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Patrzałek P, Hałoń A, Guziński M, Pomorski M, Tokarczyk W, Patrzałek D. Resection of Biliary Cystadenoma in a Pregnant Woman: A Case Report With Five Years of Follow-Up. Cureus 2024; 16:e56752. [PMID: 38650796 PMCID: PMC11033605 DOI: 10.7759/cureus.56752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/25/2024] Open
Abstract
Biliary cystadenomas (BCAs), rare cystic tumors occurring in the biliary system, account for fewer than 5% of cystic lesions in the liver. This case details successful resection in a 29-year-old pregnant woman at seven weeks gestation. Urgent left hemihepatectomy and cholecystectomy removed a mucinous hepatobiliary cystadenoma. Postoperatively, a healthy newborn was delivered by cesarean section. Five-year follow-up showed no recurrence. BCAs present diagnostic challenges due to nonspecific symptoms, and surgical intervention, preferably complete resection, is recommended for potential malignancy, after weighing benefits against complications in critical hepatic vessel lesions.
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Affiliation(s)
| | - Agnieszka Hałoń
- Department of Pathomorphology and Oncological Cytology, Wroclaw Medical University, Wroclaw, POL
| | - Maciej Guziński
- Department of Radiology, Wroclaw Medical University, Wroclaw, POL
| | - Michał Pomorski
- Department of Gynecology, Wroclaw Medical University, Wroclaw, POL
| | | | - Dariusz Patrzałek
- Department of Vascular, General and Transplant Surgery, Wroclaw Medical University, Wroclaw, POL
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2
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Aziz H, Hamad A, Afyouni S, Kamel IR, Pawlik TM. Management of Mucinous Cystic Neoplasms of the Liver. J Gastrointest Surg 2023; 27:1963-1970. [PMID: 37221388 DOI: 10.1007/s11605-023-05709-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/09/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Mucinous cystic neoplasms of the liver (MCN-L) including biliary cystadenomas (BCA) and biliary cystadenocarcinomas (BCAC) are rare cystic lesions that comprise less than 5% of all liver cysts and affect only a small subset of individuals. We herein review the current evidence regarding the clinical presentation, imaging characteristics, tumor markers, pathological findings, clinical management, and prognosis of MCN-L. METHODS A comprehensive review of the literature was performed using MEDLINE/Pubmed and Web of Science databases. In PubMed, the terms "biliary cystadenoma," "biliary cystadenocarcinoma," and "non parasitic hepatic cysts" were queried to identify the most recent data on MCN-L. RESULTS US imaging, CT, and MRI, as well as consideration of clinicopathological features, are required to appropriately characterize and diagnose hepatic cystic tumors. BCA are premalignant lesions and cannot be reliably differentiated from BCAC based on imaging alone. As such, both types of lesions should be treated with margin-negative surgical resection. Following surgical resection, recurrence is fairly low among patients with BCA and BCAC. Despite having worse long-term outcomes than BCA, the prognosis following surgical resection of BCAC still remains more favorable than other primary malignant liver tumors. CONCLUSION MCN-L are rare cystic liver tumors that include BCA and BCAC, which can be difficult to differentiate based on imaging alone. Surgical resection remains the mainstay of management for MCN-L with recurrence being generally uncommon. Future multi-institutional studies are still required to better understand the biology behind BCA and BCAC to improve the care of patients with MCN-L.
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Affiliation(s)
- Hassan Aziz
- Department of Surgery, University of Iowa, Iowa City, IA, USA
| | - Ahmad Hamad
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, 395 W. 12Th Avenue, Suite 670, Columbus, OH, USA
| | - Shadi Afyouni
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ihab R Kamel
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, 395 W. 12Th Avenue, Suite 670, Columbus, OH, USA.
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3
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Hoti KD, Shkololli AJ, Shatri J, Hyseni F, Roy P, Maliha M, Kubra KT, Musa J, Vokshi V, Obando A, Saha T, Syed Z, Saini J, Rakovica L, Choudhary J. Biliary cystadenoma: Case report with MRI findings and surgical confirmation. Radiol Case Rep 2022; 17:3974-3978. [PMID: 35991384 PMCID: PMC9388884 DOI: 10.1016/j.radcr.2022.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/22/2022] Open
Abstract
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
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Affiliation(s)
- Kreshnike Dedushi Hoti
- Faculty of Medicine “Hasan Prishtina ” Clinic of Radiology, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Argjira Juniku Shkololli
- Department of Pathophysiology, Clinic of Gastroenterology, University Clinical Center of Kosovo, Prishtina, Kosovo
- Corresponding author.
