Primary cystic carcinoma of the liver

Biliary cystadenocarcinoma of the liver: the need for complete resection

We report on a patient with biliary cystadenocarcinoma and review 112 previously published cases of this rare cystic hepatic neoplasm. This tumour mainly occurs in women at a ratio of 62% (female) to 38% (male), and at an average age of 56.2 years (range 18-88 years). The origin of these neoplasms is intrahepatic in 97% of cases and extrahepatic in the remaining 3%. The clinical symptoms are nonspecific and are not distinctive from benign cystic liver lesions unless invasive growth of the tumour occurs or distant metastases are present. Sonography and computed tomography (CT), as well as magnetic resonance imaging (MRI) demonstrate the multilocular nature of the tumour with septal or mural nodules. Discrete soft tissue masses, thick and coarse calcifications and varying density on CT or intensity on MRI within the loculi are additional non-specific imaging findings. The best therapeutic result with a 5-year survival rate of 100% and a recurrence rate of only 13% was achieved by complete excision (n = 16). Surgical removal of the tumour by complete excision is, therefore, the treatment of choice for biliary cystadenocarcinomas.

A case of biliary cystadenocarcinoma

Biliary cystadenocarcinoma is a very rare cystic tumor that arises in the liver or, less frequently, in the extrahepatic biliary system. It has been shown to arise in congenital liver cysts, bile ducts, biliary cystadenoma, in the context of fibropolycystic disease and in the hepatoduodenal ligament. Common presenting symptoms include an abdominal mass, local pain, nausea, jaundice, fever or occasional ascites. Some patients are asymptomatic, the lesion being an incidental finding at autopsy or surgery. Approximately 50 cases have been reported in the literature. We report a case of biliary cystadenocarcinoma in a 63-year-old man with a review of the literature.

A report of 5 cases of cystic bile duct carcinoma of the liver and proposal of a new classification

Primary biliary cystadenocarcinoma of the liver is rare. Among 239 patients with primary liver cancer admitted to our service during the last 13 years, there were 5 cases of cystic bile duct carcinoma of the liver. Three of these were cystadenocarcinoma, one was adenocarcinoma arising from a liver cyst, and one was carcinoma of the intrahepatic bile ducts with cystic dilatation. A better classification of these entities seems necessary, and it is suggested that malignant cystic tumors of the liver should be divided into 3 groups: Group A is cystic adenocarcinoma, group B is bile duct carcinoma with primary or secondary intrahepatic bile duct, and group C is degenerative cyst formation by other types of malignant tumors. Cystic adenocarcinoma (Group A) can then be further subdivided into cystadenocarcinoma, cystadenocarcinoma with cystadenoma, and carcinoma in a simple cyst of the liver.

Intrahepatic bile duct cystadenocarcinoma: case report and imaging diagnosis

The authors report the 30th case in the literature of cystadenocarcinoma of the liver and the second case arising in the caudate lobe. This case illustrates the 2 main questions raised by this tumor: the importance of differentiating benign and malignant cystadenoma and bile duct cyst on sonographic and scanographic aspects and the surgical management of these tumors of the liver, especially in this malignant centrohepatic case.

A case of biliary cystadenocarcinoma with morphologic and histochemical features of hepatocytes

A case of biliary cystadenocarcinoma is presented in which the lesion seemed to partially differentiate into hepatocellular carcinoma. This patient had a cystic tumor in the left lobe of the liver, the interior being filled with papillary tumors. Histologic examination disclosed papillary growth of columnar tumor cells, together with tumor cells akin to hepatocytes (they had a distinct cell boundary, nuclear membrane, and nucleolus) showing a cobblestone appearance in some areas. Electron microscopic examination of this area showed bile canalicular structures. Histochemically, the tissue stained positively with the Luna-Ishak canalicular (LIC) technique; periodic acid-Schiff (PAS) staining demonstrated coexisting glycogen granulo-positive cells and mucus-producing cells. Thus, in this biliary cystadenocarcinoma, some tumor cells demonstrated the morphologic and histochemical features of hepatocytes.

Cystadenoma with mesenchymal stroma (CMS) in the liver and bile ducts. A clinicopathologic study of 17 cases, 4 with malignant change

This study of 17 cases describes a homogeneous clinicopathologic group of tumors previously subsumed under the general term, hepatobiliary cystadenoma. This unique group of neoplasms that the authors have termed "cystadenoma with mesenchymal stroma" (CMS), occurred exclusively in women and showed two essential tumor components: a cyst lining of columnar to cuboidal, mucin secreting epithelium; and a moderately to densely cellular stroma composed of spindle (rarely oval) cells. The stromal element appeared similar to primitive mesenchyme, both on light and electron microscopic study, showing variable differentiation toward fibroblasts, smooth muscle, adipose tissue and capillaries. Cases of hepatobiliary "cystadenoma" in the literature with histology similar to CMS had similar sex and age incidences, while histologically dissimilar cases, lacking the mesenchymal stroma, had significantly different parameters. Four cases of CMS in this series showed malignant change that was manifested as papillary adenocarcinoma, suggesting the need for complete surgical removal of these premalignant neoplasms.

A case of biliary cystadenocarcinoma with recurrent jaundice. Diagnostic evaluation of computed tomography

A 73-year-old male patient with biliary cystadenocarcinoma and episodes of recurrent jaundice is reported. This very rare tumor was suggested as a possible diagnosis by the computed tomographic findings showing intrahepatic cystic masses with septations and papillary projections. The diagnosis of the mucin-producing tumor was supported by aspiration of mucinous bile with a cannule inserted endoscopically via the major duodenal papilla. The computed tomographic findings and the diagnosis were verified by pathologic studies made on the material obtained surgically. The mucinous bile is assumed to have been responsible for the recurrent jaundice.

