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Hu C, Lei Y, Liu X, Yu X, Geng Z, Liu Y, Yang L, Tie X, Zhou W, Li X, Zhang Y, Liang Y. Dissecting microenvironment in cystadenomas and hepatic cysts based on single nucleus RNA-sequencing data. Comput Biol Med 2024; 176:108541. [PMID: 38744012 DOI: 10.1016/j.compbiomed.2024.108541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/13/2024] [Accepted: 04/28/2024] [Indexed: 05/16/2024]
Abstract
Hepatic cystadenoma is a rare disease, accounting for about 5% of all cystic lesions, with a high tendency of malignant transformation. The preoperative diagnosis of cystadenoma is difficult, and some cystadenomas are easily misdiagnosed as hepatic cysts at first. Hepatic cyst is a relatively common liver disease, most of which are benign, but large hepatic cysts can lead to pressure on the bile duct, resulting in abnormal liver function. To better understand the difference between the microenvironment of cystadenomas and hepatic cysts, we performed single-nuclei RNA-sequencing on cystadenoma and hepatic cysts samples. In addition, we performed spatial transcriptome sequencing of hepatic cysts. Based on nucleus RNA-sequencing data, a total of seven major cell types were identified. Here we described the tumor microenvironment of cystadenomas and hepatic cysts, particularly the transcriptome signatures and regulators of immune cells and stromal cells. By inferring copy number variation, it was found that the malignant degree of hepatic stellate cells in cystadenoma was higher. Pseudotime trajectory analysis demonstrated dynamic transformation of hepatocytes in hepatic cysts and cystadenomas. Cystadenomas had higher immune infiltration than hepatic cysts, and T cells had a more complex regulatory mechanism in cystadenomas than hepatic cysts. Immunohistochemistry confirms a cystadenoma-specific T-cell immunoregulatory mechanism. These results provided a single-cell atlas of cystadenomas and hepatic cyst, revealed a more complex microenvironment in cystadenomas than in hepatic cysts, and provided new perspective for the molecular mechanisms of cystadenomas and hepatic cyst.
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Affiliation(s)
- Congxue Hu
- College of the First Affiliated Hospital of Harbin Medical University, Bioinformatics Science and Technology, Harbin Medical University, Harbin, 150081, China
| | - Yongqi Lei
- College of the First Affiliated Hospital of Harbin Medical University, Bioinformatics Science and Technology, Harbin Medical University, Harbin, 150081, China
| | - Xinyang Liu
- College of the First Affiliated Hospital of Harbin Medical University, Bioinformatics Science and Technology, Harbin Medical University, Harbin, 150081, China
| | - Xingxin Yu
- College of the First Affiliated Hospital of Harbin Medical University, Bioinformatics Science and Technology, Harbin Medical University, Harbin, 150081, China
| | - Zhida Geng
- College of the First Affiliated Hospital of Harbin Medical University, Bioinformatics Science and Technology, Harbin Medical University, Harbin, 150081, China
| | - Yu Liu
- College of the First Affiliated Hospital of Harbin Medical University, Bioinformatics Science and Technology, Harbin Medical University, Harbin, 150081, China
| | - Liyu Yang
- College of the First Affiliated Hospital of Harbin Medical University, Bioinformatics Science and Technology, Harbin Medical University, Harbin, 150081, China
| | - Xuehong Tie
- College of the First Affiliated Hospital of Harbin Medical University, Bioinformatics Science and Technology, Harbin Medical University, Harbin, 150081, China
| | - Wenzhe Zhou
- College of the First Affiliated Hospital of Harbin Medical University, Bioinformatics Science and Technology, Harbin Medical University, Harbin, 150081, China
| | - Xia Li
- College of the First Affiliated Hospital of Harbin Medical University, Bioinformatics Science and Technology, Harbin Medical University, Harbin, 150081, China
| | - Yunpeng Zhang
- College of the First Affiliated Hospital of Harbin Medical University, Bioinformatics Science and Technology, Harbin Medical University, Harbin, 150081, China.
| | - Yingjian Liang
- College of the First Affiliated Hospital of Harbin Medical University, Bioinformatics Science and Technology, Harbin Medical University, Harbin, 150081, China.