| | - Jeton Shatri
- Faculty of Medicine “Hasan Prishtina ” Clinic of Radiology, University Clinical Center of Kosovo, Prishtina, Kosovo
| | | | - Pooja Roy
- Department of Laborotory Medicine and Pathology, Mayo Clinic, Rochester, USA
- Minnesota Internal Medicine Resident, Harlem Hospital Ctr, , New York, USA
| | | | | | - Juna Musa
- Department of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, USA
| | - Valon Vokshi
- Department of Anesthesiology and Reanimation, University Clinical Center of Kosovo
| | - Alejandro Obando
- Endoscopy Unit, Hospital Bautista, Managua, Nicaragua
- Surgical Unit, Hospital Vivian Pellas, Managua, Nicaragua
| | - Tias Saha
- Diabetic Association Medical College, Faridpur, Bangladesh
| | - Zaina Syed
- Biochemistry, Hunter College, CUNY. New York, USA
| | - Jasmine Saini
- Department of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, USA
| | - Loran Rakovica
- St.Barnabas Hospital, Department of Medicine, New York, USA
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4
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Chen H, Luo F, Liu Y, Wang F, Lei Q, Ho WI, Lau WY. Total Laparoscopic Resection of an Extrahepatic Mucinous Biliary Cystadenoma with Liver Involvement (with Video). Ann Surg Oncol 2022; 29:7646-7651. [DOI: 10.1245/s10434-022-12150-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022]
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5
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Strasberg SM, Chapman WC. Enucleation of Biliary Cystadenomas: a Review. J Gastrointest Surg 2021; 25:2700-2706. [PMID: 34505221 DOI: 10.1007/s11605-021-05106-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/01/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biliary cystadenomas are very rare benign tumors which can transform into cystadenocarcinomas. The largest case series reported on 221 cases over 30 years from 10 HPB centers, i.e., about 7 cases per center per decade. The recommended treatment is liver resection. Enucleation of biliary cystadenomas has been done rarely. The purpose of the study was to determine the outcome of enucleation of these cysts, particularly the mortality rate and the recurrence rate. METHODS A keyword search was done using OVID followed by a search of the bibliography of papers describing the enucleation of biliary cystadenomas. Of 45 articles obtained, 25 were retained. The main reasons for exclusion were non-English language and review articles. RESULTS One hundred three patients in the 25 studies were treated with enucleation. Thirteen studies described prior treatments that had failed with resulting recurrence requiring re-treatment. The main indication for enucleation was large central cysts for which liver resection would be high risk. There were no postoperative deaths in patients treated by enucleation. Thirteen studies provided long-term follow-up in 40 patients, a substantial number given the rarity of the tumor. There were no recurrences or transformations to malignancy. CONCLUSIONS Enucleation seems to represent a reasonable treatment technique for BCA, especially when a large cystic lesion is located centrally and/or would require a large liver resection with significant loss of parenchyma.
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Affiliation(s)
- Steven M Strasberg
- Section of Hepato-Pancreato-Biliary Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, and Washington University School of Medicine in St. Louis, St Louis, MO, USA.
| | - William C Chapman
- Section of Transplantation Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, and Washington University School of Medicine in St. Louis, St Louis, MO, USA
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Gao J, Zheng J, Cai J, Kirih MA, Xu J, Tao L, Liang Y, Feng X, Fang J, Liang X. Differentiation and management of hepatobiliary mucinous cystic neoplasms: a single centre experience for 8 years. BMC Surg 2021; 21:146. [PMID: 33743655 PMCID: PMC7981987 DOI: 10.1186/s12893-021-01110-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 02/21/2021] [Indexed: 12/26/2022] Open
Abstract
Background Hepatobiliary mucinous cystic neoplasms (H-MCNs) are relatively rare cystic neoplasms in the liver. The differential diagnosis of H-MCNs remains big challenging, and the management and prognosis between the hepatic simple cyst (HSC) and H-MCNs are quite different. This study aimed to present our experience in the management of H-MCNs and provide a preoperative H-MCNs risk prediction nomogram to differentiating H-MCNs from liver cystic lesions. Methods 29 patients diagnosed with H-MCNs and 75 patients diagnosed with HSC between June 2011 and June 2019 at Zhejiang University School of medicine, Sir Run-Run Shaw Hospital were reviewed in this study. We analyzed the demographic and clinicopathological variables. Results US, CT, and MRI could accurately diagnose only 3.4%, 46.1%, and 57.1% of H-MCNs, respectively. After univariate analysis and multivariate logistic regression analysis, the variables significantly associated with H-MCNs were enhancement after contrast (p = 0.009), tumour located in the left lobe (p = 0.02) and biliary ductal dilation (p = 0.027). An H-MCNs risk predictive nomogram was constructed, which showed excellent discrimination (areas under the receiver operating characteristic curve were 0.940) and consistent calibration between the predicted probability and actual probability. Conclusion Among patients with H-MCNs, the location of the tumour, enhancement in CT scan, and biliary duct dilation are significantly independent risk factors. The appropriate treatment of H-MCNs is radical resection. Using our Nomogram could facilitate screening and identification of patients with liver cystic lesions.
