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Baltagiannis EG, Tsili A, Goussia A, Glantzouni A, Frigkas K, Charchanti A, Glantzounis GK, Gomatos IP. Complex cystic liver lesions: classification, diagnosis, and management. Ann Gastroenterol 2024; 37:255-265. [PMID: 38779639 PMCID: PMC11107409 DOI: 10.20524/aog.2024.0876] [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: 07/27/2023] [Accepted: 01/09/2024] [Indexed: 05/25/2024] Open
Abstract
Cystic liver disease has been increasingly reported in the literature, with a prevalence as high as 15-18%. Hepatic cysts are usually discovered incidentally, while their characterization and classification rely on improved imaging modalities. Complex cystic liver lesions comprise a wide variety of novel, re-introduced, and re-classified clinical entities. This spectrum of disorders ranges from non-neoplastic conditions to benign and malignant tumors. Their clinicopathological features, prognostic factors, and oncogenic pathways are incompletely understood. Despite representing a heterogeneous group of disorders, they can have similar clinical and imaging characteristics. As a result, the diagnosis and management of complex liver cysts can become quite challenging. Furthermore, inappropriate diagnosis and management can lead to high morbidity and mortality. In this review, we aim to offer up-to-date insight into the diagnosis, classification, and management of the most common complex cystic liver lesions.
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Affiliation(s)
- Evangelos G. Baltagiannis
- HPB Unit, Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina (Evangelos G. Baltagiannis, Georgios K. Glantzounis)
| | - Athina Tsili
- Department of Radiology, University Hospital of Ioannina and School of Medicine, University of Ioannina (Athina Tsili)
| | - Anna Goussia
- Department of Pathology, University Hospital of Ioannina and School of Medicine, University of Ioannina (Anna Goussia)
| | - Anastasia Glantzouni
- Department of Radiology, G. Hatzikosta General Hospital, Ioannina (Anastasia Glantzouni)
| | - Konstantinos Frigkas
- Department of Radiology, University Hospital of Alexandroupolis and School of Medicine, Democritus University of Thrace, Alexandroupolis (Konstantinos Frigkas)
| | - Antonia Charchanti
- Department of Anatomy-Histology-Embryology, School of Medicine, University of Ioannina (Antonia Charchanti)
| | - Georgios K. Glantzounis
- HPB Unit, Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina (Evangelos G. Baltagiannis, Georgios K. Glantzounis)
| | - Ilias P. Gomatos
- Department of Transplant Surgery, “Laiko” General Hospital of Athens (Ilias P. Gomatos), Greece
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Yoshimoto T, Takajo T, Iijima H, Yamamoto R, Takihara H, Nishimoto F. Comparison of endoscopic ultrasound-guided drainage and percutaneous drainage combined with minocycline sclerotherapy for symptomatic hepatic cysts: A retrospective study. Medicine (Baltimore) 2024; 103:e37677. [PMID: 38552057 PMCID: PMC10977566 DOI: 10.1097/md.0000000000037677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/01/2024] [Indexed: 04/02/2024] Open
Abstract
Simple hepatic cysts (SHC) are generally asymptomatic and incidentally diagnosed using imaging studies. Asymptomatic SHC does not require treatment, but symptomatic SHC warrants treatment using different modalities, including intravenous antibiotic therapy, ultrasound-guided percutaneous catheter drainage (PCD) with sclerotherapy, and surgery. The dissemination of endoscopic ultrasonography (EUS) intervention techniques has enabled the performance of puncture and drainage via the transgastrointestinal route for intra-abdominal abscesses. Despite the development of an EUS-guided drainage method for treating symptomatic SHC, only a few case reports using this method have been reported. This study retrospectively analyzed the safety and feasibility of EUS-guided drainage of symptomatic SHC as well as its clinical outcomes and compared it with combined therapy using PCD and minocycline sclerotherapy. The records of 10 consecutive patients with 11 symptomatic SHCs treated with either EUS-guided drainage or PCD combined with minocycline sclerotherapy at the Musashino Tokushukai Hospital from August 2019 to January 2024 were retrospectively examined. All cases in both groups achieved technical and clinical success, with no reported adverse events. The median reduction rates of the major cyst diameters in the EUS-guided drainage and PCD with sclerotherapy groups were 100% (interquartile range [IQR]: 94%-100%) and 67% (IQR: 48.5%-85%). The length of hospital stay was 7 and 22.5 days in the EUS-guided and PCD with sclerotherapy groups (P = .01). EUS-guided drainage of symptomatic SHC is a safe and effective therapeutic alternative to percutaneous drainage with sclerotherapy and surgery for treating symptomatic SHC.
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Affiliation(s)
- Taiji Yoshimoto
- Department of Gastroenterology, Musashino Tokushukai Hospital, Tokyo, Japan
| | - Takeshi Takajo
- Department of Gastroenterology, Musashino Tokushukai Hospital, Tokyo, Japan
| | - Hirokazu Iijima
- Department of Surgery, Musashino Tokushukai Hospital, Tokyo, Japan
| | - Ryuichi Yamamoto
- Department of Gastroenterology, Tokyo-west Tokushukai Hospital, Tokyo, Japan
| | - Hiroshi Takihara
- Department of Gastroenterology, Uji Tokushukai Hospital, Uji, Kyoto, Japan
| | - Fumiya Nishimoto
- Division of Gastroenterology Department of Internal Medicine Showa University Fujigaoka Hospital Kanagawa Japan
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Kim R, Oh JS, Kim SH, Chun HJ. Complete and Incomplete Alcohol Sclerotherapy for Treatment of Symptomatic Hepatic Cysts: Comparison of Volume Reduction and Clinical Outcomes. J Clin Med 2024; 13:1472. [PMID: 38592276 PMCID: PMC10932187 DOI: 10.3390/jcm13051472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/09/2024] [Accepted: 03/01/2024] [Indexed: 04/10/2024] Open
Abstract
Background: The purpose of this study was to compare the efficacy of incomplete alcohol sclerotherapy with complete treatment for hepatic cysts. Methods: From 2005 to 2021, a total of 80 patients (19 males, 61 females; median age 65 years; age range, 42-86 years) who underwent alcohol sclerotherapy for symptomatic benign hepatic cysts were enrolled and retrospectively reviewed. Complete treatment was defined as injecting 25-33% of the aspirated cyst volume with alcohol in 2-3 cycles, with a maximum of 100 mL per cycle. The overall volume reduction rate was compared between the complete and incomplete treatment groups. The response, based on cystic volume reduction, was classified as a complete regression (CR), near-complete regression (NCR), partial regression (PR), or no response (NR). CR and NCR were considered objective responses. Among 80 patients with 85 hepatic cysts, 26 patients with 29 hepatic cysts received incomplete treatment. Results: The overall volume reduction rate was not significantly different between the complete and incomplete treatment groups (94.39% vs. 95.47%, respectively, p = 0.623). The CR and NCR groups showed a significantly higher rate of symptom improvement than the PR and NR groups (p = 0.043). Conclusions: In conclusion, the efficacy of incomplete alcohol sclerotherapy was not inferior to that of complete treatment.
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Affiliation(s)
- Ran Kim
- Department of Radiology, Chung-Ang University Gwang Myeong Hospital, Chung-Ang University College of Medicine, Gwang Myeong 14353, Republic of Korea;
| | - Jung-Suk Oh
- Department of Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea; (S.-H.K.); (H.-J.C.)
| | - Su-Ho Kim
- Department of Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea; (S.-H.K.); (H.-J.C.)
| | - Ho-Jong Chun
- Department of Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea; (S.-H.K.); (H.-J.C.)
