An Excerpt of 2022 European Association for the Study of the Liver Clinical Practice Guidelines on the Management of Cystic Liver Diseases / 胃肠病学

The advent of enhanced radiological imaging techniques has facilitated the diagnosis of cystic liver lesions. Concomitantly, the evidence base supporting the management of these diseases has matured over the last decades. As a result, comprehensive clinical guidance on the subject matter is warranted. This guideline covers the diagnosis and management of hepatic cysts, mucinous cystic neoplasms of the liver, polycystic liver disease, caroli disease, caroli syndrome, biliary hamartomas and peribiliary cysts. On the basis of in⁃depth review of the relevant literature, this guideline provides recommendations to navigate clinical dilemmas followed by supporting text. The recommendations are graded according to the Oxford Centre for Evidence⁃based Medicine system and categorized as "weak" or "strong". This guideline aims to provide the best available evidence to aid the clinical decision⁃making process in the diagnosis and treatment of patients with cystic liver diseases, and presents the readers with translations and summarizations of the above mentioned recommendations.

An excerpt of 2022 European Association for the Study of the Liver clinical practice guidelines on the management of cystic liver diseases / 中华消化杂志

The advent of enhanced radiological imaging techniques has facilitated the diagnosis of cystic liver lesions. Concomitantly, the evidence base supporting the management of these diseases has matured over the last decades. As a result, comprehensive clinical guidance on the subject matter is warranted. This guideline covers the diagnosis and management of hepatic cysts, mucinous cystic neoplasms of the liver, biliary hamartomas, polycystic liver disease, caroli disease, caroli syndrome, biliary hamartomas and peribiliary cysts. On the basis of in-depth review of the relevant literature, this guideline provide recommendations to navigate clinical dilemmas followed by supporting text. The recommendations are graded according to the Oxford Centre for Evidence-Based Medicine system and categorized as "weak" or "strong" . This guideline aims to provide the best available evidence to aid the clinical decision-making process in the management of patients with cystic liver disease, and presents the readers with translations and summarizations of the above mentioned recommendations.

Quiste hepático gigante complicado por rotura traumática / Giant Hepatic Cyst Complicated by Traumatic Rupture

Introducción: Quistes hepáticos son formaciones de contenido líquido-seroso rodeado de parénquima hepático normal y sin comunicación con la vía biliar intrahepática. Mayor incidencia en adultos mayores de 50 años, con una relación mujer / hombre de 1.5: 1. Son asintomáticos. Los síntomas se presentan debido a su tamaño o bien por la presencia de complicaciones como la hemorragia, la rotura, la infección intraquística, o la compresión de estructuras adyacentes. Objetivo: Caracterizar a una paciente que presenta quiste hepático gigante complicado por rotura traumática. Caso clínico: Paciente femenino de 81 años, acudió a emergencia luego de haber presentado caída impactándose sobre superficie dura a nivel de parrilla costal e hipocondrio derecho, presentó dolor abdominal intenso acompañado de nausea y vómito. Al examen físico mostró signos claros de irritación peritoneal. Se realizó tomografía axial computarizada que reporta rotura de la pared de quiste hepático y aproximadamente 600 ml de líquido libre en cavidad. Se efectúo tratamiento quirúrgico de emergencia al realizar destechamiento del quiste y lavado de la cavidad. Conclusiones: Los quistes hepáticos, debido a su tamaño o complicaciones pueden poner en peligro la vida de los pacientes. Es necesario que dentro del arsenal diagnóstico del cirujano esté presente el conocimiento de esta patología(AU)

Introduction: Hepatic cysts are formations with liquid-serous content surrounded by normal liver parenchyma and without communication with the intrahepatic bile duct. It is reported with higher incidence in adults over fifty years of age, with a women/men ratio of 1.5: 1. They are asymptomatic; symptoms appear due to either their size or the presence of complications such as hemorrhage, rupture, intracystic infection, or compression of adjacent structures. Objective: To characterize a patient with a giant hepatic cyst complicated by traumatic rupture. Clinical case: A 81-year-old female patient went to the emergency room after falling and subsequently impacting herself on a hard surface at the level of the rib cage and right hypochondrium; she presented intense abdominal pain accompanied by nausea and vomiting. The physical examination showed clear signs of peritoneal irritation. A computerized axial tomography was performed, reporting rupture of the hepatic cyst wall and approximately 600 mL of free fluid within the cavity. Emergency surgical treatment was performed after cyst unroofing and cavity washing. Conclusions: Hepatic cysts, due to their size or complications, can endanger the patients' lives. It is necessary for the surgeon to consider knowledge of this condition as part of his or her diagnostic resources(AU)