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Affiliation(s)
- Jiaqi Gao
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Junhao Zheng
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Jingwei Cai
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Mubarak Ali Kirih
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Junjie Xu
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Liye Tao
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Yuelong Liang
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Xu Feng
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Jing Fang
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Xiao Liang
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China.
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Abstract
Cancers of the biliary tract include intra- and extrahepatic cholangiocarcinomas and gallbladder cancer. Biliary tract cancers are diseases with unfavorable prognoses. In recent years, several lesions have been described as precursors that precede biliary cancers. They include flat and microscopic lesions known as biliary intraepithelial neoplasia, macroscopic and tumor-forming intraductal papillary biliary neoplasia, intraductal tubular neoplasia, and mucinous cystic neoplasm of the bile duct. These conditions are rarely diagnosed, while their natural history and progression to cancer have yet to be adequately characterized. This review examines the epidemiology, pathology, molecular biology, diagnosis, and therapy of these various precursors. Further research is required if we are to better understand this evolving field and improve the prevention and early detection of bile duct cancer.
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8
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Klompenhouwer AJ, Ten Cate DWG, Willemssen FEJA, Bramer WM, Doukas M, de Man RA, Ijzermans JNM. The impact of imaging on the surgical management of biliary cystadenomas and cystadenocarcinomas; a systematic review. HPB (Oxford) 2019; 21:1257-1267. [PMID: 31085104 DOI: 10.1016/j.hpb.2019.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/27/2019] [Accepted: 04/12/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Biliary Cystadenomas (BCA) are considered to be benign but may transform to Biliary Cystadenocarcinomas (BCAC). The aim of this systematic review was to assess the diagnostic work-up and necessity of complete surgical resection. METHOD A systematic literature search was performed in Embase.com, Medline (Ovid), Cochrane Central, Web-of-Science and Google Scholar. Articles reporting on diagnostic work-up or outcome of various treatment strategies were included. RESULTS Fifty-one articles with 1218 patients were included: 971 with BCA and 247 with BCAC. Patients with BCA were more often female (91% vs 63.8%, p < 0.001). On radiologic imaging BCAC more often had calcifications (p = 0.008), mural nodules (p < 0.001) and wall enhancement (p < 0.001). Reported treatment strategies were resection, enucleation, or fenestration/marsupialization. Recurrence was reported in 5.4% after resection for BCA and 4.8% after resection for BCAC. Recurrence after fenestration/marsupialization varied from 81.6% to 100% for both BCA as BCAC. Mortality rate was 0 in patients with BCA and 24% in BCAC. CONCLUSION Due to the difficulty in accurately diagnosing these biliary cystic lesions and the availability of different surgical approaches, patients with suspected BCA or BCAC should be treated in a center specialized in liver surgery with state-of-the-art imaging and all surgical techniques to prevent mismanagement of this rare disease.
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Affiliation(s)
- Anne J Klompenhouwer
- Erasmus MC, University Medical Center Rotterdam, Department of Surgery, Rotterdam, the Netherlands.
| | - David W G Ten Cate
- Erasmus MC, University Medical Center Rotterdam, Department of Surgery, Rotterdam, the Netherlands
| | - Francois E J A Willemssen
- Erasmus MC, University Medical Center Rotterdam, Department of Radiology, Rotterdam, the Netherlands
| | - Wichor M Bramer
- Erasmus MC, University Medical Center Rotterdam, Medical Library, Rotterdam, the Netherlands
| | - Michael Doukas
- Erasmus MC, University Medical Center Rotterdam, Department of Pathology, Rotterdam, the Netherlands
| | - Robert A de Man
- Erasmus MC, University Medical Center Rotterdam, Department of Gastroenterology and Hepatology, Rotterdam, the Netherlands
| | - Jan N M Ijzermans
- Erasmus MC, University Medical Center Rotterdam, Department of Surgery, Rotterdam, the Netherlands.