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Kinoshita S, Nishizawa T, Tojo M, Hirai Y, Nakazato Y, Miyanaga R, Fujimoto A, Inoue K, Ebinuma H, Suzuki H, Kikuchi M. Simple drainage versus drainage with minocycline infusion for symptomatic hepatic cysts. J Clin Biochem Nutr 2023; 72:89-91. [PMID: 36777076 PMCID: PMC9899919 DOI: 10.3164/jcbn.22-89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/20/2022] [Indexed: 11/11/2022] Open
Abstract
Percutaneous treatment of symptomatic hepatic cysts includes simple drainage and drainage with sclerosing agents. We compared the efficacy of simple drainage with that of drainage with minocycline infusion for treating symptomatic hepatic cysts. We retrospectively evaluated 11 patients who underwent percutaneous drainage of symptomatic hepatic cysts. In seven cases, minocycline infusion was added at the discretion of the clinician. Cyst volume was evaluated before drainage, immediately after drainage, and after long-term follow-up. Cyst volume was calculated before treatment by multiplying the orthogonal diameters using the ellipsoid formula. Relapse was defined as the regrowth of the cyst with symptoms. Cyst volume immediately after drainage and after long-term follow-up was significantly less than that before treatment for the drainage with minocycline infusion group (p<0.05) but not for the simple drainage group. The relapse rates were 25% (1/4) for the simple drainage group and 0% for the drainage with minocycline infusion group. Drainage with minocycline infusion could be a promising option for treating symptomatic hepatic cysts, although simple drainage was not reliable.
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Affiliation(s)
- Satoshi Kinoshita
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo 152-8902, Japan,Gastroenterology, Saitama Medical Center, Saitama 330-0074, Japan
| | - Toshihiro Nishizawa
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita, Chiba 286-8520, Japan,To whom correspondence should be addressed. E-mail:
| | - Masaya Tojo
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo 152-8902, Japan
| | - Yuichiro Hirai
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo 152-8902, Japan,Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Yoshihiro Nakazato
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo 152-8902, Japan,Gastroenterology, Saitama Medical Center, Saitama 330-0074, Japan
| | - Ryoichi Miyanaga
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo 152-8902, Japan
| | - Ai Fujimoto
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo 152-8902, Japan,Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Toho University, Tokyo 143-8541, Japan
| | - Kazuaki Inoue
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita, Chiba 286-8520, Japan
| | - Hirotoshi Ebinuma
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita, Chiba 286-8520, Japan
| | - Hidekazu Suzuki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Masahiro Kikuchi
- Gastroenterology, Clinic of a Wind, Komazawa, Tokyo 154-0011, Japan
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He XX, Sun MX, Lv K, Cao J, Zhang SY, Li JN. Percutaneous aspiration and sclerotherapy of a giant simple hepatic cyst causing obstructive jaundice: A case report and review of literature. World J Gastrointest Surg 2022; 14:706-713. [PMID: 36158281 PMCID: PMC9353755 DOI: 10.4240/wjgs.v14.i7.706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/30/2022] [Accepted: 06/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Giant simple hepatic cysts causing intrahepatic duct dilatation and obstructive jaundice are uncommon. A variety of measures with different clinical efficacies and invasiveness have been developed. Nonsurgical management, such as percutaneous aspiration and sclerotherapy, is often applied.
CASE SUMMARY The case is a 39-year-old female with a 5-mo history of cutaneous and scleral icterus, loss of appetite, and dark urine. Lab tests showed jaundice and liver function abnormalities. Imaging revealed a giant simple hepatic cyst obstructing the intrahepatic bile ducts. A combination of percutaneous catheter aspiration and lauromacrogol sclerotherapy was successfully performed and the effects were satisfactory with the size of cyst decreasing from 13.7 cm × 13.1 cm to 3.0 cm × 3.0 cm. Further literature review presented the challenges of managing giant simple hepatic cysts that cause obstructive jaundice and compared the safety and efficacy of a combination of percutaneous aspiration and lauromacrogol sclerotherapy with other management strategies.
CONCLUSION Giant simple hepatic cysts can cause obstructive jaundice, and a combination of percutaneous catheter aspiration and sclerotherapy with lauromacrogol are suggested to treat such cases.
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Affiliation(s)
- Xu-Xia He
- Department of Gastroenterology, Peking Union Medical College Hospital, Beijing 10000, China
| | - Mei-Xing Sun
- Department of Gastroenterology, Peking Union Medical College Hospital, Beijing 10000, China
| | - Ke Lv
- Department of Ultrasound, Peking Union Medical College Hospital, Beijing 10000, China
| | - Jian Cao
- Department of Radiology, Peking Union Medical College Hospital, Beijing 10000, China
| | - Sheng-Yu Zhang
- Department of Gastroenterology, Peking Union Medical College Hospital, Beijing 10000, China
| | - Jing-Nan Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Beijing 10000, China
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Eso Y, Shimizu H, Takai A, Takahashi K, Seno H. Ultrasound-guided polidocanol foam sclerotherapy for symptomatic giant hepatic cyst: A single-center experience. Hepatol Res 2022; 52:557-565. [PMID: 35355375 DOI: 10.1111/hepr.13769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/16/2022] [Accepted: 03/11/2022] [Indexed: 02/08/2023]
Abstract
AIM Simple hepatic cysts are typically benign; however, when they are large and symptomatic, therapeutic intervention is required. We previously reported our initial experience with ultrasound (US)-guided polidocanol foam sclerotherapy in three patients with symptomatic giant hepatic cysts. In the present study, we examined the efficacy and safety of polidocanol foam sclerotherapy in a larger number of patients with long-term follow-up. METHODS Between May 2016 and April 2021, 15 patients with symptomatic giant hepatic cysts were referred to our hospital. All patients were prospectively included in the study and underwent US-guided polidocanol foam sclerotherapy. RESULTS The mean maximum diameter and estimated cyst volume were 128.4 mm (77-223 mm) and 922.3 ml (123.2-2797 ml), respectively. Polidocanol foam was successfully administered through an 8.5-Fr pigtail catheter in all patients. The percentages of cyst diameter/volume after 1-3 months, 3-6 months, 6 months-1 year, 1-2 years, and 2-4 years of sclerotherapy were 66.8%/36.5%, 48.1%/14.8%, 34.1%/6.9%, 28.2%/3.7%, and 26.2%/3.1%, respectively. During the follow-up period, there were no cases of symptom recurrence or need for additional treatment due to cyst re-growth. Six patients (40%) had fever, one had nausea, and one had right-sided chest pain, but none of these adverse events required prolonged hospitalization or readmission. CONCLUSIONS US-guided polidocanol foam sclerotherapy may be an effective and safe method for the treatment of symptomatic giant hepatic cysts.
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Affiliation(s)
- Yuji Eso
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hironori Shimizu
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsushi Takai
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ken Takahashi
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Seno
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Dundar I, Ozgokce M, Durmaz F, Ozkacmaz S, Turkoglu S, Goya C. Efficiency of diffusion-weighted MRI for differentiating radiologically similar simple and type I hydatid cysts of the liver. Acta Radiol 2022; 63:143-148. [PMID: 33478235 DOI: 10.1177/0284185120988131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Determining the nature of purely cystic hepatic lesions is essential because different kinds have different follow-ups, treatment options, and complications. PURPOSE To explore the potential of apparent diffusion coefficient (ADC) values of diffusion-weighted imaging (DWI) for the differentiation of type I hydatid cysts (HC) and simple liver cysts (SLC), which have similar radiological appearances. MATERIAL AND METHODS This single-center prospective study was conducted during 2016-2019. Round, homogenous, anechoic liver cysts >1 cm were classified according to at least two years of imaging follow-up, radiological features, serology, as well as puncture aspiration injection reaspiration procedure and pathology results. ADC values of 95 cysts (50 type I HCs and 45 SLCs) were calculated on DWI. The differences in ADC values were analyzed by independent t-test. RESULTS Of 51 patients, 28 were female, 23 were male (mean age 32.07 ± 22.95 years; age range 5-82 years). Mean diameter of 45 SLCs was 2.59 ± 1.23 cm (range 1.2-7.6 cm) and ADCmean value was 3.03 ± 0.47 (range 2.64-5.85) while mean diameter of 50 type I HCs was 7.49 ± 2.95 cm (range 2.8-14 cm) and ADCmean value was 2.99 ± 0.29 (range 2.36-3.83). There was no statistically significant difference in ADC values between type I HCs and SLCs. CONCLUSION Some studies report that ADC values of type I HCs are statistically significantly lower than those of SLCs. Others suggest no significant difference. In our study with a higher number of cases, using ADC parameters similar to those in previous studies, we did not find any statistically significant difference.
