J Yeungnam Med Sci.  2022 Jul;39(3):250-255. 10.12701/yujm.2021.01256.

Pedunculated mucinous cystic neoplasm of the liver: a case report

• Ha SW
• Hwang S
• Han H
• Han SI
• Hong SM

• KMID: 2532079
• DOI: http://doi.org/10.12701/yujm.2021.01256

Abstract

In 2010, the World Health Organization classified mucin-producing bile duct tumors of the liver into two distinct entities; mucinous cystic neoplasm of the liver (MCN-L) and intraductal papillary mucinous neoplasm of the bile duct. We present the case of a patient with MCN-L having a uniquely pedunculated shape. A 32‐year‐old woman was referred to our institution with a diagnosis of biliary cystic neoplasm. She had undergone left salpingo-oophorectomy for ovarian cancer 15 years ago. Imaging studies showed an 8 cm-sized well defined, multiloculated cystic lesion suggesting a mucinous cystic neoplasm. The cystic mass was pedunculated at the liver capsule and pathologically diagnosed as MCN-L. The mass was resected with partial hepatectomy. The patient recovered uneventfully. She was discharged 7 days postoperatively. The patient has been doing well for 6 months after the operation. The patient will be followed up annually because of the favorable postresection prognosis of MCN-L.

Keyword

Cystic neoplasm; Intraductal papillary neoplasm; Mucins; Ovarian-like stroma; WHO classification

Figure

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  Fig. 1. Preoperative computed tomography showing an 8 cm-sized well defined, multiloculated cystic lesion. There is some high attenuation portion within the cystic lesion indicating hemorrhage (arrows) in (A, C) the arterial phase and (B, D) portal phase images. Diffuse fatty liver is present.

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  Fig. 2. Fluorodeoxyglucose positron emission tomography showing an 8 cm-sized metabolic defect in the right liver (arrow).

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  Fig. 3. Intraoperative findings. (A) There are noticeable adhesions around the cystic mass in the right liver dome. (B) The cystic mass is pedunculated at the liver capsule. (C) The mass is delivered after partial hepatectomy at the pedunculated neck portion. (D) A cast-like depression is left at the liver parenchyma.

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  Fig. 4. Gross photographs of the resected specimen. (A) External shape and (B) internal morphology of the cystic mass are visible. The cystic lesion of 8×6×4 cm is multiloculated and filled with mucinous fluid. Arrow indicates the resected liver parenchyma attached to the neck portion. Arrowhead indicates the focal luminal thickening suggestive of resolved hematoma.

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  Fig. 5. Microscopic findings. (A) The cyst is lined by tall columnar tumor cells having intracytoplasmic mucin and elongated nuclei with mild cytologic atypia (hematoxylin and eosin stain, ×200). (B) The subepithelial ovarian-type stromal cells are diffusely positive for estrogen receptor (immunohistochemical stain, ×200).

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  Fig. 6. Computed tomography at 5 days after the operation showing usual postoperative findings. (A) Fluid collection is identified at the site of mass. (B) Multiple metal clips indicate the site of pedunculated neck portion.

Reference

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