Biliary cystadenoma

Intrahepatic biliary cystadenoma, a challenging diagnosis and management: A case report

INTRODUCTION AND IMPORTANCE

Biliary cystadenoma (BC) is a benign hepatic cystic tumor with degenerative potential. Hepatic MRI can help guide the diagnosis. Surgical resection is recommended due to the malignant potential of biliary cystadenomas. Only anatomopathological examination of the surgical specimen can establish the definitive diagnosis of BC. The objective of this case report is to enhance our understanding of this disease and contribute to precise diagnosis for optimal management.

CASE PRESENTATION

A 55-year-old woman with a history of hypertension and atrial fibrillation presented to the surgery department with paroxysmal right hypochondrial pain. Ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) revealed a large septated cystic lesion occupying segments II, III, and IV of the liver. The patient underwent left hepatectomy without incident. The postoperative course was marked by a deep collection opposite the sectional area, which was successfully treated with antibiotics and radiological drainage. The pathological diagnosis confirmed BC without signs of malignancy, and no recurrence was detected post-surgery.

CLINICAL DISCUSSION

The rarity of BC, the absence of specific clinical signs and its potential for malignant transformation, underline the need for sophisticated imaging techniques. However, preoperative radiological diagnosis does not exceed 50 %. The operative decision requires a multidisciplinary discussion between radiologists and surgeons. This case highlights the unavailability of radical surgical treatment in cases of strong preoperative suspicion of BC. The cooperation of the pathologist in the histological diagnosis is crucial.

CONCLUSION

The diagnosis of BC should be considered in cases of multilocular cystic lesions in the liver, particularly in instances of recurrent cysts. Imaging aids in both positive and differential diagnoses. Complete resection is the recommended treatment for any suspected BC.

Successful Laparoscopic Resection of Biliary Cystadenoma: A Case Report

Biliary cystadenomas are rare hepatic lesions originating from the biliary epithelium. We present the case of a 32-year-old female who presented with persistent right upper quadrant abdominal pain, prompting a thorough investigation. Mildly elevated liver enzymes were noted on laboratory testing. Imaging studies, including a contrast-enhanced CT scan, revealed a 14 cm multiloculated cystic lesion in the right lobe of the liver. A biliary cystadenoma was confirmed, leading to a collaborative decision for laparoscopic resection. Intraoperative findings and histopathological examination supported the diagnosis, and the patient had an uneventful recovery postoperatively. This case report underscores the clinical complexity of biliary cystadenomas and highlights the successful multidisciplinary management of a young patient through laparoscopic resection. The case contributes valuable insights into the diagnostic and therapeutic challenges associated with these uncommon hepatic lesions.

Biliary cystadenoma: Case report with MRI findings and surgical confirmation

Biliary cystadenoma is a very uncommon benign cystic neoplasm involving the liver and the biliary tract. Most common presentations include right upper quadrant pain, nausea, vomiting, obstructive jaundice, and enlarging liver size. It can mimic many more commonly occurring diseases such as hepatic cyst, hepatic abscess, hydatid disease of the liver, and hepatic tuberculosis. Hence it becomes very challenging for physicians to correctly diagnose it due to its rarity and similarity with other conditions. Furthermore, very few pieces of literature guide physicians in correctly identifying the disease. Based on his physical examination and detailed investigation, we present a case report of a 72-year-old female diagnosed with biliary cystadenoma. We hope that this case report will significantly add to the existing literature on this subject.

Intrahepatic Biliary Cystadenoma With Colonic Adenomatous Polyps in a Patient With Chronic Hepatitis B: A Case Report and Literature Review

Background: Biliary cystadenomas are rare cystic tumors of the bile duct system that are mostly benign but also have the possibility of malignant transformation. Biliary cystadenomas mostly occur in the intrahepatic bile ducts and are more common in middle-aged women. Due to non-specific radiology, preoperative diagnosis is difficult and is usually performed by postoperative pathology. Complete resection is the best treatment option, and the postoperative prognosis is good.

Case Description: This study reports a case of a patient with biliary cystadenoma who was diagnosed with simultaneous chronic hepatitis B and colon (hepatic flexure) adenomatous polyps. The patient presented to the doctor because of abdominal pain, and a blood test showed hepatitis B. Computed tomography revealed both right liver and colonic lesions. Colonoscopy revealed polyps, and the postoperative pathological diagnosis was adenomatous polyps. Laparoscopic resection of the right liver tumor was performed, and it was diagnosed as hepatobiliary cystadenoma by postoperative pathological analysis combined with immunohistochemistry.