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Hutchens JA, Lopez KJ, Ceppa EP. Mucinous Cystic Neoplasms of the Liver: Epidemiology, Diagnosis, and Management. Hepat Med 2023; 15:33-41. [PMID: 37016682 PMCID: PMC10066895 DOI: 10.2147/hmer.s284842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/01/2023] [Indexed: 04/06/2023] Open
Abstract
Mucinous cystic neoplasms (MCNs) are rare tumors of the liver, occasionally seen in the biliary tree. Epidemiologic data are limited by their indolence and recent changes to diagnostic criteria. They are considered premalignant lesions capable of invasive behavior. While their etiology remains unknown, their female predominance, age of onset, and hormonally responsive ovarian-type stroma suggest ectopic organogenesis during embryologic development. MCNs can typically be recognized on imaging; yet, invasiveness is often indeterminate, and percutaneous tissue biopsy has shown limited value. Therefore, complete excision is recommended for all lesions as focal malignant transformation and metastatic disease has been reported.
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Affiliation(s)
- Jeffrey A Hutchens
- Department of Surgery, Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kevin J Lopez
- Department of Surgery, Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Eugene P Ceppa
- Department of Surgery, Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
- Correspondence: Eugene P Ceppa, Associate Professor of Surgery, Section Chief of HPB Surgery, Division of Surgical Oncology, Indiana University School of Medicine, 545 Barnhill Dr, EH 541, Indianapolis, IN, 46202, USA, Tel +1-317-944-5013, Fax +1-317-968-1031, Email
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Pitchaimuthu M, Duxbury M. Cystic lesions of the liver-A review. Curr Probl Surg 2017; 54:514-542. [PMID: 29173653 DOI: 10.1067/j.cpsurg.2017.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/08/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Maheswaran Pitchaimuthu
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom; Department of HPB and Transplant Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
| | - Mark Duxbury
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
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Lee CW, Tsai HI, Lin YS, Wu TH, Yu MC, Chen MF. Intrahepatic biliary mucinous cystic neoplasms: clinicoradiological characteristics and surgical results. BMC Gastroenterol 2015; 15:67. [PMID: 26058559 PMCID: PMC4460858 DOI: 10.1186/s12876-015-0293-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 05/22/2015] [Indexed: 12/20/2022] Open
Abstract
Background Intrahepatic biliary mucinous cystic neoplasms are rare hepatic tumors and account for less than 5% of intrahepatic cystic lesions. Accurate preoperative diagnosis is difficult and the outcome differs among various treatment modalities.The aim of this study is to investigate the clinico-radiological characteristics of intrahepatic biliary mucinous cystic neoplasms and to establish eligible diagnostic and treatment suggestions. Methods Nineteen patients with intrahepatic biliary cystadenomas and two patients with biliary cystadenocarcinomas were retrospectively reviewed. Their clinico-radiological variables and survival outcome were analyzed. Results Of the 19 patients with biliary cystadenoma, 16 (84.2 %) were female. 11 (57.9 %) patients had symptoms before operation with the most common presenting symptom being abdominal pain. Among the patients with available data, serum and cystic fluid CA 19–9 levels were invariably elevated and the CA 19–9 level in the cystic fluid was significantly higher than that in the serum. Loculations (84.2 %) and septations (63.2 %) were the most common radiologic findings. For treatment, 11 (57.9 %) patients received radical resection by either enucleation or hepatic resection, while the remaining 8 (42.1 %) patients underwent only fenestration of liver cysts. Radical resection provided a significantly better clinical outcome than fenestration in terms of tumor recurrence (p = 0.018). The only two male patients with biliary cystadenocarcinoma received radical hepatic resection and achieved a disease-free survival of 16.5 months and 33 months, respectively. Conclusion Intrahepatic biliary mucinous cystic neoplasms are rare and preoperative diagnosis is difficult. Internal septations and loculations on radiologic examinations should raise some suspicion of this diagnosis. Complete tumor excision is the standard treatment that may provide patients with better long term results after the operation.
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Affiliation(s)
- Chao-Wei Lee
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan.
| | - Hsin-I Tsai
- Department Anesthesiology, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - Yann-Sheng Lin
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - Tsung-Han Wu
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - Ming-Chin Yu
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan.
| | - Miin-Fu Chen
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan.