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Affiliation(s)
- Ilyas Dundar
- Department of Radiology, Van Yuzuncu Yil University, Faculty of Medicine, Van, Turkey
| | - Mesut Ozgokce
- Department of Radiology, Van Yuzuncu Yil University, Faculty of Medicine, Van, Turkey
| | - Fatma Durmaz
- Department of Radiology, Van Yuzuncu Yil University, Faculty of Medicine, Van, Turkey
| | - Sercan Ozkacmaz
- Department of Radiology, Van Yuzuncu Yil University, Faculty of Medicine, Van, Turkey
| | - Saim Turkoglu
- Department of Radiology, Van Yuzuncu Yil University, Faculty of Medicine, Van, Turkey
| | - Cemil Goya
- Department of Radiology, Van Yuzuncu Yil University, Faculty of Medicine, Van, Turkey
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Durmaz F, Ozgokce M, Turkoglu S, Dundar İ, Goya C. Ultrasound Elastography in the Differentiation of Simple Cyst and Type I Hydatid Cyst of the Liver. Ultrasound Q 2021; 37:129-132. [PMID: 34057913 DOI: 10.1097/ruq.0000000000000504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Hydatid cyst (HC) is a parasitic disease that is endemic particularly to the sheep-breeding regions of the world, our country included. Given their propensity to materialize most commonly in the liver, our study evaluates the value of ultrasound elastography in the differential diagnosis of simple cyst and type I HCs of the liver.The study involved a total of 73 cysts (22 simple cysts, 51 type I HCs) that were removed using the puncture aspiration injection reaspiration technique between 2016 and 2018. All measurements were made using a Siemens ACUSON S2000 (Siemens Healthcare, Erlangen, Germany) device with a 4-MHZ 4C1 convex probe, an acoustic radiation force impulse elastography procedure, and a Virtual Touch IQ option. The difference between the mean shearwave elastography (SWE) values of both groups was analyzed with an independent t test.Of the 70 patients involved in the study, 29 were female and 41 were male, with a mean ± SD age of 38.85 ± 17.62 years (range, 5-82 years). Upon the examination of the 22 simple cysts and the 51 HCs, the mean ± SD SWE values were found to be 2.6 ± 0.96 (0.96-4.25) and 2.8 ± 1.69 (0.66-4.84), respectively. No statistically significant difference was identified between the SWE values of type I HCs and simple cysts (P > 0.005).Although HCs and simple cysts had similar radiological appearances, and a relative difference was noted in the differentiation of the elastographic measurements, this difference was not statistically significant. Accordingly, more comprehensive and various studies are needed.
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Affiliation(s)
- Fatma Durmaz
- Department of Radiology, Hakkari State Hospital, Hakkari
| | - Mesut Ozgokce
- Department of Radiology, Medicine Faculty, Van Yuzuncu Yil University, Van, Turkey
| | - Saim Turkoglu
- Department of Radiology, Medicine Faculty, Van Yuzuncu Yil University, Van, Turkey
| | - İlyas Dundar
- Department of Radiology, Bingöl State Hospital, Bingöl, Turkey
| | - Cemil Goya
- Department of Radiology, Medicine Faculty, Van Yuzuncu Yil University, Van, Turkey
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Zhang JW, Peng C, Ye YS, Li W. Giant simple hepatic cyst with multiple elevated serum tumor markers: A case report. World J Gastrointest Surg 2020; 12:549-554. [PMID: 33437405 PMCID: PMC7769747 DOI: 10.4240/wjgs.v12.i12.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/16/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Simple hepatic cysts are relatively common in adults, and mostly appear as asymptomatic incidental radiologic findings. Occasionally, a large cyst will cause symptoms. Elevations in the serum biomarkers protein induced by vitamin K absence (PIVKA)-II, cancer antigen (CA) 12-5, and CA19-9 are often associated with malignant tumors in the liver or bile ducts. This is the first report to describe a case of hepatic cyst with elevated levels of PIVKA-II and CA12-5.
CASE SUMMARY An 84-year-old Chinese woman was admitted with gradual abdominal distension. Her symptoms started 1 year ago, and she had poor appetite and a weight loss of 5 kg within the past 2 wk. She denied any symptoms associated with abdominal pain, fever and chills, nausea and vomiting, etc. The abdomen was enlarged, more in the right upper quadrant, without tenderness. Laboratory examination showed significantly increased serum levels of PIVKA-II, CA12-5, and CA19-9. A computed tomography scan revealed multiple round cysts in the liver with clear boundaries. The largest cyst was 20.1 cm × 12.2 cm × 19.6 cm in size, located in the right lobe of the liver with mild dilatation of the intrahepatic bile duct, but there was no contrast enhancement. Percutaneous drainage on the largest hepatic cyst and polycinnamol sclerosing agent injection into the cyst cavity were performed. After treatment, the patient’s symptoms relieved and the elevated serum tumor makers reduced to the normal levels dramatically.
CONCLUSION The present report identifies an unusual case of a giant hepatic cyst with marked elevation of serum tumor marker levels of PIVKA-II, CA12-5, and CA19-9. After treatment, these three serum markers dramatically decreased to normal levels. The mechanisms for the elevation of these tumor markers may be as follows: (1) A giant hepatic cyst compresses the liver, causing injury to the hepatocytes, which may lead to secretion of a large amount of PIVKA-II; and (2) Some tumor-associated antigens, such as carcinoembryonic antigen, CA19-9, CA12-5, and CA15-3, are expressed on inflammatory cells.
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Affiliation(s)
- Jia-Wei Zhang
- Department of Hepatobiliary-Pancreatic Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
- Department of Vascular Surgery, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Cheng Peng
- Department of Hepatobiliary-Pancreatic Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
- Department of Hepatobiliary-Pancreatic Surgery, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
| | - Yan-Shuo Ye
- Department of Hepatobiliary-Pancreatic Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Wei Li
- Department of Hepatobiliary-Pancreatic Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
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Laparoscopic management of simple hepatic cyst. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kajihara Y. A Hemorrhagic Hepatic Cyst Leading to Compression of the Inferior Vena Cava. Chonnam Med J 2019; 55:116-117. [PMID: 31161124 PMCID: PMC6536439 DOI: 10.4068/cmj.2019.55.2.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Yusaku Kajihara
- Department of Gastroenterology, Fuyoukai Murakami Hospital, Aomori, Japan
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12
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Eso Y, Furuta A, Takai A, Takahashi K, Ueda Y, Marusawa H, Seno H. Ultrasound-guided microfoam sclerotherapy with polidocanol for symptomatic giant hepatic cyst: Initial experience. Hepatol Res 2018; 48:1055-1063. [PMID: 29882287 DOI: 10.1111/hepr.13202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/12/2018] [Accepted: 06/01/2018] [Indexed: 12/26/2022]
Abstract
AIM In cases of symptomatic giant hepatic cysts, appropriate treatment is required to relieve symptoms. Ethanol, minocycline hydrochloride, and ethanolamine oleate have been conventionally used for ultrasound (US)-guided sclerotherapy. However, liquid sclerosing agents could mix with the residual fluid in the cyst and reduce their sclerotic effects. We carried out US-guided microfoam sclerotherapy using polidocanol for three patients and evaluated its efficacy and safety. METHODS Between May 2016 and March 2017, three female patients with symptomatic giant hepatic cysts were referred to our hospital. All of them were prospectively included in this study. RESULTS The maximum diameters of the hepatic cysts in the three patients were 92 × 89 × 86 mm, 155 × 119 × 140 mm, and 223 × 195 × 123 mm, respectively. Polidocanol microfoam was successfully administered through an 8.5-Fr pigtail catheter for all patients. One, two, and three microfoam sclerotherapy sessions were undertaken according to the initial cyst volume for cases 1, 2, and 3, respectively. The mean reduction rates of the cyst volume were 90.1% (85.5-98.9%) at 3 months, 96.3% (91.9-99.9%) at 6 months, and 99.5% (99.1-99.9%) at 9 months after treatment. No significant treatment-induced adverse effects were observed. CONCLUSION Ultrasound-guided microfoam sclerotherapy using polidocanol could be an effective and safe method for the treatment of symptomatic giant liver cysts.