Biliary cystadenocarcinoma arising in a congenital cyst

The case of a biliary cystadenoma containing foci of cystadenocarcinoma is reported, along with the first electron microscopic description of this lesion. Both neoplastic and congenital origins have been implicated in the pathogenesis of biliary cystadenomas. In this case hamartomatous bile ducts were found, supporting a congenital origin for at least some biliary cystadenomas. Careful pathologic evaluation is emphasized since malignant degeneration can be detected only after thorough sectioning.

Biliary cystadenocarcinoma with peritoneal carcinomatosis

An autopsy report of a patient with a hugh biliary cystadenocarcinoma arising in the right lobe of the liver is presented. The tumor had been though to be benign, but peritoneal carcinomatosis developed 18 months after the operation. Autopsy revealed marked peritoneal dissemination of mucinous adenocarcinoma, apparently a result of peritoneal seeding of hepatic cystadenocarcinoma, which was presumed to be triggered by cyst aspiration performed during the operation. Experience indicates that surgical procedures on cystic liver disease should be carried out carefully, considering the possible existence of malignancy.

Biliary cystadenocarcinoma: Case report of hepatic malignancy originating in benign cystadenoma

A case of biliary cystadenoma undergoing malignant dedifferentiation is presented. Biliary cystadenocarcinoma is an infrequently occurring neoplasm; fewer than 20 cases have been reported in the literature. This case is the first in which there is documentation of cystadenocarcinoma arising from a previously diagnosed benign cystadenoma. Over a six-year period, the patient had three recurrences. The initial lesion and the first two recurrences were treated by drainage and biopsy. Histologically each succeeding specimens showed increasing atypia. Finally the majority of the lesion was excised, and microscopic examination revealed both benign and atypical epithelium and papillary adenocarcinoma, suggesting transition from benign to malignant. Thus, in view of the malignant potential of biliary cystadenomas, treatment of choice is total excision if surgically feasible.

Biliary cystadenocarcinoma: report of a case presenting with osseous metastasis and a review of the literature

Biliary cystadenocarcinoma is a rare malignancy, and osseous metastasis resulting from this tumor have been recorded in only one of the 19 documented cases in the literature. The case report of this 59-year-old male is unusual in that the patient's initial clinical manifestations of the disease were that of osseous metastases, while the primary tumor eluded discovery for greater than 1 year. Although this is the first documented case in which radiation and chemotherapy were used to control the disease, the use of these agents may have contributed to the delay in establishing the primary site of the tumor. The clinical and pathologic features of this and the previously reported cases are reviewed with an emphasis on the newer diagnostic modalities being used in more recent cases to establish the diagnosis for this tumor.

Cholangiocarcinoma coexisting with developmental liver cysts: a distinct entity different from liver cystadenocarcinoma

We report one liver cystadenocarcinoma and two cholangiocarcinomas coexisting with developmental liver cysts. The cystadenocarcinoma was a solitary multilocular cyst with histological features similar to those seen in ovarian mucinous cystadenocarcinoma. In contrast, the other two tumours were a mixture of solid adenocarcinoma and multiple non-neoplastic cysts containing serous fluid and lined mainly by atrophic epithelium. In both these cases renal cysts were also present and in one case there was focal malignant change of the epithelium lining the cysts from which the solid adenocarcinoma could have originated. Our observations support the view that cholangiocarcinoma associated with developmental liver cysts is an entity different from liver cystadenocarcinoma.

Carcinoma arising in the cyst of the liver--report of three cases--

A generally recognized concept dictates that surgical intervention for non-parasitic cysts of the liver is mostly palliative such as aspiration of the content, suture and closure, internal or external drainage, marsupialization, and unroofing of the cyst, while total excision of the entire cyst, which sometimes necessitates hepatic resection, is not usually recommended.3, 6, 9 The results of these lesser procedures have been acceptable, favoring those conservative procedures. This paper presents three cases with carcinoma arising in the cysts of the liver. Review of the present cases with five comparable cases appearing in the literature revealed that young female population and left lobe of the liver are frequently involved. Hence the general trend for palliative procedures should be reassessed. Possible malignancy should be considered when a patient belongs to this category, the cystic content is not clear, or the cystic wall presents irregular texture with nodules. The carcinomatous changes would have been of higher incidence than reported if the entire cysts had been more carefully examined.

Biliary cystadenoma and cystadenocarcinoma: report of 14 cases and review of the literature

The clinical and pathologic features and long-term follow-up of eight patients with biliary cystadenoma and six patients with biliary cystadenocarcinoma are reported and the previous literature is reviewed. All the cystadenomas were in middle-aged women, but the six cystadenocarcinomas occurred in both male (4) and female (2) patients. The majority of the patients with cystadenoma and half of those with cystadenocarcinoma presented with an abdominal mass. Four of the patients whose cystadenoma was excised are alive and well for periods of time ranging from 2 1/2 to 13 years. Two of the patients with cystadenocarcinoma have survived for three years and for three years and eight months, respectively, after subtotal hepatic lobectomy. Morphologically the cystadenocarcinomas differ from the cystadenomas in that the former have cellular pleomorphism and anaplasia and infiltration of the underlying fribrous stroma; they can invade adjacent viscera and may occasionally metastasize to distant sites. The presence of benign epithelium in most cystadenocarcinomas supports their origin from cystadenoma.