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Outcome following Resection of Biliary Cystadenoma: A Single Centre Experience and Literature Review. Int J Hepatol 2015; 2015:382315. [PMID: 26839708 PMCID: PMC4709616 DOI: 10.1155/2015/382315] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/14/2015] [Accepted: 12/15/2015] [Indexed: 02/06/2023] Open
Abstract
Background. Biliary cystadenomas (BCAs) are rare, benign, potentially malignant cystic lesions of the liver, accounting for less than 5% of cystic liver tumours. We report the outcome following resection of biliary cystadenoma from a single tertiary centre. Methods. Data of patients who had resection of BCA between January 1993 and July 2014 were obtained from liver surgical database. Patient demographics, clinicopathological characteristics, operative data, and postoperative outcome were analysed. Results. 29 patients had surgery for BCA. Male : female ratio was 1 : 28. Clinical presentation was abdominal pain (74%), jaundice (20%), abdominal mass (14%), and deranged liver function tests (3%). Cyst characteristics included septations (48%), wall thickening (31%), wall irregularity (38%), papillary projections (10%), and mural nodule (3%). Surgical procedures included atypical liver resection (52%), left hemihepatectomy (34%), right hemihepatectomy (10%), and left lateral segmentectomy (3%). Median length of stay was 7 (IQ 6.5-8.5) days. Two patients developed postoperative bile leak. No patients had malignancy on final histology. Median follow-up was 13 (IQ 6.5-15.7) years. One patient developed delayed biliary stricture and one died of cholangiocarcinoma 11 years later. Conclusion. Biliary cystadenomas can be resected safely with significantly low morbidity. Malignant transformation and recurrence are rare. Complete surgical resection provides a cure.
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Martel G, Alsharif J, Aubin JM, Marginean C, Mimeault R, Fairfull-Smith RJ, Mohammad WM, Balaa FK. The management of hepatobiliary cystadenomas: lessons learned. HPB (Oxford) 2013; 15:617-22. [PMID: 23458638 PMCID: PMC3731583 DOI: 10.1111/hpb.12026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 10/28/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Mucinous cystic neoplasms of the liver (hepatobiliary cystadenomas) are rare neoplastic lesions. Such cysts are often incorrectly diagnosed and managed, and carry a risk of malignancy. The objective of this study was to review the surgical experience with these lesions over 15 years. METHODS A retrospective chart review identified consecutive patients undergoing surgery for liver cystadenomas from 1997-2011. Clinical data were collected and summarized. RESULTS Thirteen patients (mean age 51 years, 12/13 females) with cysts 4.6-18.1 cm were identified. Most cysts were located in the left lobe/centrally (11/12) and had septations (8/13). Mural nodularity was infrequent (3/13). Nine patients had liver resection/enucleation, whereas four had unroofing. Frozen section analysis had a high false-negative rate (4/6). All patients had cystadenomas, of which two had foci of invasive carcinoma (cystadenocarcinoma) within mural nodules. There was no 90-day mortality. All but one patient (myocardial infarction) were alive at a median follow-up of 23.1 months. No patient with unroofing has developed malignancy to date. CONCLUSIONS Non-invasive hepatobiliary cystadenomas present as large central/left-sided cysts in young or middle-aged women. Associated malignancy was relatively uncommon and found within mural nodules. Intra-operative frozen section analysis was ineffective at ruling out cystadenomas. Complete excision is recommended, but close follow-up might be considered in patients with a prohibitive technical or medical risk, in the absence of nodularity on high-quality imaging.
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Affiliation(s)
- Guillaume Martel
- Liver and Pancreas Unit, Division of General Surgery, Gastrointestinal Pathology Section, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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Emre A, Serin KR, Özden İ, Tekant Y, Bilge O, Alper A, Güllüoğlu M, Güven K. Intrahepatic biliary cystic neoplasms: Surgical results of 9 patients and literature review. World J Gastroenterol 2011; 17:361-5. [PMID: 21253396 PMCID: PMC3022297 DOI: 10.3748/wjg.v17.i3.361] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 09/18/2010] [Accepted: 09/26/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the eligible management of the cystic neplasms of the liver.