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Affiliation(s)
- Yuji Eso
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akihiro Furuta
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsushi Takai
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ken Takahashi
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshihide Ueda
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroyuki Marusawa
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Hiroshi Seno
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Radojković M, Dimić S, Širić Z, Dimić I, Petrović D, Stojanović M, Karanikolić A. COMPARATIVE ANALYSIS OF ALCOHOL SCLEROTHERAPY VERSUS CATHETER DRAINAGE IN THE TREATMENT OF NON-PARASITIC BENIGN LIVER CYSTS. ACTA MEDICA MEDIANAE 2017. [DOI: 10.5633/amm.2017.0407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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14
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Shi G, Sun S, Li H, Fan Y, Liao Y, Zheng D, Huang M, Zhang H. A case of a giant cyst in the left lobe of the liver successfully treated with endoscopic ultrasound-guided fine needle aspiration (with video). Endosc Ultrasound 2017:210609. [PMID: 28707654 PMCID: PMC5664857 DOI: 10.4103/2303-9027.210609] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Gan Shi
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
| | - Shengbin Sun
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
| | - Hui Li
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
| | - Yan Fan
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
| | - Yusheng Liao
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
| | - Dan Zheng
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
| | - Manling Huang
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
| | - Heng Zhang
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
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15
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Sawada N, Endo T, Mikami K, Igarashi G, Sakamoto J, Tono H, Fukuda S. Kidney Injury due to Ureteral Obstruction Caused by Compression from Infected Simple Hepatic Cyst. Case Rep Gastroenterol 2017. [PMID: 28626377 PMCID: PMC5471780 DOI: 10.1159/000475919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Simple hepatic cysts are common and most often asymptomatic. In symptomatic cases, hemorrhage, rupture, and infection are major complications. However, urinary tract obstruction caused by a simple hepatic cyst is rare. We treated an 82-year-old Japanese man with an infected giant hepatic cyst causing right hydronephrosis who had a past history of left nephrectomy for renal cell carcinoma. The patient underwent ultrasound-guided percutaneous drainage and sclerotherapy with minocycline hydrochloride for the infected hepatic cyst. Right hydronephrosis was relieved, and renal dysfunction improved with regression of the hepatic cyst after treatment. This is the first report of hydronephrosis due to ureteral obstruction caused by compression from a hepatic cyst.
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Affiliation(s)
- Naoya Sawada
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tetsu Endo
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kenichiro Mikami
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Go Igarashi
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Juichi Sakamoto
- Department of Internal Medicine, Hirosaki Municipal Hospital, Hirosaki, Japan
| | - Hiroshi Tono
- Department of Internal Medicine, Hirosaki Municipal Hospital, Hirosaki, Japan
| | - Shinsaku Fukuda
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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16
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Heo JH, Kang JY, Lee MS, Cho BH, Hwang SY, Song JH, Yang JI, Choi JS. [A Case of Biliary Obstruction Caused by Liver Cyst]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 68:270-273. [PMID: 27871164 DOI: 10.4166/kjg.2016.68.5.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Most cystic lesions of the liver are found incidentally in imaging studies because they are not symptomatic, and generally do not require treatment. Rarely, however, symptomatic hepatic cysts may develop complications and require treatment. Here, we describe a case of a 77-year-old woman who developed biliary obstruction with abdominal pain due to compression of the bile duct by a simple hepatic cyst. We confirmed the diagnosis based on symptoms and imaging studies. The patient'ssymptoms improved after simple cyst ablation by sclerotherapy.
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Affiliation(s)
- Jae Hyuk Heo
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ju Yeon Kang
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Myong Seob Lee
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Byeong Hak Cho
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seon Yeong Hwang
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jeong Hoon Song
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ju Il Yang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Sik Choi
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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17
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Ćwik G, Wyroślak-Najs J, Solecki M, Wallner G. Evaluation of the utility value of percutaneous drainage of symptomatic hepatic cysts combined with an obliteration attempt. J Ultrason 2016; 16:260-72. [PMID: 27679729 PMCID: PMC5034020 DOI: 10.15557/jou.2016.0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/16/2016] [Accepted: 03/23/2016] [Indexed: 12/03/2022] Open
Abstract
Aim The goal of the paper was to evaluate the procedure of percutaneous drainage of symptomatic hepatic cysts under the transabdominal ultrasound control combined with obliteration. Material and method Within the period from 2005 to 2015, 70 patients diagnosed with a simple hepatic cyst of symptomatic nature were subject to hospitalization and treated at the 2nd General, Gastroenterological and Cancer Surgery of the Alimentary System Center and Clinics of the Medical University of Lublin. All the patients subject to evaluation were qualified to percutaneous drainage under an ultrasound control. The drainage utilized typical sets of drains with the diameter of at least 9 F, most often of pigtail type. The fluid aspirated form the cyst was dispatched for complex laboratory testing. Further, a 10% sodium chloride solution was administered to the cyst through the drain, in the volume depending on the previous size of the cyst and the patient's reaction. Results Patients reported for a re-visit within the period from 3 to 9 months following the procedure. Complete obliteration of the cyst was confirmed only in 8 patients (11%). Cyst recurrence was reported in cases when during the ultrasound evaluation, the diameter of the cyst following aspiration and obliteration enlarged to over 75% of the initial dimension. In this group, in 10 out of 12 examined (83%) there was a relapse of the previously observed ailments. Among patients, who has a cyst imaged within the period of observation, which had the diameter from 50% to 75% of the previous size, only in 6 cases (37.5%) the initial symptoms relapsed. Conclusions The utilization of a drainage and obliteration enables one to achieve the acceptable result of the therapy as well as significant decrease in the number of previously reported ailments and symptoms described.
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Affiliation(s)
- Grzegorz Ćwik
- II Chair and Department of General, and Gastroenterological Surgery and Surgical Oncology of the Alimentary Tract, Medical University of Lublin, Poland
| | - Justyna Wyroślak-Najs
- II Chair and Department of General, and Gastroenterological Surgery and Surgical Oncology of the Alimentary Tract, Medical University of Lublin, Poland
| | - Michał Solecki
- II Chair and Department of General, and Gastroenterological Surgery and Surgical Oncology of the Alimentary Tract, Medical University of Lublin, Poland
| | - Grzegorz Wallner
- II Chair and Department of General, and Gastroenterological Surgery and Surgical Oncology of the Alimentary Tract, Medical University of Lublin, Poland
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Larssen TB, Viste A, Horn A, Haldorsen IS, Espeland A. Single-session alcohol sclerotherapy of symptomatic liver cysts using 10-20 min of ethanol exposure: no recurrence at 2-16 years of follow-up. Abdom Radiol (NY) 2016; 41:1776-81. [PMID: 27156079 PMCID: PMC5002038 DOI: 10.1007/s00261-016-0769-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To assess long-term results after single-session alcohol sclerotherapy of symptomatic benign liver cysts performed with maximum 20 min of exposure to alcohol. METHODS We included 47 patients aged 32-88 years (42 women, 5 men) with 51 benign non-parasitic liver cysts that were exposed to ethanol for 7-20 min in a single sclerotherapy session and were followed for at least 24 months. Each cyst was emptied before injecting ethanol (10% of cyst volume, but maximum 100 mL) into it. The patient rotated from side to side to facilitate contact between ethanol and the whole cyst wall. Pre-treatment cyst volume was defined as the volume of aspirated cyst fluid after complete emptying of the cyst. Follow-up cyst volume was estimated based on computed tomography images. RESULTS Cyst volumes were 30-4900 (median 520) mL at pre-treatment and 0-230 (median 1) mL at 24-193 (median 56) months follow-up, a reduction of 83-100% (median 99.7%). No cyst required repeated treatment during the follow-up. Median volume reduction was 99.7% at median 49 months of follow-up for 35 cysts exposed to ethanol for 7-10 min vs. 99.6% at median 75 months of follow-up for 16 cysts exposed for 20 min (p = 0.83, Mann-Whitney test). Ethanol intoxication occurred in one patient. There were no other complications except for pain. CONCLUSION Long-term results of single-session alcohol sclerotherapy performed with maximum 20 min of exposure to ethanol were satisfactory with no sign of recurrence of cyst fluid.