Differential diagnosis for hepatic cyst diseases / 中华普通外科杂志

Objective@#To invastigate how to differentiate the single cystic hepatic hydatidosis from single hepatic cysts.@*Methods@#From Apr 2014 to Aug 2018 at the First Affiliated Hospital of Xinjiang Medical University, 30 cases of liver single cystic diseases were misdiagnosed·Relevant clinical data were compared including medical history, imaging features, immunological examination etc.@*Results@#18 cases of echinococcosis were misdiagnosed as hepatic cysts before operation, and 12 patients with hepatic cysts were misdiagnosed as hepatic cystic echinococcosis before operation.There were no significant differences between the two groups in eosinophil count (Eo#)(t=1.35, P>0.05), albumin (t=0.38, P>0.05), aspartate aminotransferase (t=0.99, P>0.05), and CT values(t=0.85, P>0.05). The results suggest that anti-EgCF antibody(χ2=4.26, P<0.05) and EgB antibody (χ2=7.26, P<0.05) are of significantly differential value in the identification of the two diseases.@*Conclusion@#Levels of anti-EgB and anti-EgCF antibodies to hepatic cystic echinococcosis are higher than that to single hepatic cysts.

Differential diagnosis for hepatic cyst diseases / 中华普通外科杂志

Objective To invastigate how to differentiate the single cystic hepatic hydatidosis from single hepatic cysts.Methods From Apr 2014 to Aug 2018 at the First Affiliated Hospital of Xinjiang Medical University,30 cases of liver single cystic diseases were misdiagnosed · Relevant clinical data were compared including medical history,imaging features,immunological examination etc.Results 18 cases of echinococcosis were misdiagnosed as hepatic cysts before operation,and 12 patients with hepatic cysts were misdiagnosed as hepatic cystic echinococcosis before operation.There were no significant differences between the two groups in eosinophil count (Eo#) (t =1.35,P ＞ 0.05),albumin (t =0.38,P ＞ 0.05),aspartate aminotransferase (t =0.99,P ＞ 0.05),and CT values (t =0.85,P ＞ 0.05).The results suggest that antiEgCF antibody (x2 =4.26,P ＜ 0.05) and EgB antibody (x2 =7.26,P ＜ 0.05) are of significantly differential value in the identification of the two diseases.Conclusion Levels of anti-EgB and anti-EgCF antibodies to hepatic cystic echinococcosis are higher than that to single hepatic cysts.

Diagnosis and treatment of benign liver nodules: Brazilian Society of Hepatology (SBH) recommendations

ABSTRACT Space-occupying lessions of the liver may be cystic or solid. Ultrasonography is an extremely useful method for initial screening, and suffices for diagnosis of simple hepatic cysts. Complex cysts and solid masses require computed tomography or magnetic resonance imaging for confirmation. Wide surgical excision is indicated in cystadenoma or cystadenocarcinoma. Clinical and epidemiological data are important, as nodules in noncirrhotic livers are more likely to be benign. Hemangiomas, the most common benign tumors, require no follow-up after diagnostic confirmation if they are small and asymptomatic. Patients with giant, symptomatic hemangiomas or compression of adjacent structures should be referred to hepatobiliary centers for potential surgery. The genetic heterogeneity of hepatocellular adenoms and their epidemiology and prognosis prompted classification of these tumors into four subtypes based on histology and immunohistochemistry. The major complications of hepatocellular adenoms are rupture with bleeding and malignant transformation. Rupture occurs in approximately 30% of cases. The main risk factors are tumors size >5 cm and inflammatory subtype. Hepatocellular adenoms may enlarge during pregnancy due to marked hormonal stimulation. As oral contraceptive pills and anabolic steroids have associated with hepatocellular adenoms growth, particularly of the hepatocyte nuclear factor-1 alfa subtype, these drugs should be discontinued. Focal nodular hyperplasia is the second most common benign tumor of hte liver. It is most frequent in women aged 20 to 60, and 70% to 90% of cases are asymptomatic. In the adsence of a central scar and/or other hallmarks of Focal nodular hyperplasia, with uncertainty between this diagnosis and hepatocellular adenoma, liver-specific contrast agentes are indicated.