METHODS: The charts of 9 patients who underwent surgery for intrahepatic biliary cystic liver neoplasms between 2003 and 2008 were reviewed retrospectively. Informed consent was obtained from the patients and approval was obtained from the designated review board of the institution.
RESULTS: All patients were female with a median (range) age of 49 (27-60 years). The most frequent symptom was abdominal pain in 6 of the patients. Four patients had undergone previous laparotomy (with other diagnoses) which resulted in incomplete surgery or recurrences. Liver resection (n = 6) or enucleation (n = 3) was performed. The final diagnosis was intrahepatic biliary cystadenoma in 8 patients and cystadenocarcinoma in 1 patient. All symptoms resolved after surgery. There has been no recurrence during a median (range) 31 (7-72) mo of follow up.
CONCLUSION: In spite of the improvement in imaging modalities and increasing recognition of biliary cystadenoma and cystadenocarcinoma, accurate preoperative diagnosis may be difficult. Complete surgical removal (liver resection or enucleation) of these lesions yields satisfying long-term results.
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Ren XL, Yan RL, Yu XH, Zheng Y, Liu JE, Hou XB, Zuo SY, Fu XY, Chang H, Lu JH. Biliary cystadenocarcinoma diagnosed with real-time contrast-enhanced ultrasonography: Report of a case with diagnostic features. World J Gastroenterol 2010; 16:131-5. [PMID: 20039461 PMCID: PMC2799910 DOI: 10.3748/wjg.v16.i1.131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Biliary cystadenocarcinoma is a very rare malignant cystic tumor of the liver, which is often misdiagnosed due to a poor recognition of it. We report a case of a 60-year-old man with biliary cystadenocarcinoma with his real time contrast enhanced ultrasound (CEUS) characteristics compared to those of computed tomography (CT) and magnetic resonance imaging (MRI), which were correlated with the surgical and pathologic findings. Cystic wall enhancement, internal septations and intra-cystic solid portions in the arterial phase were observed on CEUS after contrast agent injection. The enhancement was washed out progressively and depicted as hypo-enhancement in the portal and late phases. CT revealed a large irregular cystic lesion in the left liver lobe with no clear septations and solid components. MRI showed an irregular cystic occupying lesion with septations.
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9
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Kudo Y, Kikuchi T, Sato Y, Hirau K, Sugawara K, Sato T, Yamada N, Saito Y, Sugita A, Ishida H. Hepatobiliary cystadenocarcinoma with rapid growth: report of a case. J Med Ultrason (2001) 2008; 35:133-8. [PMID: 27278837 DOI: 10.1007/s10396-008-0178-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Accepted: 04/03/2008] [Indexed: 12/14/2022]
Abstract
We describe a case of histologically proven hepatobiliary cystadenocarcinoma with an emphasis on the longterm clinical course. The patient was a 75-year-old man who had been diagnosed as having a simple hepatic cyst at our hospital and had been followed up by abdominal sonography (US) for about 10 years. However, the lesion subsequently showed a sudden increase in size and a marked change in US findings, i.e., from a benign hepatic cyst to a complete solid lesion. Contrast-enhanced US revealed the lesion to be filled with fine vessels. This rapid change led us to strongly suspect a hepatobiliary cystadenocarcinoma and, thus, left lateral segmentectomy was performed. The patient is doing well 6 months after the surgical treatment.
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Affiliation(s)
- Yumiko Kudo
- Department of Clinical Physiology, Yuri Kumiai General Hospital, 38 Kawaguchii, Yurihonjo, 015-0051, Japan.