Conclusion: In patients with chronic hepatitis, the shape of biliary cystadenoma may not be very typical, and it is necessary to combine this with immunohistochemistry for diagnosis. When multiple lesions are detected in the painful area, the diagnosis of each lesion and its treatment sequence are worthy of consideration. Under normal circumstances, the prognosis of biliary cystadenoma is good; however, in patients with chronic hepatitis B, more cases need to be observed for verification.

Biliary cystadenoma masquerading as an adnexal cyst in pregnancy

The aetiological diagnosis of cystic masses detected on routine ultrasound during pregnancy can be challenging. Unless approached cautiously with a detailed history and adequate use of imaging techniques, misdiagnosis of these cystic masses are not uncommon. Cystic masses diagnosed during pregnancy are mostly of ovarian origin; however, other non-ovarian cystic masses are also detected incidentally or at laparotomy/laparoscopy. We report a rare case of ruptured biliary cystadenoma in a pregnant woman diagnosed at emergency laparotomy. She was taken up for surgery with a provisional impression of ruptured adnexal cyst. However, the cyst was found to be arising from the liver and the histology of the cyst wall was reported as biliary cystadenoma.

Giant biliary mucinous cystadenoma mimicking mesenchymal hamartoma of the liver in a child: A case report

INTRODUCTION

Biliary cystadenomas (BCAs) are rare benign tumors with malignant potential. They are most commonly found in middle-aged women and are quite infrequently reported in children. Even with advanced imaging, diagnosing and distinguishing BCA from other cystic liver lesions remain challenging.

CASE PRESENTATION

A 5-year-old boy was brought in by his parents to our hospital with abdominal swelling that had been persistent for a year, along with loss of appetite and weight loss. On examination, the abdomen was distended and dull on percussion. We considered mesenchymal hamartoma of the liver (MHL) as the top differential after an abdominal CT scan with contrast showed a multi-loculated cystic tumour. For both definitive diagnosis and therapy, the patient underwent exploratory laparotomy with excision of the cystic mass. Surprisingly, histopathology examination of the resected specimen revealed biliary mucinous cystadenoma (BCA).

CONCLUSION

Since conservative methods are associated with high recurrence rates, biliary mucinous cystic neoplasms require a high index of suspicion and should be handled with total surgical resection. In the post-operative phase, periodic surveillance imaging is recommended due to the risk of recurrence and malignant transformation.

Biliary cystadenoma associated with Opisthorchis viverrini infection in a domestic cat (Felis catus)

A 12-year-old, female, domestic cat (Felis catus) presented with dehydration, emaciation, anorexia, and lethargy. The cat was unresponsive to medical treatment and euthanized; the carcass was submitted for pathological diagnosis. Necropsy revealed icteric mucous membranes. The liver was enlarged, with multinodular, cystic, white masses, 0.5-4.0 cm in diameter, scattered throughout. Microscopically, the biliary epithelium presented with a proliferation of multifocal cystic masses, occasionally with periodic acid-Schiff-positive fluid within the cysts. Simple cuboidal epithelial cells showed small, round to oval, vesicular nuclei and rare mitotic figures. There were also multifocal trematode-like parasites situated within the biliary tracts. Immunohistochemistry of the cystic masses was positive for pan-cytokeratin and proliferating cell nuclear antigen, while negative for vimentin. Molecular analysis and gene sequencing of the parasite indicated that it was Opisthorchis viverrini. Based on the pathological findings and molecular analysis, the cat was diagnosed with biliary cystadenoma related to O. viverrini infection. This report described an unusual case of O. viverrini infection associated with biliary tumor in a cat, and raises the possibility of domestic cats as a reservoir host of the human liver fluke.

Extrahepatic biliary cystadenoma: a rare cause of biliary obstruction

Biliary cystadenoma is a rare tumor of the biliary tree and a rare cause of obstructive jaundice. Most are intrahepatic, and pure extrahepatic biliary cystadenoma is less common. Cases are more common in women. Unless suspected, diagnosis of extrahepatic biliary cystadenoma is often delayed. Here, we report the case of a young woman with extrahepatic biliary cystadenoma who presented at Raja Isteri Pengiran Anak Saleha Hospital with obstructive jaundice initially thought to be due to a large biliary stone based on the endoscopic cholangiogram image. She was successfully managed with resection of the cystadenoma.

Diagnosis and treatment of intrahepatic biliary cystadenoma

AIM: To explore the clinical features of intrahepatic biliary cystadenoma, so as to raise awareness of the disease and reduce the misdiagnosis rate.

