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Yang Y, Chen W, Cen H, Li Z, Di X, Wu Y, Liu L. Intrahepatic biliary cystadenoma: Confusion, experience, and lessons learned from our center. Front Oncol 2022; 12:1003885. [DOI: 10.3389/fonc.2022.1003885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/28/2022] [Indexed: 11/12/2022] Open
Abstract
BackgroundIntrahepatic biliary cystadenoma (IBC) is a rare benign cystic tumor of the liver. So far, it has not been comprehensively understood, which causes incorrect diagnosis, treatment confusion, and even inappropriate treatment. Here, we reviewed clinical data of IBC patients in our center, shared our experiences and lessons learned, and improved the level of diagnosis and treatment.MethodsThe clinical data of 10 patients with pathologically diagnosed IBC, admitted to the Department of Hepatobiliary Surgery of the Affiliated Hospital of Guangdong Medical University from January, 2007, to January, 2022 were retrospectively analyzed.Results10 patients underwent surgery and were discharged successfully. Cyst morphology: multiple cysts: 6 cases (6/10), monocular cyst: four cases(4/10). Six patients (6/10) were diagnosed as IBC preoperatively and received hepatectomy. Four patients with monocular cyst IBC underwent intraoperative frozen section examination, except one case showed IBC; the rest were misdiagnosed as simple liver cyst. In three misdiagnosed patients, one underwent open left hepatectomy seven days after the initial operation. The other patient refused to undergo reoperation and required follow-up observation. The last patient could not tolerate hepatectomy due to insufficient residual liver volume and chose follow-up observationConclusionFor IBC, especially monocular IBC, it is easy to be misdiagnosed as simple hepatic cyst, which brings great confusion to clinical treatment. We propose strengthening communication with pathologists to deepen understanding of IBC. Attention should be paid to the cyst wall’s shape and the cyst fluid’s properties during the operation to avoid the missed diagnosis, misdiagnosis, or even improper operation. For suspicious cases, directly choose hepatectomy to avoid reoperation after thoroughly evaluating the patient’s condition.
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Complete resection for a giant recurrent biliary cystadenoma: A surgical case report and review of literature. Ann Med Surg (Lond) 2022; 78:103785. [PMID: 35734662 PMCID: PMC9207045 DOI: 10.1016/j.amsu.2022.103785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/08/2022] [Accepted: 05/10/2022] [Indexed: 12/26/2022] Open
Abstract
Background Biliary cystadenoma is a rare cystic neoplasm of the liver. The clinical signs and symptoms are nonspecific, and treatment strategy is variable. Case presentation In this study, we presented a case of a 32-year-old female with multilocular biliary cystadenoma. The patient underwent partial removal of the hepatic cyst two times in two different hospitals for two years and that the histopathological results were biliary cystic adenoma but was successfully treated by radical resection after the second recurrence. The patient underwent a J-shaped laparotomy. The giant cystic mass measuring 20 cm × 15 cm was below the position of the right anterior segment. This lesion pushed the liver parenchyma to both sides and compressed the hepatic hilum, causing dilatation of the intrahepatic bile ducts. The patient underwent complete resection of cystic mass. During the dissection, a 0.5mm-diameter fistula of left hepatic duct with the cyst was found. It was sutured using absorbable polydioxanone (PDS 6.0) and the cystic duct tube (C tube) (6 Fr) was inserted via the cystic duct into the left hepatic duct due to drain the bile fluid. Discussion A biliary cystadenoma (BCA) primary origin is occasionally rare. Although imaging modalities such as ultrasound, computed tomography and magnetic resonance imaging could be suggestive, however, the definitive diagnosis is depended on the histological examination. Despite of being a benign tumor, it has a high risk of recurrence after conservative treatment. The potential risk for malignant is also present. Therefore, complete resection of the tumors is the treatment of choice. Conclusion We herein present a report of a rare case with had a giant biliary cystadenoma (BCA) primary origin. This report aims to improve the understanding of the diagnosis and management of this uncommon disease. A biliary cystadenoma (BCA) primary origin is occasionally rare, the clinical manifestations are variable and non-specific. BCA should be suspected when there is a multilocular and thick-walled cystic on liver imaging modalities. Histological examination and immunohistochemistry staining are considered as the gold standard. Radical surgery (enucleation or liver resection) must be still the most effective and major treatment approach.