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Affiliation(s)
- Trond Bjerke Larssen
- Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, 5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Pb 7804, 5020, Bergen, Norway
| | - Asgaut Viste
- Department of Clinical Medicine, University of Bergen, Pb 7804, 5020, Bergen, Norway
- Department of Acute and Gastrointestinal Surgery, Haukeland University Hospital, Jonas Liesvei 65, 5021, Bergen, Norway
| | - Arild Horn
- Department of Acute and Gastrointestinal Surgery, Haukeland University Hospital, Jonas Liesvei 65, 5021, Bergen, Norway
| | - Ingfrid Salvesen Haldorsen
- Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, 5021, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Pb 7804, 5020, Bergen, Norway
| | - Ansgar Espeland
- Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, 5021, Bergen, Norway.
- Department of Clinical Medicine, University of Bergen, Pb 7804, 5020, Bergen, Norway.
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19
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Hotta M, Yoshida H, Makino H, Yokoyama T, Maruyama H, Uchida E. Spontaneous rupture of a simple hepatic cyst: report of a case. J NIPPON MED SCH 2015; 82:113-6. [PMID: 25959204 DOI: 10.1272/jnms.82.113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We describe the spontaneous rupture of a simple hepatic cyst. A 62-year-old woman was admitted for right upper quadrant pain of sudden onset. The patient denied a history of abdominal trauma. Computed tomography of the abdomen showed a 13-cm-diameter solitary hepatic cyst in the right lobe. Part of the cyst surface was irregular, and the internal echo was heterogeneous. Retained fluid was detected under the liver capsule. Ten days after admission, computed tomography revealed that the volume of fluid retained under the liver capsule had decreased but that the hepatic cyst had enlarged again. The patient was referred to our hospital for further evaluation and treatment. Physical examination revealed mild right upper quadrant pain, but no signs or symptoms of peritonitis or abnormalities of the chest or heart. Percutaneous puncture was performed with a needle and an 8-French pigtail catheter under ultrasonographic guidance. Brown serous fluid was aspirated. After the removal of approximately 1,000 mL of fluid, contrast medium was injected to check for communications between the cyst and the biliary tree and to document the absence of leakage into the peritoneal cavity. After complete aspiration of the cyst fluid, 200 mg of minocycline hydrochloride dissolved in 10 mL of saline was injected into the cyst, and the catheter was flushed with 10 mL of saline (total volume of saline, 20 mL). The catheter was then clamped for 30 minutes. After percutaneous aspiration, the patient's symptoms resolved. Minocycline hydrochloride was injected daily for 7 days, and the catheter was removed. There has been no evidence of recurrence after 2 years.
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Affiliation(s)
- Masahiro Hotta
- Department of Surgery, Nippon Medical School Tama Nagayama Hospital
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20
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Lee S, Seo DW, Paik WH, Park DH, Lee SS, Lee SK, Kim MH. Ethanol lavage of huge hepatic cysts by using EUS guidance and a percutaneous approach. Gastrointest Endosc 2014; 80:1014-21. [PMID: 24890421 DOI: 10.1016/j.gie.2014.03.037] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 03/21/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND EUS-guided and percutaneous lavage therapy for large hepatic cysts can replace surgical drainage. EUS-guided therapy can especially enable the alcohol lavage to be done with a 1-step approach. OBJECTIVE To evaluate the utility of EUS-guidance and percutaneous ethanol lavage therapy. DESIGN Retrospective cohort study. SETTING Tertiary-care referral teaching hospital. PATIENTS Adult patients with large liver cysts who underwent cyst drainage and alcohol ablation between 2009 and 2012. INTERVENTIONS Ethanol lavage via percutaneous and/or EUS-guided approaches. MAIN OUTCOME MEASUREMENTS Feasibility, efficacy, and safety of ethanol lavage. RESULTS Seventeen patients with 19 hepatic cysts were enrolled. The median cyst volume before therapy was 368.9 mL (interquartile range, 195.3-795.9 mL). Ten cysts were drained by the percutaneous approach with a pigtail catheter, and 8 cysts underwent EUS-guided aspiration and lavage treatment. In 1 case, both the percutaneous approach and EUS-guided puncture were used. During the median 11.5-month follow-up of the percutaneous approach group, the cysts showed 97.5% reduction. During the median 15-month follow-up of the EUS-guided group, the cysts showed nearly 100% reduction. Percutaneous catheter drainage ethanol lavage was more feasible for right-sided larger cysts, whereas the EUS-guided approach was useful for left-sided lobe cysts. LIMITATIONS Single-center retrospective study. CONCLUSION Excellent symptomatic and radiologic responses and long-term results were achieved with percutaneous catheter-guided and EUS-guided ethanol lavage. Ethanol lavage could be considered a primary method of treatment for hepatic cysts given its high degree of technical feasibility and safety.
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Affiliation(s)
- Seohyun Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Wan Seo
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Hyun Paik
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hyun Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Soo Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Koo Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myung-Hwan Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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21
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Casteleijn NF, Visser FW, Drenth JPH, Gevers TJG, Groen GJ, Hogan MC, Gansevoort RT. A stepwise approach for effective management of chronic pain in autosomal-dominant polycystic kidney disease. Nephrol Dial Transplant 2014; 29 Suppl 4:iv142-53. [PMID: 25165181 DOI: 10.1093/ndt/gfu073] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Chronic pain, defined as pain existing for >4-6 weeks, affects >60% of patients with autosomal-dominant polycystic disease (ADPKD). It can have various causes, indirectly or directly related to the increase in kidney and liver volume in these patients. Chronic pain in ADPKD patients is often severe, impacting physical activity and social relationships, and frequently difficult to manage. This review provides an overview of pathophysiological mechanisms that can lead to pain and discusses the sensory innervation of the kidneys and the upper abdominal organs, including the liver. In addition, the results of a systematic literature search of ADPKD-specific treatment options are presented. Based on pathophysiological knowledge and evidence derived from the literature an argumentative stepwise approach for effective management of chronic pain in ADPKD is proposed.