METHODS: Clinical data for 11 intrahepatic biliary cystadenoma patients treated from January 2009 to August 2013 at the Second Affiliated Hospital of Nanchang University were analyzed retrospectively. The clinical manifestations, imaging features, surgical and pathological characteristics were summarized.

RESULTS: There were one male (age, 49 years) and 10 females (mean age, 54.5 years±2.0 years). Main clinical manifestations were abdominal pain and discomfort, and two cases had jaundice. Imaging data showed intrahepatic bile duct dilatation and cystic or solid mass lesions; one patient had gallstones, two had intrahepatic bile duct stones, and two had gallbladder polyps. Pathological examinations showed five cases of intrahepatic biliary cystadenoma, two cases of mucinous cystadenoma, two cases of papillary cystadenoma, and two cases of borderline cystadenoma. All patients underwent complete surgical resection, and no recurrence was observed during follow-up.

CONCLUSION: Intrahepatic biliary cystadenoma often occurs in middle-aged women, and its clinical manifestations are not specific. Ultrasound, computed tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography can help improve the diagnosis and preoperative assessment of the disease. Complete resection is recommended for the treatment of this disease.

Evaluation of hepatic cystic lesions

Hepatic cysts are increasingly found as a mere coincidence on abdominal imaging techniques, such as ultrasonography (USG), computed tomography (CT) and magnetic resonance imaging (MRI). These cysts often present a diagnostic challenge. Therefore, we performed a review of the recent literature and developed an evidence-based diagnostic algorithm to guide clinicians in characterising these lesions. Simple cysts are the most common cystic liver disease, and diagnosis is based on typical USG characteristics. Serodiagnostic tests and microbubble contrast-enhanced ultrasound (CEUS) are invaluable in differentiating complicated cysts, echinococcosis and cystadenoma/cystadenocarcinoma when USG, CT and MRI show ambiguous findings. Therefore, serodiagnostic tests and CEUS reduce the need for invasive procedures. Polycystic liver disease (PLD) is arbitrarily defined as the presence of > 20 liver cysts and can present as two distinct genetic disorders: autosomal dominant polycystic kidney disease (ADPKD) and autosomal dominant polycystic liver disease (PCLD). Although genetic testing for ADPKD and PCLD is possible, it is rarely performed because it does not affect the therapeutic management of PLD. USG screening of the liver and both kidneys combined with extensive family history taking are the cornerstone of diagnostic decision making in PLD. In conclusion, an amalgamation of these recent advances results in a diagnostic algorithm that facilitates evidence-based clinical decision making.

Biliary cystadenoma in a Maltese dog: clinical and diagnostic findings

A 14-year-old Maltese dog presented for complete medical examination due to intermittent vomiting and diarrhea observed during the previous two days. A single, solitary, lobulated cystic mass was observed in the liver upon ultrasonographic and computed tomographic examination. After surgical hepatic resection to remove the mass, histological examination revealed a multilocular cyst lined by cuboidal to columnar epithelial cells, which is consistent with biliary cystadenoma. Here, we report the clinical, clinicopathological, histopathological, and diagnostic imaging findings of biliary cystadenoma in a dog.

Biologic and clinical features of benign solid and cystic lesions of the liver

The widespread use of imaging analyses, either routinely or to evaluate symptomatic patients, has increased the detection of liver lesions (tumors and cysts) in otherwise healthy individuals. Although some of these incidentally discovered masses are malignant, most are benign and must be included in the differential diagnosis. The management of benign hepatic tumors ranges from conservative to aggressive, depending on the nature of the lesions. New imaging modalities, increased experience of radiologists, improved definition of radiologic characteristics, and a better understanding of the clinical features of these lesions have increased the accuracy of diagnoses and reduced the need for invasive diagnostic tests. These advances have led to constant adjustments in management approaches to benign hepatic lesions. We review the biologic and clinical features of some common hepatic lesions, to guide diagnosis and management strategies.

Spontaneous rupture of a recurrent hepatic cystadenoma

Biliary cystadenoma is a rare cystic tumor of the middle aged woman that usually arises in the liver or occasionally in the extrahepatic bile ducts. It has a strong potential for recurrence and for malignant transformation. The lack of specific clinical and biological features hinders diagnosis before surgery. The spontaneous rupture of a hepatobiliary cystadnoma is a very rare and potentially life-threatening complication, with only two reported cases in the English literature. We report a case with spontaneous rupture of a recurrent hepatobiliary cystadenoma in a 32 year-old woman.