Ann Hepatobiliary Pancreat Surg.  2020 Feb;24(1):85-89. 10.14701/ahbps.2020.24.1.85.

Biliary cystadenoma in an endemic zone of hydatid cyst: A rare surgical surprise

• Ramavath K
• Kaman L
• Gupta A
• Singh A
• Das A

• KMID: 2471195
• DOI: http://doi.org/10.14701/ahbps.2020.24.1.85

Abstract

The advancement of radiological investigations has led to the early and incidental detection of hepatic cystic lesions. These are most commonly the simple cysts but can be malignant as well. Despite the recent advances, these lesions still pose a diagnostic as well as therapeutic challenge. The biliary cystadenomas and carcinomas form around 5% of all the malignant cystic lesions of liver. These lesions are hardly diagnosed preoperatively and are usually a histopathological surprise. They warrant a surgical excision. Herewith, the authors are describing a case of cystic hepatic neoplasm initially misdiagnosed as hydatid cyst of liver and discovered to be a vascular cystic lesion intraoperatively. This patient underwent resection of the lesion and was discovered to harbour biliary cystadenoma on histopathological specimen.

Keyword

Biliary cystadenoma; Cystadenocarcinoma; Hydatid cyst of liver

MeSH Terms

Cystadenocarcinoma
Cystadenoma*
Echinococcosis*
Humans
Liver
Liver Neoplasms

Figure

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  Fig. 1 Multiloculated hypodense lesion (9 to 50 HU) with with multiple thick septae seen in segment IV A, IV B and V. The lesion is abutting the anterior abdominal wall anteriorly, medially it is abutting the psoas muscle and IVC and displacing few small bowel loops. It is also abutting the antropyloric region of stomach and duodenum and also displacing head of pancreas.

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  Fig. 2 (A) Resected gross specimen of ~18×16×9 cm with bosselated surface containing multiple cysts. (B) Cut section of whole specimen containing multiple cystic lesions. Luminal aspect of the cyst was smooth and contains mucinous fluid.

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  Fig. 3 Histopathology report: multiloculated cyst contains variable size of cystic spaces lined by mucinous epithelium, at places it is replaced by macrophages sheets. It contains fibrous septae, fibrocollagenous tissue and moderate degree of lymphocytes rich chronic inflammation with lymphoid aggregates. Many proliferating vascular and lymphatic channels are also seen. There was no evidence of ovarian stroma. No neoplastic cells were seen. Overall features of biliary cyst adenoma without ovarian stroma.

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