RESUMO As lesões que ocupam espaço no fígado podem ser císticas ou sólidas. A ultrassonografia é extremamente útil como rastreamento inicial, bastando como método diagnósticos em casos de cistos simples. Em cistos complexos e em nódulos sólidos é necessária a complementação diagnóstica com tomografia computadorizada ou ressonância magnética. Em casos de cistadenoma ou cistadenocarcinoma, a ampla retirada cirúrgica está indicada. Dados clínico-epidemiológicos são importantes, já que nódulos em fígados não-cirróticos têm maiores probabilidades de serem benignos. Para os hemangiomas, tumores benignos mais frequentes, após a confirmação diagnóstica não existe necessidade de acompanhamento sistemático quando os nódulos são pequenos e assintomáticos. Hemangiomas gigantes sintomáticos ou comprimindo órgãos vizinhos devem ser encaminhados a centros de referência para avaliação de intervenção cirúrgica. A heterogeneidade genética nos adenomas hepatocelulares bem como características epidemiológicas e prognósticas motivou sua classificação em quatro subtipos, com base em achados histológicos e de imunohistoquímica. As principais complicações que ocorrem com o adenomas hepatocelulares são ruptura com hemorragia e transformação carcinomatosa. A primeira ocorre em cerca de 30% dos casos e o principal fator de risco para esta complicação são tumores maiores do que 5 cm, do subtipo hiperplasia nodular focal 1A, esses medicamentos devem ser suspensos. A hiperplasia nodular focal é o segundo tumor benigno mais frequente, mais comum nas mulheres entre 20 e 60 anos, sendo assintomáticos em 70% a 90% dos casos. Na ausência de lesão cicatricial central e/ou outros sinais sugestivos de hiperplasi nodular focal, havendo dúvida diagnóstica com adenoma hepatocelular, o uso de contraste hepatespecíficos está indicado.

Diagnosis and treatment of nonparasitic hepatic cysts / 中华消化外科杂志

The diagnosis of nonparasitic hepatic cysts has been significantly improved with the development of imaging techniques,however,the successful differential diagnosis depends on more careful consideration.The differential diagnosis of multiple hepatic cysts and polycystic liver disease depends on the family heredity,number of cysts,combination of polycystic kidney,division and the results of B ultrasound.The differential diagnosis of hepatic cyst and hepatic cystic adenocarcinoma depends on the imaging features and results of histopathological examination.Recently,laparoscopic surgery has been widespread-ly used in the management of hepatic cystic disease,while it still cannot replace open surgery.The individualized and various treatment should be selected according to the condition of the patients.

Diagnosis and treatment of intrahepatic biliary cystadenoma: a report of 7 cases / 中华肝胆外科杂志

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.

Resultados de la cirugía laparoscópica en quistes hepáticos no parasitarios / Results of laparoscopic surgery in nonparasitic hepatic cysts

Los quistes hepáticos no hidatídicos (QHNH) se detectan de forma incidental, pueden ser únicos y múltiples. Desde que se describió el tratamiento laparoscópico de estos, se han reportado diversas series; existiendo por ende evidencia que avala la cirugía laparoscópica de estas lesiones. El objetivo de este estudio, es reportar los resultados del tratamiento laparoscópico de QHNH en términos de morbilidad postoperatoria (MPO). Serie de casos. Se incluyeron pacientes intervenidos quirúrgicamente vía laparoscópica por QHNH en el Hospital Clínico de la Universidad Mayor entre enero de 2008 y diciembre de 2012. El estudio preoperatorio consistió en exámenes generales, determinación de ELISA-IgE e IgG para hidatidosis, ecotomografía abdominal o tomografía computarizada. En el período estudiado, se intervinieron 17 pacientes con QHNH, resecándose en ellos, un total de 39 quistes. El 76,5 por ciento de los casos eran de sexo femenino; y la mediana de edad de la serie fue de 56 años. La mediana del diámetro ecográfico de las lesiones fue de 7,5 cm. Se realizó quistectomía subtotal en todos ellos, sin utilización de drenaje. Se realizó epiploplastia en 4 pacientes. En el 82,4 por ciento de los casos se ejecutó de forma simultánea una colecistectomía por colelitiasis. La mediana del tiempo quirúrgico fue de 51 minutos. No fue necesario convertir a ningún paciente. La serie no registra MPO ni mortalidad. La mediana de estancia hospitalaria fue de 1 día. El estudio histopatológico confirmó "quiste de tipo biliar" en la totalidad de los casos. Con un seguimiento mínimo de 6 meses, no se ha evidenciado MPO tardía ni reaparición de las lesiones resecadas. El tratamiento aplicado a esta serie de casos de QHNH, se asocia a escasa estancia hospitalaria y buena evolución a corto y mediano plazo.