| | - Takaya Kikuchi
- Department of Clinical Physiology, Yuri Kumiai General Hospital, 38 Kawaguchii, Yurihonjo, 015-0051, Japan
| | - Yoshiaki Sato
- Department of Clinical Physiology, Yuri Kumiai General Hospital, 38 Kawaguchii, Yurihonjo, 015-0051, Japan
| | - Kenji Hirau
- Department of Surgery, Yuri Kumiai General Hospital, Yurihonjo, Japan
| | - Koh Sugawara
- Department of Surgery, Yuri Kumiai General Hospital, Yurihonjo, Japan
| | - Toshihiro Sato
- Department of Gastroenterology, Yuri Kumiai General Hospital, Yurihonjo, Japan
| | - Nobuo Yamada
- Department of Gastroenterology, Yuri Kumiai General Hospital, Yurihonjo, Japan
| | - Yutaka Saito
- Department of Radiology, Yuri Kumiai General Hospital, Yurihonjo, Japan
| | - Akihiro Sugita
- Department of Pathology, Yuri Kumiai General Hospital, Yurihonjo, Japan
| | - Hideaki Ishida
- Center of Diagnostic Ultrasound, Red Cross Hospital, Akita, Japan
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Ramacciato G, Nigri GR, D'Angelo F, Aurello P, Bellagamba R, Colarossi C, Pilozzi E, Del Gaudio M. Emergency laparotomy for misdiagnosed biliary cystadenoma originating from caudate lobe. World J Surg Oncol 2006; 4:76. [PMID: 17090300 PMCID: PMC1635700 DOI: 10.1186/1477-7819-4-76] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Accepted: 11/07/2006] [Indexed: 12/26/2022] Open
Abstract
Background Biliary cystadenoma is a rare benign neoplasm, which is often misdiagnosed for a hepatic abscess or a hydatid cyst that tends to recur and is at risk for progression to malignant neoplasm. Case presentation This case describes a 30-year-old woman admitted to our institution in an emergency setting. The patient was originally misdiagnosed as affected by a hepatic hydatid cyst at another hospital, and then emergently treated at our Institution for severe abdominal pain. Histologic evaluation of the cyst showed that it was a biliary cystadenoma and, therefore, the patient underwent a hepatic resection in order to completely remove the lesion. Conclusion Complete excision of any suspicious hepatic cystic lesion remains the best method for diagnosis and treatment of cystadenoma. Incomplete excision of most biliary cystadenoma results in a higher rate of recurrence and the risk of malignant transformation. We report this case to elucidate the clinical presentation, preoperative evaluation, and surgical treatment of these rare lesions.
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Affiliation(s)
- Giovanni Ramacciato
- Hepatobiliary-pancreatic Surgery, University of Rome "La Sapienza", II School of Medicine, Sant'Andrea Hospital, Rome, Italy
| | - Giuseppe R Nigri
- Hepatobiliary-pancreatic Surgery, University of Rome "La Sapienza", II School of Medicine, Sant'Andrea Hospital, Rome, Italy
| | - Francesco D'Angelo
- Hepatobiliary-pancreatic Surgery, University of Rome "La Sapienza", II School of Medicine, Sant'Andrea Hospital, Rome, Italy
| | - Paolo Aurello
- Hepatobiliary-pancreatic Surgery, University of Rome "La Sapienza", II School of Medicine, Sant'Andrea Hospital, Rome, Italy
| | - Riccardo Bellagamba
- Hepatobiliary-pancreatic Surgery, University of Rome "La Sapienza", II School of Medicine, Sant'Andrea Hospital, Rome, Italy
| | - Cristina Colarossi
- Department of Pathology, University of Rome "La Sapienza", II School of Medicine, Sant'Andrea Hospital, Rome, Italy
| | - Emanuela Pilozzi
- Department of Pathology, University of Rome "La Sapienza", II School of Medicine, Sant'Andrea Hospital, Rome, Italy
| | - Massimo Del Gaudio
- Department of General Surgery, Liver and Multivisceral Transplantation Unit., University of Modena and Reggio Emilia, Italy
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Abstract
CT has always played a major role in the imaging of the liver despite continuous challenge by ultrasound and MR imaging. Introduction of multidetector row CT technology has helped CT to excel in its already established indications and has expanded its capabilities by adding new clinical indications, such as CT angiography or liver perfusion. This article discusses the advantages of multidetector row CT scanners in liver imaging, examines the guidelines to improve image quality by optimizing scanning protocols and contrast administration strategies, and reviews the current and potential clinical applications.
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Affiliation(s)
- Aytekin Oto
- Department of Radiology, University of Texas Medical Branch at Galveston, 2.815 John Sealy Annex, 301 University Boulevard, Galveston, TX 77555, USA.