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Tholomier C, Wang Y, Aleynikova O, Vanounou T, Pelletier JS. Biliary mucinous cystic neoplasm mimicking a hydatid cyst: a case report and literature review. BMC Gastroenterol 2019; 19:103. [PMID: 31234803 PMCID: PMC6591873 DOI: 10.1186/s12876-019-1001-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 05/28/2019] [Indexed: 02/07/2023] Open
Abstract
Background Biliary mucinous cystic neoplasms are rare cystic lesions of the liver which carry pre-malignant potential. Given the scarcity of reports in the literature, they pose a considerable challenge to clinical management, particularly with regards to accurate pre-operative diagnosis. Case presentation We present the case of a 37-year-old Tunisian woman who presented with subacute right upper quadrant pain and a large multi-loculated cystic lesion, most consistent with a hydatid cyst. She underwent an open right hepatectomy, and pathology surprisingly revealed a biliary mucinous cystadenoma. Herein, we review the current literature on biliary mucinous cystic neoplasms, with a particular emphasis on diagnostic investigations, key radiological features and optimal treatment modalities. Conclusion Biliary mucinous cystic neoplasms require a high index of suspicion and should be managed with complete surgical resection, as conservative techniques are associated with high recurrence rates. Considering the potential for malignant transformation, periodical surveillance imaging is recommended in the post-operative period.
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Affiliation(s)
- Côme Tholomier
- Division of General Surgery, Jewish General Hospital, 3755 Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada.,Division of Urology, McGill University Health Center, Montréal, QC, Canada
| | - Yifan Wang
- Division of General Surgery, Jewish General Hospital, 3755 Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada
| | - Olga Aleynikova
- Department of Pathology, Jewish General Hospital, Montreal, QC, Canada
| | - Tsafrir Vanounou
- Division of General Surgery, Jewish General Hospital, 3755 Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada
| | - Jean-Sebastien Pelletier
- Division of General Surgery, Jewish General Hospital, 3755 Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada.
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Jwa EK, Hwang S. Clinicopathological features and post-resection outcomes of biliary cystadenoma and cystadenocarcinoma of the liver. Ann Hepatobiliary Pancreat Surg 2017; 21:107-113. [PMID: 28989996 PMCID: PMC5620470 DOI: 10.14701/ahbps.2017.21.3.107] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 08/10/2017] [Accepted: 08/16/2017] [Indexed: 12/12/2022] Open
Abstract
Backgrounds/Aims Biliary cystadenoma (BCA) and biliary cystadenocarcinoma (BCAC) account for 5%-10% of liver cystic diseases. In this study, we analysed the clinical presentation and surgical management of patients with BCA and BCAC. Methods We retrospectively analysed the medical records of 23 BCA and 7 BCAC cases diagnosed between January 2007 and December 2013. Results There was a statistically significant difference in age (p=0.044) and sex (p=0.048) between BCA and BCAC groups. In the BCA group, 17 patients showed no symptoms (74%), 5 had abdominal pain (22%) and 1 showed abdominal distension (4%). In the BCAC group, two patients were without any symptoms (29%), three had abdominal pain (43%), one showed abdominal distension (14%) and one had fever and chills (14%). The cystic lesion size was widely variable; thus, there was no statistical difference (p=0.84). Complete resection was performed in all patients with BCA and BCAC. No tumour recurrence developed in patients with BCA. In patients with BCAC, 1-, 3- and 5-year disease-free survival rates were 100%, 85.7% and 57.1%, respectively, and 1-, 3- and 5-year overall patient survival rates were 100%, 100% and 75.0%, respectively. Conclusions It is difficult to distinguish between BCA and BCAC via clinical manifestations and diagnostic imaging findings. Surgical resection is the treatment of choice for BCA and BCAC, and patient prognosis after complete resection was very favourable.
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Affiliation(s)
- Eun-Kyoung Jwa
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Hwang
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Dua MM, Gerry J, Salles A, Tran TB, Triadafilopoulos G, Visser BC. Biliary Cystadenoma: A Suggested "Cystamatic" Approach? Dig Dis Sci 2016; 61:1835-8. [PMID: 26514678 DOI: 10.1007/s10620-015-3943-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 10/22/2015] [Indexed: 01/29/2023]
Affiliation(s)
- Monica M Dua
- Division of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Suite H3691, Stanford, CA, 94305, USA.
| | - Jon Gerry
- Division of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Suite H3691, Stanford, CA, 94305, USA
| | - Arghavan Salles
- Division of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Suite H3691, Stanford, CA, 94305, USA
| | - Thuy B Tran
- Division of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Suite H3691, Stanford, CA, 94305, USA
| | | | - Brendan C Visser
- Division of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Suite H3691, Stanford, CA, 94305, USA
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