Nonparasitic hepatic cysts (NPHC) can be detected incidentally, and may be single or multiple. Since described laparoscopic treatment of NPHC, several series have been reported, therefore there is enough evidence that support the role of laparoscopic surgery in the treatment of NPHC. The aim of this study is to report the results of laparoscopic treatment of QHNH in terms of postoperative morbidity (POM). Case series. Patients operated laparoscopically by NPHC in the Universidad Mayor Clinical Hospital, Temuco, between January 2008 and December 2012 were included. The preoperative evaluation consisted of general exams, ELISA-IgE and IgG determination for hydatid disease, abdominal ultrasonography or abdominal CT scan. During the study period, 17 patients with NPHC were operated, resecting them a total of 39 cysts. 76.5 percent of patients were female, and the median age of the series was 56 years. The median sonographic diameter of the lesions was 7.5 cm. Subtotal cystectomy was performed in all of them, without using drainage. Epiploplasty was performed in 4 patients. In 82.4 percent of cases simultaneously cholecystectomy for cholelithiasis was performed. The median operative time was 51 minutes. Neither patient was converted. The series does not register MPO or mortality. The median hospital stay was 1 day. Histopathology confirmed the "biliary type cyst" in all cases. With a minimum follow up of 6 months, there is no evidence or late MPO or recurrence of the lesions resected. The treatment applied to this series of NPHC, is associated with short hospital stay and good outcome in the short and medium term.

Polycystic echinococcosis in the state of Acre, Brazil: contribution to patient diagnosis, treatment and prognosis

The lack of knowledge regarding polycystic hydatid disease results in delayed or even incorrect diagnosis. The lack of systematic information regarding treatment also makes it difficult to assess the results and prognosis in patients with peritoneal and hepatic lesions caused by Echinococcus vogeli. Here we describe the clinical features of patients, propose a radiological classification protocol and describe a therapeutic option for the treatment of hydatid disease that previously had only been used for cases of cystic echinococcosis (Echinococcus granulosus). A prospective cohort study was initiated in 1999 and by 2009 the study included 60 patients. These patients were classified according to the PNM classification (parasite lesion, neighbouring organ invasion and metastases) and placed in one of three therapeutic modalities: (i) chemotherapy with albendazole at a dose of 10 mg/kg/day, (ii) surgical removal of cysts or (iii) percutaneous puncture of the cysts via puncture, aspiration, injection and re-aspiration (PAIR). The results were stratified according to therapeutic outcome: "cure", "clinical improvement", "no improvement", "death" or "no information". The PNM classification was useful in indicating the appropriate therapy in cases of polycystic hydatid disease. In conclusion, surgical therapy produced the best clinical results of all the therapies studied based on "cure" and "clinical improvement" outcomes. The use of PAIR for treatment requires additional study.

Treatment and its prognosis of polycystic hepatic disease and multiple simple hepatic cysts / 中国综合临床

Objective To evaluate the effects of different surgical treatments on polycystic hepatic disease and multiple simple hepatic cysts.Methods A total of 35 cases of polycystic hepatic disease and 54 cases of multiple simple hepatic cysts were surgically treated in our department from Jan.1998 to Jan.2006.Of the 35 cases of polycystic hepatic disease,12 were treated with the partial hepatic resection in combination with cyst fenestration,18 with laparotomic fenestration,5 with laparoscopic fenestration.Of the 54 cases of multiple simple hepatic cysts,6were treated with percutaneons aspiration and instillation of sclerosing agents (ethanol) under the guidance of ultrasonography B,36 with laparotomic fenestration,13 with laparoscopic fenestration.The surgical outcome and longterm follow-up outcome were retrospectively analyzed.Results After treatment,all polycystic hepatic disease patients experienced relief of symptoms when discharged.And the follow-up for an average of 3.0 years showed that 2 patients developed recurrence after the partial hepatic resection in combination with cyst fenestration,8 after the laparotomic fenestration,5 after the laparoscopic fenestration.The recurring rates were 16.7%,44.4% and 100.0% ,respectively.However,all patients of multiple simple liver cysts cured.Conclusions The approach of partial hepatic resection in combination with cyst fenestration is the most effective treatment for polycystic hepatic disease.Liver transplantation can cure polycystic hepatic disease,and is the only effective approach for severe cases.Percutaneous aspiration under the guidance of ultrasonography B is only effective for relief of symptoms before operation.Laparoscopic fenestration should be applied with caution.Laparoscopic fenestration is the first choice for multiple simple hepatic cysts with clinical symptoms.

Treatment of hepatic cysts with dehydrated alcohol sclerosing agent guided by CT / 介入放射学杂志

Objective To evaluate the clinical effects of CT guided percutaneous aspiration and sclerotherapy in treatment of hepatic cysts.Methods Sixty three patients with single(n=41)and muttiple(n= 22)hepatic cysts were undertaken CT guided pereutaneous aspiration and sclerotherapy with injection of absolute alcohol.Results Sixty three patients underwent follow-up for 3-15 months after the operation showing effective indexes as grade 0 for 4(6.39%),gradeⅠfor 8(12.69%),gradeⅡfor 23(36.51%)and gradeⅢfor 28(44.44%)cases.The total effective rate reached 93.61%.No serious complications occurred. Conclusion Sclerosing therapy with absolute alcohol is safe,economic,simple and effective for treating hepatic cysts.(J Intervent Radiol,2007,16:850-852)