarcinoma (BCA) are rare neoplasms of the liver. Among 178 patients with primary liver neoplasms who underwent surgery during the last two years at our department, there were only one case of BC and three cases of BCA. The BC case was a 57-year-old female with 15-cm-sized multilocular cystic mass containing mucin. That patient, who had undergone a simple excision of a liver cyst 6 years earlier under the diagnosis of a cystadenoma, received a repeated wedge resection and is still doing well, no recurrence, 41 months after the resection. One BCA case was a 59-year-old female with an 8-cm-sized multilocular cystic mass. She underwent an extended left lobectomy and is still alive, without recurrence, 55 months later. Another BCA case was 77-year-old female with multiple multilocular masses which had degenerated due to sclerotherapy; the masses were removed by a wedge resection. She has been alive 35 months without recurrence. The other BCA case was a 37-year-old female with a 10-cm-sized unilocular mass with lung metastasis. She underwent an extended left lobectomy and survived 22 months. Malignant transformation of a BC to a BCA is well documented, and recurrence is the rule following incomplete resection. Complete resection of a BC and radical resection of a BCA seem to offer a chance for long-term survival.
Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Cystadenocarcinoma , Cystadenoma , Diagnosis , Hepatectomy , Liver , Liver Neoplasms , Lung , Mucins , Neoplasm Metastasis , Recurrence , SclerotherapyABSTRACT
Biliary cystadenoma of the liver is a rare multilocular cystic neoplasm of biliary origin. it occurs most often in middle aged women and rarely in children. Histogenesis of this tumor is uncertain. It may be developmental in origin arising from aberrant hamartomatous bile ducts or ectopic rests of embryonic biliary cystadenoma of the liver discovered at 8 month of intrauterine fetal life. This case supports its congenital theory.