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2013, Number 6

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Ann Hepatol 2013; 12 (6)

Giant biliary mucinous cystadenoma of the liver

Grubor NM, Colovic RB, Atkinson HD, Micev MT

Language: English
References: 40
Page: 979-983
PDF size: 243.92 Kb.


ABSTRACT

Biliary mucinous cystadenomas (BMC) of the liver are rare benign cystic tumors, however an estimated 20% undergo malignant transformation. They have recently been redefined as mucinous cystic neoplasms in the 2010 WHO classification. The preferred treatment is through radical resection, as there are high recurrence rates with other treatment modalities; however this is often not possible in patients with bilobar or giant cysts, and liver transplantation may be indicated. We present a patient with a giant biliary mucinous cystadenoma of the liver and discuss the management with reference to the literature. A 47 year-old woman presented with a 6-week history of moderate epigastric discomfort on a background of 12 months of symptom-free abdominal distension. A giant cystic bilobar tumor of the liver measuring 22 x 23 x 17 cm was diagnosed and characterised by ultrasound scan and magnetic resonance imaging. Serum bilirubin, alkaline phosphatase and gamma-glutamyl transpeptidase were elevated, though other laboratory data including tumor markers (CEA, aFP, CA19-9) were within normal limits. Total excision of the cyst was not possible due to its size and position, and the patient underwent cyst drainage, a sub-total cyst excision and omentoplasty. Histology confirmed a benign biliary mucinous cystadenoma with an ovarian stroma. Though the patient remained clinically well, routine post-operative computed tomography (CT) surveillance showed an 11 cm recurrent cyst at 6 months. A partial cyst resection with close follow-up, regular CA19-9 serology and ultrasound/CT imaging, may be a reasonable alternative for bilobar or giant cysts. However should any features pathognomonic of malignancy develop, then a liver transplantation is indicated.


REFERENCES

  1. Ishak KG, Willis GW, Cummins SD, Bullock AA. Biliary cystadenoma and cystadenocarcinoma: report of 14 cases and review of the literature. Cancer 1977; 39: 322-38.

  2. Cahill CJ, Bailey ME. Biliary cystadenoma. Am J Roentgenol 1983; 140: 630.

  3. Kim K, Choi J, Park Y, Lee W, Kim B. Biliary cystadenoma of the liver. J Hepatobiliary Pancreat Surg 1998; 5: 348-52.

  4. Kazama S, Hiramatsu T, Kuriyama S, Kuriki K, Kobayashi R, Takabayashi N, Furukawa K, et al. Giant intrahepatic biliary cystadenoma in a male: a case report, immunohistopathological analysis, and review of the literature. Dig Dis Sci 2005; 50: 1384-9.

  5. Farges O, Menu Y, Benhamou JP. Non-parasitic cystic diseases of the liver and intrahepatic biliary tree. In: Blumgart LH (ed.). London: WB Saunders Company Ltd; 2000, p. 1249-50.

  6. Short WF, Nedwich A, Levy HA, Howard JM. Biliary cystadenoma. Report of a case and review of the literature. Arch Surg 1971; 102: 78-80.

  7. Devaney K, Goodman ZD, Ishak KG. Hepatobiliary cystadenoma and cystadenocarcinoma. A light microscopic and immunohistochemical study of 70 patients. Am J Surg Pathol 1994; 18: 1078-91.

  8. Wheeler DA, Edmondson HA. Cystadenoma with mesenchymal stroma (CMS) in the liver and bile ducts. A clinicopathologic study of 17 cases, 4 with malignant change. Cancer 1985; 56: 1434-45.

  9. Akwari OE, Tucker A, Seigler HF, Itani KM. Hepatobiliary cystadenoma with mesenchymal stroma. Ann Surg 1990; 211: 18-27.

  10. Florman SS, Slakey DP. Giant biliary cystadenoma: case report and literature review. Am Surg 2001; 67: 727-32.

  11. Keech MK. Cystadenomata of the pancreas and intrahepatic bile ducts. Gastroenterology 1951; 19: 568-74.

  12. Tsui WMS, Adsay NV, Crawford JM. Mucinous cystic neoplasms of the liver. In: Bosman FT, Carneiro F, Hruban RH, Theise ND (eds). World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Digestive System. Lyon: IARC Press; 2010, p. 236–238.

  13. Marcial MA, Hauser SC, Cibas ES, Braver J. Intrahepatic biliary cystadenoma. Clinical, radiological, and pathological findings. Dig Dis Sci 1986; 31: 884-8.

  14. Karak PK, Karak AK, Singh SP, Mukaopadhyay S, Berry M. Biliary cystadenoma mistaken as hydatid cyst. Trop Gastroenterol 1993; 14: 109-13.

  15. van Roekel V, Marx WJ, Baskin W, Greenlaw RL. Cystadenoma of the liver. J Clin Gastroenterol 1982; 4: 167-72.

  16. Manouras A, Lagoudianakis E, Alevizos L, Markogiannakis H, Kafiri G, Bramis C, Filis K. et al. Laparoscopic fenestration of multiple giant biliary mucinous cystadenomas of the liver. World J Gastroenterol 2008; 14: 4257-9.