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Soares KC, Arnaoutakis DJ, Kamel I, Anders R, Adams RB, Bauer TW, Pawlik TM. Cystic neoplasms of the liver: biliary cystadenoma and cystadenocarcinoma. J Am Coll Surg 2013; 218:119-28. [PMID: 24045144 DOI: 10.1016/j.jamcollsurg.2013.08.014] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 08/18/2013] [Accepted: 08/20/2013] [Indexed: 02/06/2023]
Affiliation(s)
- Kevin C Soares
- Division of Surgical Oncology, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dean J Arnaoutakis
- Division of Surgical Oncology, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ihab Kamel
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robert Anders
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Reid B Adams
- Division of Surgical Oncology, Department of Surgery, University of Virginia Health System, Charlottesville, VA
| | - Todd W Bauer
- Division of Surgical Oncology, Department of Surgery, University of Virginia Health System, Charlottesville, VA
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
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Appropriate diagnosis of biliary cystic tumors: comparison with atypical hepatic simple cysts. Eur J Gastroenterol Hepatol 2010; 22:989-96. [PMID: 20300006 DOI: 10.1097/meg.0b013e328337c971] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Biliary cystadenoma (BCA) and biliary cystadenocarcinoma (BCAC) are often confused with other intrahepatic cystic diseases. AIMS The aims of this study were to investigate predictive factors of biliary cystic tumor (BCT) and clinical characteristic of BCAC. METHODS We retrospectively reviewed preoperative diagnoses, overall characteristics and postoperative outcome of 20 BCTs and 19 cystadenoma-mimicking simple cysts that were pathologically confirmed. RESULTS Comparing with atypical simple cysts, symptoms, left-lobe cyst, thick wall, septation, mural nodule, bile duct dilatation and an increase of serum alkaline phosphatase were associated with BCTs. However, on multivariate analysis, mural nodule, left-lobe cyst, and an increase of serum alkaline phosphatase were significantly frequent in BCTs with odds ratios of 75.5, 13.8, and 33.0, respectively. Among the 20 BCTs, seven BCACs were diagnosed. The characteristics of BCACs were mural nodule (P<0.01), intrahepatic cyst debris (P<0.01), and bile duct dilation (P=0.04). Cystic fluid analysis provided no significant differences between BCT and simple cyst. After fine needle aspiration cytology of BCTs, all except one BCAC with atypical cell showed nonspecific findings. After complete surgical excision (97.4% of patients), only one patient with BCAC had recurrence during 29 months of follow-up period. CONCLUSION In hepatic cysts with mural nodule, left-lobe cyst or increment of serum alkaline phosphatase seem to be indicative of BCTs in the diagnosis of suspicious hepatic cyst. Intracystic debris, bile duct dilation, and mural nodule may be suggestive clinical features of malignancy in BCTs.
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Sistla SC, Sankar G, Basu D, Venkatesan B. Biliary cystadenocarcinoma of the gall bladder: a case report. J Med Case Rep 2009; 3:75. [PMID: 19946551 PMCID: PMC2783074 DOI: 10.1186/1752-1947-3-75] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 10/15/2009] [Indexed: 11/18/2022] Open
Abstract
Introduction While biliary cystadenoma and biliary cystadenocarcinoma involving the liver are not uncommon, biliary cystadenocarcinoma of the gall bladder is an extremely rare lesion and can be very difficult to diagnose. Case presentation A 50-year-old Indian woman presented with pain and swelling in the right hypochondrium. An ultrasonography revealed a cystic lesion arising from the gallbladder fossa. This lesion was initially managed with aspiration and antibiotics by the treating physician. The patient was referred for surgical management because the abscess was not resolved through conservative treatment. A diagnosis of an infected nonparasitic cyst was made and deroofing of the cyst was performed. A histopathological examination of the excised cyst wall showed cystadenocarcinoma. The patient subsequently underwent a successful surgical excision of the lesion. Conclusion Infective lesions of the liver are common in developing countries and are usually managed through aspiration and antibiotics. Cystadenocarcinoma of the gallbladder needs to be considered in the differential diagnosis of cystic lesions arising from the gallbladder fossa. A high index of suspicion and cytological examination from the wall of such complex lesions will help in the timely management of such lesions.
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Affiliation(s)
- Sarath Chandra Sistla
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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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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Teoh AYB, Ng SSM, Lee KF, Lai PBS. Biliary Cystadenoma and Other Complicated Cystic Lesions of The Liver: Diagnostic and Therapeutic Challenges. World J Surg 2006; 30:1560-6. [PMID: 16865321 DOI: 10.1007/s00268-005-0461-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Biliary cystadenomas are complicated cystic lesions of the liver. They are rare and pose considerable diagnostic and therapeutic challenges. METHODS We present our experience managing these lesions by performing a retrospective review of all patients with a preoperative diagnosis of or histologically proven biliary cystadenoma who underwent surgery between January 1995 and January 2005 at our institution. Altogether, 20 patients (16 women, 4 men) with a mean age of 58 years underwent a total of 22 operations. The diagnosis of biliary cystadenoma was based on exclusion of other pathologic entities and the presence of radiologic characteristics of biliary cystadenoma. Abdominal ultrasonography (US), computed tomography, or both were performed in all patients. US-guided fine-needle aspiration cytology was performed in seven patients and all of them were negative for malignancy. A preoperative diagnosis of biliary cystadenoma was made in 16 patients based on clinical and radiologic features and was correct in 6 of them. Diagnosis of biliary cystadenoma was not suspected in four patients. RESULTS The overall diagnostic accuracy was 30%. Enucleation was the most common surgical procedure and was performed in 10 patients. The mean follow-up period was 5.5+/-2.8 years. No recurrence was detected in patients with confirmed biliary cystadenoma after adequate excision. CONCLUSIONS The findings of this study highlight the difficulty with preoperative diagnosis of biliary cystadenoma, which has seldom been discussed in the literature. Preoperative differentiation by means of radiologic imaging is inaccurate (30%). Any therapy short of complete excision leads to local recurrence and risk of malignant transformation. Complete excision of any suspicious lesion remains the best method of diagnosis and treatment.
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Affiliation(s)
- Anthony Y B Teoh
- Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
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