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12
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Vogt DP, Henderson JM, Chmielewski E. Cystadenoma and Cystadenocarcinoma of the Liver: A Single Center Experience. J Am Coll Surg 2005; 200:727-33. [PMID: 15848365 DOI: 10.1016/j.jamcollsurg.2005.01.005] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2004] [Revised: 01/10/2005] [Accepted: 01/10/2005] [Indexed: 12/24/2022]
Abstract
BACKGROUND Biliary cystadenomas and cystadenocarcinomas comprise 5% of cystic lesions in the liver. Cystadenomas are often incorrectly diagnosed as simple cysts, which results in inadequate therapy. Recurrence and possible malignant transformation are consequences of incomplete excision. Cystadenocarcinomas are very rare tumors that are felt to be biologically indolent. STUDY DESIGN A retrospective review of 18 cystadenomas and 4 cystadenocarcinomas treated at the Cleveland Clinic from July 1985 to November 2002. RESULTS All 18 patients with cystadenomas were women; mean age was 48 years. The majority (16 of 18) were symptomatic. Preoperative CT scans demonstrated cyst(s) with septations in all patients. Fifty-five percent had undergone prior intervention(s) to treat the cyst. Thirteen patients had complete excision of the cystadenoma, either by enucleation or liver resection. None of the patients developed recurrent cystadenomas (mean followup 37 months). Of 4 patients with cystadenocarcinoma, 3 were women; mean age was 60 years. All were symptomatic. Preoperative CT scans demonstrated masses with both cystic and solid components. No patient had undergone prior intervention. All had a liver resection. Two patients died of metastatic disease at 6 and 12 months, respectively. One patient is alive and disease-free at 16 years; 1 is alive with metastatic disease 10 years after the liver resection. CONCLUSIONS Cystadenomas are uncommon tumors that are often incorrectly diagnosed as simple cysts. Preoperative imaging that demonstrates the presence of internal septations highly suggests the diagnosis of cystadenoma. Intraoperative biopsy and frozen section(s) are essential, although they are not 100% accurate. Cystadenomas require complete excision to prevent recurrence and the possibility of malignant transformation. Cystadenocarcinomas are very rare. Despite complete resection, cystadenocarcinomas can recur in a short period of time. The biologic behavior of these tumors can vary widely.
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Affiliation(s)
- David P Vogt
- Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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13
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Nyland TG, Koblik PD, Tellyer SE. Ultrasonographic evaluation of biliary cystadenomas in cats. Vet Radiol Ultrasound 1999; 40:300-6. [PMID: 10519311 DOI: 10.1111/j.1740-8261.1999.tb00365.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The purpose of this study was to describe the ultrasonographic appearance of biliary cystadenomas in cats and compare the findings to a similar rare form of liver tumor in humans. Biliary cystadenomas are uncommon, benign liver tumors of older cats that may occur as focal or multifocal cystic lesions within the liver. The records of 10 cats which had abdominal ultrasonography and histologic diagnosis of biliary cystadenoma were reviewed. The average age of affected cats was 13.3 years (range 10-16 years). Eight cats were neutered males and two were neutered females. In three cats, the tumors were not seen ultrasonographically due to their small size or from being obscured by near-field reverberation echoes. The remaining seven cats had solitary (4 cats) or multifocal (3 cats) masses corresponding to variable ultrasonographic patterns: multilocular masses containing thin-walled cysts, hyperechoic masses with cystic components, or masses of mixed echogenicity with cystic components. The masses had variable ultrasonographic patterns when multifocal disease was present. Recognizable cysts were evident somewhere within the tumors seen ultrasonographically, although sometimes the cysts appeared very small. The biliary cystadenomas were thought to be clinically silent. Although liver enlargement or a cranial abdominal mass was palpable in 4 cats, no consistent trend of clinical signs, CBC or serum biochemical abnormalities could be directly attributed to biliary cystadenoma. The treatment of choice is surgical resection of the tumor, as continued growth may compress adjacent vital structures within the liver. The differential diagnosis of biliary cystadenomas from other cystic liver lesions such as hepatic cysts, hematomas, abscesses, parasitic cysts, or other liver tumors is discussed.
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Affiliation(s)
- T G Nyland
- Department of Surgical & Radiological Sciences, School of Veterinary Medicine, University of California, Davis 95616, USA
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