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Affiliation(s)
- Niek F Casteleijn
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Folkert W Visser
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Tom J G Gevers
- Department of Gastroenterology and Hepatology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Gerbrand J Groen
- Pain Centre, Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marie C Hogan
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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22
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Benzimra J, Ronot M, Fuks D, Abdel-Rehim M, Sibert A, Farges O, Vilgrain V. Hepatic cysts treated with percutaneous ethanol sclerotherapy: time to extend the indications to haemorrhagic cysts and polycystic liver disease. Eur Radiol 2014; 24:1030-8. [PMID: 24563160 DOI: 10.1007/s00330-014-3117-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/14/2014] [Accepted: 02/05/2014] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To describe the long-term clinical and morphological outcome of symptomatic hepatic cysts treated with percutaneous ethanol sclerotherapy (PES). METHODS From December 2003 to September 2011, all patients with hepatic cysts undergoing PES with a follow-up after 12 months were included. Evolution of the volume of the cysts and clinical and biological data were recorded. Features of the cyst were evaluated in each patient: simple, haemorrhagic or developed on underlying polycystic liver disease (PCLD). RESULTS Fifty-eight cysts (median volume 666 mL) were treated in 57 patients (52 women, mean age 58 years (18-80)). Twenty-two patients (39 %) had simple hepatic cysts, 19 (33 %) had dominant cysts on PCLD and 20 had haemorrhagic cysts (34.5 %), including 4 with PCLD. After a mean 27.3 months of follow-up, the final median cystic volume was 13.5 mL (p < 0.0001), and the median reduction in cyst volume was 94 % (58-100 %). Treatment was satisfactory in 95 % of the patients (54/57) (symptoms disappeared in 45/57 (79 %), decreased in 9/57 (16 %)). There was no clinical or morphological difference between patients with PCLD, haemorrhagic cysts or simple cysts. CONCLUSION The clinical and morphological efficacy of a single session of PES is very high, regardless of the presence of intracystic haemorrhage or underlying PCLD. KEY POINTS • The clinical efficacy of percutaneous ethanol sclerotherapy is very high. • Haemorrhagic content should not be a contraindication for percutaneous sclerotherapy. • Dominant cysts on polycystic liver disease should be treated with PES. • Imaging follow-up should not be performed shortly after the procedure.
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Affiliation(s)
- Julie Benzimra
- Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France
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CT Differentiation of Mucin-Producing Cystic Neoplasms of the Liver From Solitary Bile Duct Cysts. AJR Am J Roentgenol 2014; 202:83-91. [DOI: 10.2214/ajr.12.9170] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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24
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Maruyama Y, Okuda K, Ogata T, Yasunaga M, Ishikawa H, Hirakawa Y, Fukuyo K, Horiuchi H, Nakashima O, Kinoshita H. Perioperative challenges and surgical treatment of large simple, and infectious liver cyst - a 12-year experience. PLoS One 2013; 8:e76537. [PMID: 24098524 PMCID: PMC3788716 DOI: 10.1371/journal.pone.0076537] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 09/02/2013] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cystic lesions of the liver consist of a heterogeneous group of disorders that can present diagnostic and therapeutic challenges. METHODS A retrospective review of all medical records of adult patients diagnosed with large (>7 cm) cystic lesions of the liver between January 2000 and December 2011, at Kurume University Hospital. Cases with polycystic disease were excluded. RESULTS Twenty three patients were identified. The mean size was 13.9 cm (range, 7-22cm). The majority of simple cysts were found in women (females: males, 2: 21). In 19 patients, the cyst was removed surgically by wide deroofing (laparoscopically in 16 cases, combined with ethanol sclerotherapy in 13 cases). Infection of the liver cyst occurred in one patient, who later underwent central bi-segmentectomy. CONCLUSION Simple large cysts of the liver can be successfully treated by laparoscopic deroofing and alcohol sclerotherapy. Large hepatic cyst considered to need drainage should be removed surgically to avoid possible infection.
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Affiliation(s)
- Yuichiro Maruyama
- Department of Surgery, University School of Medicine, Kurume, Japan
- * E-mail:
| | - Koji Okuda
- Department of Surgery, University School of Medicine, Kurume, Japan
| | - Toshiro Ogata
- Department of Surgery, University School of Medicine, Kurume, Japan
| | | | - Hiroto Ishikawa
- Department of Surgery, University School of Medicine, Kurume, Japan
| | - Yusuke Hirakawa
- Department of Surgery, University School of Medicine, Kurume, Japan
| | - Kenjiro Fukuyo
- Department of Surgery, University School of Medicine, Kurume, Japan
| | | | - Osamu Nakashima
- Department of Pathology, University School of Medicine, Kurume, Japan
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25
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Law R, Leise MD, Baron TH. Transduodenal drainage of a malignant ovarian pseudocyst for palliation of gastroduodenal and biliary obstruction (with video). GASTROINTESTINAL INTERVENTION 2013. [DOI: 10.1016/j.gii.2013.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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26
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de Estrada J, Schumacher J. Treatment of an 18-year-old mare for bilateral, branchial remnant cysts. EQUINE VET EDUC 2013. [DOI: 10.1111/j.2042-3292.2012.00413.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Chaudhary S, Qian Q. Acute abdomen and ascites as presenting features of autosomal dominant polycystic kidney disease. World J Hepatol 2012; 4:394-8. [PMID: 23355918 PMCID: PMC3554804 DOI: 10.4254/wjh.v4.i12.394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 09/02/2012] [Accepted: 11/17/2012] [Indexed: 02/06/2023] Open
Abstract
We describe a patient with sudden onset of abdominal pain and ascites, leading to the diagnosis of autosomal dominant polycystic kidney disease (ADPKD). Her presentation was consistent with acute liver cyst rupture as the cause of her acute illness. A review of literature on polycystic liver disease in patients with ADPKD and current management strategies are presented. This case alerts physicians that ADPKD could occasionally present as an acute abdomen; cyst rupture related to ADPKD may be considered in the differential diagnoses of acute abdomen.
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Affiliation(s)
- Sanjay Chaudhary
- Sanjay Chaudhary, Qi Qian, Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, United States
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28
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Jairajpuri ZS, Jetley S, Hassan MJ, Hussain M. Hydatid disease in childhood: revisited report of an interesting case. J Parasit Dis 2012; 36:265-8. [PMID: 24082540 DOI: 10.1007/s12639-012-0127-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 05/26/2012] [Indexed: 10/28/2022] Open
Abstract
Hydatid disease is a zoonosis caused by the tapeworm of Echinococcus spp. The disease is widely endemic in many sheep and cattle rearing locales. However, hydatidosis does not remain restricted to endemic geographical locales anymore but rather is a global health concern. It is a major public health burden causing significant morbidity and mortality. Echinococcus granulosus involvement in children has a different pattern than adults. Children of all age groups are susceptible and localization of the disease in the lungs is more commonly seen. Multiple liver cysts in the paediatric age group is relatively uncommon. We report an interesting case of multiple liver cysts in a 5-year old boy which was diagnosed as hydatid cysts on histopathological examination.
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Affiliation(s)
- Zeeba Shamim Jairajpuri
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, Hamdard Nagar, New Delhi, 110062 India
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Hasegawa Y, Abo D, Sakuhara Y, Kato F, Kamishimma T, Shimizu T, Ito YM, Terae S, Shirato H. Usefulness of portography and contrast-enhanced computed tomography to predict the embolized area in percutaneous transhepatic portal vein embolization with absolute ethanol under temporary balloon occlusion. Jpn J Radiol 2011; 30:53-61. [PMID: 22135113 DOI: 10.1007/s11604-011-0008-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 08/03/2011] [Indexed: 01/10/2023]
Abstract
PURPOSE To assess the usefulness of portography and contrast-enhanced computed tomography (CECT) for predicting the embolized area after the first injection of absolute ethanol (AE) in right portal vein embolization (RPVE). MATERIALS AND METHODS Portograms were retrospectively reviewed in 50 patients (30 men and 20 women, mean age 65 years) who had undergone percutaneous transhepatic RPVE with AE under temporary balloon occlusion (TBO) between February 2002 and October 2009. The enhancement pattern before embolization and the embolization pattern after the first AE injection were analyzed by portography. The angles of portal branches against the horizontal plane were measured in 48 patients using pre-treatment CECT. RESULTS The enhancement pattern was not consistent with the embolization pattern in 35 patients (p < 0.001). When the anterior branch angles were divided into two groups at -5°, 0°, 10°, and 15°, the frequency of the posterior-branch-dominant embolization pattern was higher in the more negatively angled group (p = 0.002-0.041). CONCLUSION The distribution of AE is different from that of contrast medium in percutaneous transhepatic RPVE under TBO. The pre-treatment measurement of the angles of portal branches against the horizontal plane on CECT is suggested to be useful for predicting the embolized area.
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Affiliation(s)
- Yu Hasegawa
- Department of Radiology, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo 060-8638, Japan.