  17. Stanley J, Vujic I, Schabel SI, Gobien RP, Reines HD. Evaluation of biliary cystadenoma and cystadenocarcinoma. Gastrointest Radiol 1983; 8: 245-8.

  18. Lind DS, Adolph V, Parker GA. Mucinous biliary cystadenoma: a case report and review of the literature. J Surg Oncol 1992; 51: 207-10.

  19. Beuran M, Venter MD, Dumitru L. Large mucinous biliary cystadenoma with “ovarian-like” stroma: a case report. World J Gastroenterol 2006; 12: 3779-81.

  20. Zhou JP, Dong M, Zhang Y, Kong FM, Guo KJ, Tian YL. Giant mucinous biliary cystadenoma: a case report. Hepatobiliary Pancreat Dis Int 2007; 6: 101-3.

  21. Del Poggio P, Jamoletti C, Forloni B, De Benedictis R, Mattiello M, Corti D, Pezzica E. Malignant transformation of biliary cystadenoma: a difficult diagnosis. Dig Liver Dis 2000; 32: 733-6.

  22. Hanazaki K. Intrahepatic biliary cystadenoma demonstrated by intraoperative cholangiography. Hepatogastroenterology 1996; 43: 1024-8.

  23. Catinis GE, Frey DJ, Skinner JW, Balart LA. Hepatic cystadenoma: an unusual presentation. Am J Gastroenterol 1998; 93: 827-9.

  24. Wee A, Nilsson B, Kang JY, Tan LK, Rauff A. Biliary cystadenocarcinoma arising in a cystadenoma. Report of a case diagnosed by fine needle aspiration cytology. Acta Cytol 1993; 37: 966-70.

  25. Colovic R, Grubor N, Micev M, Colovic N. Biliary mucinous cystadenoma of the liver with focal malignant alteration. Srp Arh Celok Lek 2005; 133: 65-8.

  26. Nakajima T, Sugano I, Matsuzaki O, Nagao K, Kondo Y, Miyazaki M, Wada K. Biliary cystadenocarcinoma of the liver. A clinicopathologic and histochemical evaluation of nine cases. Cancer 1992; 69: 2426-32.

  27. Woods GL. Biliary cystadenocarcinoma: case report of hepatic malignancy origination in benign cystadenoma. Cancer 1981; 47: 2936-40.

  28. Palacios E, Shannon M, Solomon C, Guzman M. Biliary cystadenoma: ultrasound, CT, and MRI. Gastrointest Radiol 1990; 15: 313-6.

  29. Choi BI, Lim JH, Han MC, Lee DH, Kim SH, Kim YI, Kim CW. Biliary cystadenoma and cystadenocarcinoma: CT and sonographic findings. Radiology 1989; 171: 57-61.

  30. Hagiwara A, Inoue Y, Shutoh T, Kinoshita H, Wakasa K. Haemorrhagic hepatic cyst: a differential diagnosis of cystic tumour. Br J Radiol 2001; 74: 270-2.

  31. Lewis WD, Jenkins RL, Rossi RL, Munson L, ReMine SG, Cady B, Braasch JW, et al. Surgical treatment of biliary cystadenoma. A report of 15 cases. Arch Surg 1988; 123: 563-8.

  32. Scott FR, More L, Dhillon AP. Hepatobiliary cystadenoma with mesenchymal stroma: expression of oestrogen receptors in formalin-fixed tissue. Histopathology 1995; 26: 555-8.

  33. Kokubo T, Itai Y, Ohtomo K, Itoh K, Kawauchi N, Minami M. Mucin-hypersecreting intrahepatic biliary neoplasms. Radiology 1988; 168: 609-14.

  34. Knott AW, Ampudia RJ, Evankovich C, Teplick SK, Herrera JL, Tucker JA Jr., Rodning CB. Biliary cystadenoma: rare variant of intrahepatic cystic disease. South Med J 2000; 93: 698-702.

  35. Henson SW Jr., Gray HK, Dockerty MB. Benign tumors of the liver. VI. Multilocular cystadenomas. Surg Gynecol Obstet 1957; 104: 551-4.

  36. Sanchez H, Gagner M, Rossi RL, Jenkins RL, Lewis WD, Munson JL, Braasch JW. Surgical management of nonparasitic cystic liver disease. Am J Surg 1991; 161: 113-8.

  37. Davies W, Chow M, Nagorney D. Extrahepatic biliary cystadenomas and cystadenocarcinoma. Report of seven cases and review of the literature. Ann Surg 1995; 222: 619-25.

  38. Thomas KT, Welch D, Trueblood A, Sulur P, Wise P, Gorden DL, Chari RS, et al. Effective treatment of biliary cystadenoma. Ann Surg 2005; 241: 769-73.

  39. Madariaga JR, Iwatsuki S, Starzl TE, Todo S, Selby R, Zetti G. Hepatic resection for cystic lesions of the liver. Ann Surg 1993; 218: 610-4.

  40. Romagnoli R, Patrono D, Paraluppi G, David E, Tandoi F, Strignano P, Lupo F, et al. Liver transplantation for symptomatic centrohepatic biliary cystadenoma. Clin Res Hepatol Gastroenterol 2011; 35: 408-13.




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