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Endoscopic ultrasound-guided injection therapy for hepatobiliary disease. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2011; 18:311-8. [DOI: 10.1007/s00534-010-0354-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Görtz RS, Amann K, Janka R, Neurath MF, Boxberger F. [Liver cysts - a distinct progressive form]. ACTA ACUST UNITED AC 2011; 105:959-60. [PMID: 21240598 DOI: 10.1007/s00063-010-1167-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Rüdiger S Görtz
- Medizinische Klinik 1, Universitätsklinikum Erlangen, Erlangen, Germany.
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Ueda J, Yoshida H, Taniai N, Mineta S, Kawano Y, Uchida E. A case of spontaneous rupture of a simple hepatic cyst. J NIPPON MED SCH 2010; 77:181-5. [PMID: 20610904 DOI: 10.1272/jnms.77.181] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We describe the spontaneous rupture of a simple hepatic cyst associated with a benign course. A 64-year-old woman was admitted for right upper quadrant pain. The patient denied a history of abdominal trauma. Abdominal computed tomography (CT) showed a huge solitary hepatic cyst (diameter, 10 cm) in the right lobe. Part of the cyst surface was irregular, and the interior was heterogeneous on ultrasonography. Fluid retention was detected under the liver capsule. Spontaneous rupture of a nonparasitic hepatic cyst was suspected. The patient was admitted to our hospital for further evaluation and treatment. Examination of the abdomen revealed right upper quadrant pain but no signs or symptoms of peritonitis. One week after admission, CT revealed that the volume of fluid retained under the liver capsule had decreased. Percutaneous puncture was performed with a needle and an 8-French pigtail catheter under ultrasonographic guidance. Serous, brown fluid was aspirated. After percutaneous aspiration, the patient's symptoms resolved. Minocycline hydrochloride was given daily by intravenous injection for 7 days. The catheter was then removed. There has been no evidence of recurrence after 1 year.
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Affiliation(s)
- Junji Ueda
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo, Japan.
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Differential diagnosis for intrahepatic biliary cystadenoma and hepatic simple cyst: significance of cystic fluid analysis and radiologic findings. J Clin Gastroenterol 2010; 44:289-93. [PMID: 19770676 DOI: 10.1097/mcg.0b013e3181b5c789] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
GOALS This study evaluated the significance of cystic fluid analysis and radiologic findings in the differential diagnosis of biliary cystadenomas (BCA) and hepatic simple cysts (HSCs). BACKGROUND BCA are premalignant lesions. The treatment of choice is surgical excision. It is important to differentiate BCA from HSCs because they have different clinical significances and treatment plans. However, it is difficult to preoperatively differentiate a BCA from a HSC. STUDY This retrospective study was done with 31 patients suffering from pathologically diagnosed BCA or HSC. All patients underwent surgery between May 1995 and June 2008 at a single institution and had cystic fluid analysis preoperatively or intraoperatively. RESULTS We discovered no statistically significant differences in cystic fluid carbohydrate antigen 19-9 (CA 19-9) levels or carcinoembryonic antigen levels when comparing BCA (n=17) and HSCs (n=14). BCA were significantly more frequently associated with female sex (17/17 vs. 10/14, P=0.032), presence of a septum (16/17 vs.5/14, P=0.001), and septal thickening (8/17 vs. 1/14, P=0.021). All 3 cases with calcifications belonged to the BCA group, but sample size was too small to demonstrate statistical significance. There were no statistically significant differences in other clinical and radiologic findings including age, presence of symptoms, serum tumor markers, serum chemistry, size, location, lobulation, septal enhancement, wall enhancement, wall thickening, mural nodule, or biliary dilatation. CONCLUSIONS Cystic fluid carbohydrate antigen 19-9 levels and carcinoembryonic antigen levels were not useful for differential diagnosis of BCA vs. HSC. BCA were more common than HSCs in females, patients with a septum, and patients with septal thickening.
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Qian Q. Isolated polycystic liver disease. Adv Chronic Kidney Dis 2010; 17:181-9. [PMID: 20219621 DOI: 10.1053/j.ackd.2009.12.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 12/31/2009] [Accepted: 12/31/2009] [Indexed: 12/11/2022]
Abstract
Isolated polycystic liver disease (PCLD) is an autosomal dominant disease with genetic and clinical heterogeneity. Apart from liver cysts, it exhibits few extrahepatic manifestations, and the majority of patients with this condition are asymptomatic or subclinical. However, a small fraction of these patients develop acute liver cyst-related complications and/or massive cystic liver enlargement, causing morbidity and mortality. Currently, the management for symptomatic PCLD is centered on palliating symptoms and treating complications.
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Advances in endoscopic ultrasound, part 2: Therapy. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2009; 23:691-8. [PMID: 19826645 DOI: 10.1155/2009/786212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Mazza OM, Fernandez DL, Pekolj J, Pfaffen G, Sanchez Clariá R, Molmenti EP, de Santibañes E. Management of Nonparasitic Hepatic Cysts. J Am Coll Surg 2009; 209:733-9. [DOI: 10.1016/j.jamcollsurg.2009.09.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 09/01/2009] [Accepted: 09/01/2009] [Indexed: 12/21/2022]
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Ho KY, Brugge WR. EUS 2008 Working Group document: evaluation of EUS-guided pancreatic-cyst ablation. Gastrointest Endosc 2009; 69:S22-7. [PMID: 19179162 DOI: 10.1016/j.gie.2008.10.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Accepted: 10/28/2008] [Indexed: 02/08/2023]
Affiliation(s)
- Khek-Yu Ho
- Department of Medicine, National University Hospital, Singapore
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Brugge WR. Management and outcomes of pancreatic cystic lesions. Dig Liver Dis 2008; 40:854-9. [PMID: 18502709 DOI: 10.1016/j.dld.2008.03.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 03/31/2008] [Indexed: 12/11/2022]
Abstract
The management of pancreatic cystic lesions offers a challenge to clinicians. Mucinous cystic lesions pose a low risk of the development of neoplasia that must be taken into account in long-term management. Although the natural history has not been well defined, it is likely that malignant change in the mucinous epithelium takes place over years, very similar to what is observed with Barrett's esophagus. The traditional therapy of mucinous cystic lesions has been surgical resection. Lesions in the head of the pancreas will require a Whipple resection whereas tail lesions are managed with a distal pancreatectomy and splenectomy. In patients at high risk for surgical resection, the risk/benefit ratio may be excessively high, not supporting the use of resection therapy. Ethanol ablation therapy has been thoroughly studied in hepatic, renal, and thyroid cysts. Epithelial ablation with ethanol appears to be highly effective and relatively safe. Recently, ethanol ablation has been evaluated in pancreatic cystic neoplasms. In macrocystic lesions between 1 and 5 cm, ethanol lavage will result in epithelial ablation and cyst resolution in a high percentage of patients. Pancreatitis is rarely observed clinically and is not present in resection specimens. A randomised prospective clinical trial is currently underway.
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Affiliation(s)
- W R Brugge
- GI Unit Blake 4, Massachusetts General Hospital, Boston, MA, United States.
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Yanai H, Tada N. A simple hepatic cyst with elevated serum and cyst fluid CA19-9 levels: a case report. J Med Case Rep 2008; 2:329. [PMID: 18851758 PMCID: PMC2572621 DOI: 10.1186/1752-1947-2-329] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Accepted: 10/14/2008] [Indexed: 12/14/2022] Open
Abstract
Introduction Simple hepatic cysts rarely cause symptoms, however, occasionally they become symptomatic due to mass effect, rupture, hemorrhage, and infection. We report a patient with a large hepatic cyst with elevated serum and cyst fluid CA19-9 levels. We studied serum and cyst fluid CA19-9 levels in this patient, before and after the intracystic instillation of minocycline hydrochloride. Case presentation A 76-year-old Japanese woman was diagnosed as having an infected hepatic cyst, by physical examination and enhanced abdominal computed tomography. Serum (170 U/ml; reference: < 37 U/ml) and hepatic cyst fluid (371 U/ml) CA19-9 levels were elevated. After the intracystic instillation of minocycline hydrochloride, necrotic cells in the cyst were drained, and it totally collapsed after 1 week. Cyst fluid CA19-9 levels increased remarkably after the intracystic instillation of minocycline hydrochloride, while serum CA19-9 levels decreased significantly. Conclusion Our study is the first report to reveal the influence of intracystic instillation of minocycline hydrochloride on serum and cyst fluid CA19-9 levels in a patient with a simple hepatic cyst.
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Affiliation(s)
- Hidekatsu Yanai
- Department of Internal Medicine, Division of General Medicine, Kashiwa Hospital, The Jikei University School of Medicine, Kashiwashita, Kashiwa, Chiba, Japan.
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Lee SS, Shin JH, Woo CW, Hwang JC, Park CS, Kim HJ, Kim EY, Kim TH, Song HY. A New Model of Tracheal Stenosis in Dogs Using Combined Bronchoscopic Electrocautery and Ethanol Injection. J Vasc Interv Radiol 2008; 19:764-9. [DOI: 10.1016/j.jvir.2008.01.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Revised: 01/25/2008] [Accepted: 01/28/2008] [Indexed: 11/29/2022] Open
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Diffusion-weighted imaging in the differential diagnosis of simple and hydatid cysts of the liver. AJR Am J Roentgenol 2007; 189:1031-6. [PMID: 17954636 DOI: 10.2214/ajr.07.2251] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of our study was to evaluate the value of diffusion-weighted imaging (DWI) in the differential diagnosis of simple and hydatid cysts of the liver, particularly in the completely liquid type of hydatid cyst. SUBJECTS AND METHODS Eighty-two cysts (43 simple cysts, 39 hydatid cysts) were included in this prospective study. DWI was performed using a breath-hold single-shot echo-planar spin-echo sequence, and apparent diffusion coefficients (ADCs) were calculated. On DW trace images, the signal intensity of cysts was visually compared with the signal intensity of the liver using a 3-point scale: 0, isointense; 1, moderately hyperintense; and 2, significantly hyperintense. Quantitatively, signal intensity of the cysts, cyst-to-liver signal intensity ratios, ADC of the cysts, and cyst-to-liver ADC ratios were compared between the groups. The statistical significance was determined using the Mann-Whitney U test. RESULTS On trace DWI (b = 1,000 s/mm2), most hydatid cysts (37/39, 95%) were hyperintense, whereas most simple cysts (40/43, 93%) were isointense with the liver. Three simple cysts (7%) were moderately hyperintense and two hydatid cysts (5%) were isointense. Quantitatively, both the signal intensity and cyst-to-liver signal intensity ratio of the hydatid cysts were significantly higher than those for simple cysts (p < 0.001). The cutoff value at 1.5 yielded a sensitivity of 77%, a specificity of 86%, and positive predictive value of 83% for the cyst-to-liver signal intensity ratio. The ADC and cyst-to-liver ADC ratio of the hydatid cysts were significantly lower than those of simple cysts (p < 0.005). For the completely liquid type in particular, we observed statistically significant differences in signal intensity, signal intensity ratio, ADC, and ADC ratios from those of simple cysts (p < 0.005). With a cutoff value of 1.5, signal intensity ratio had a sensitivity of 81%, specificity of 86%, and positive predictive value of 74%. CONCLUSION DWI may help in the differential diagnosis of hydatid and simple cysts of the liver.
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Zerem E, Imamović G, Omerović S. Percutaneous treatment of symptomatic non-parasitic benign liver cysts: single-session alcohol sclerotherapy versus prolonged catheter drainage with negative pressure. Eur Radiol 2007; 18:400-6. [PMID: 17899104 DOI: 10.1007/s00330-007-0760-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Revised: 07/21/2007] [Accepted: 08/27/2007] [Indexed: 12/26/2022]
Abstract
To evaluate whether prolonged catheter drainage with negative pressure yields better results than single-session alcohol sclerotherapy in the treatment of symptomatic non-parasitic benign liver cysts. Forty patients were randomly assigned to two groups in a 24-month prospective controlled trial. One group was treated with ultrasound-guided prolonged catheter drainage with negative pressure (20 patients with 24 cysts) and the other group with single-session alcohol sclerotherapy (20 patients with 23 cysts). Patient demographics, clinical characteristics, treatment outcome, and complications were analyzed. The median volumes and 95% CI (confidence interval) for the medians and interquartile ranges of all 47 cysts before treatment and on last follow-up were: 389 ml, 143-1,127 ml, 136-1,300 ml, and 0 ml, 0-10 ml, and 0-23 ml, respectively (P<0.0001). The average volume reduction was 92.4% (range, 74.9-100%), 94.2 % (range, 74.9-100%) in the drainage and 90.2% (range, 76.9-100%) in the sclerotherapy group. Twenty-seven cysts (57.4%) disappeared completely, 16 (66.7%) in the drainage and 11 (47.8%) in the sclerotherapy group. No differences in average volume reduction, final volume and disappearance of the cysts between the groups were noted. The hospital stay was 1 day for all patients. Percutaneous treatment is safe and effective for hepatic non-parasitic cysts. Prolonged catheter drainage with negative pressure and single-session alcohol sclerotherapy had similar results.
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Affiliation(s)
- Enver Zerem
- University Medical Center, 75 000 Tuzla, Bosnia and Herzegovina.
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Naik MN, Honavar SG, Murthy RK, Raizada K, Thomas R. Ethanolamine Oleate Sclerotherapy Versus Simple Cyst Aspiration in the Management of Orbitopalpebral Cyst Associated With Congenital Microphthalmos. Ophthalmic Plast Reconstr Surg 2007; 23:307-11. [PMID: 17667104 DOI: 10.1097/iop.0b013e3180987243] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the efficacy of ethanolamine oleate (EO) sclerotherapy in the management of orbitopalpebral cysts associated with congenital microphthalmos, and compare it with simple cyst aspiration. METHODS Retrospective, interventional comparative case series of 12 orbitopalpebral cysts of 8 patients associated with congenital microphthalmos. Five cysts were treated with simple aspiration and 7 cysts with EO sclerotherapy. Cyst resolution was the main outcome measure. RESULTS Five cysts underwent aspiration alone at a median age of 12 weeks. One (20%; 95% CI, 0%-55.1%) of these 5 showed complete resolution. Seven cysts (6 patients) underwent aspiration combined with EO sclerotherapy at a median age of 30 weeks (3 had recurred following prior cyst aspiration). Postsclerotherapy, 6 eyes (85.7%; 95% CI, 59.8%-100%) showed complete cyst resolution (p = 0.072, Fisher exact test). The mean follow-up was 8.8 months (range, 3-23 months). In the EO group, 1 cyst (14.3%) required repeat sclerotherapy and another cyst showed partial resolution at 6 weeks. The number needed to treat with sclerotherapy to prevent 1 recurrence was 2 (1-5, 95% CI). No procedure-related complications were noted. CONCLUSIONS Simple aspiration of orbitopalpebral cyst is associated with a high recurrence rate and should be reserved for early prognostication of visual potential in the microphthalmic eye. Minimally invasive EO sclerotherapy provides a rapid, effective, and uncomplicated treatment modality for definitive therapy, and should be preferred in cases with no visual prognosis in the microphthalmic eye demonstrating adequate bony orbital expansion.
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Affiliation(s)
- Milind N Naik
- Ophthalmic Plastic Surgery Service, LV Prasad Eye Institute, Hyderabad, India.
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Torres VE. Treatment of polycystic liver disease: one size does not fit all. Am J Kidney Dis 2007; 49:725-8. [PMID: 17533013 DOI: 10.1053/j.ajkd.2007.04.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Accepted: 04/18/2007] [Indexed: 02/08/2023]
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