LETTERS TO THE EDITOR

 

Mucinous hepatic cystic neoplasm: An uncommon cystic lesion in the liver

Neoplasia quística mucinosa hepática: lesión quística poco frecuente en el hígado

 

 

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Key words: Hepatic cystic neoplasm. Mucinous neoplasm. Hepatic cystoadenoma.

Palabras clave: Neoplasia quística hepática. Neoplasia mucinosa. Cistoadenoma hepático.

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Dear Editor,

Hepatic cystic lesions are a heterogeneous group of diseases with different etiology, clinical manifestations and treatment. Non-invasive mucinous cystic neoplasm, previously referred to as cystoadenoma, is a benign lesion and usually an incidental finding. Due to its propensity for local recurrence as well as its malignant transformation, the treatment of choice should be surgical (1-3).

 

Case report

A 78-years-old man with an incidental solitary 9 cm segment-V-cystic hepatic neoplasm, during follow-up of bladder cancer. Hematological investigations including hydatidic serology and tumor markers were unremarkable. With the diagnosis of cystic lesion of the liver, we performed a hepatic resection with no complications and the patient was discharged on the third day. Histological study confirmed a non-invasive mucinous hepatic cystic neoplasm. There is no recurrence 12 months after surgery.

 

Discussion

Cystic hepatic neoplasms only constitute 5% of cystic lesions, but its frequency is increasing because of advances in abdominal imaging. These include the benign cystoadenoma, now referred to as non invasive hepatic mucinous neoplasm, and cystoadenocarcinoma, a malignant lesion called invasive hepatic mucinous neoplasm (1).

Cystoadenoma occurs mainly within the liver parenchyma (80-90%), with predominance for the right lobe (55%), although they have also been described in the extrahepatic biliary tree and the gallbladder (4). Regarding to clinical manifestations, many patients are asymptomatic and the lesions are found incidentally. Most commonly, symptoms include pain and sensation of an upper abdominal mass. Unusual presentation includes jaundice, cholangitis, intraperitoneal rupture, intracystic hemorrhage or compression of portal vein, among others (5). Preoperative imaging studies are the key to diagnosis in the evaluation of cystic hepatic mass, which differential diagnosis includes simple cysts, echinococcal cysts, liver abscesses, cystic degeneration of a liver neoplasm and liver metastases (5). Ultrasonography and abdominal CT are the most common imaging studies. On a CT scan, this tumor appears as a multilocular mass with septations, intracystic projections and an irregular wall, and this study is also needed for the evaluation of anatomic relations (6); however, it is difficult to make a definitive diagnosis preoperatively (2,7). Histological examination, usually obtained after resection, is essential for definitive diagnosis because it is the only way to differentiate between benign and malignant lesions.

The management is totally different from that of the other non neoplasic cysts. Treatment of non invasive mucinous hepatic neoplasm must be surgical whenever possible, due to the potential malignant degeneration of these lesions, which has been described in as many as 15% of patients (3). Regarding to the surgical technique, it should be personalized taking into account the placement of the tumor and the patient. Partial excision has worse prognosis for recurrence. If invasive carcinoma was suspected, treatment should consist of a formal liver resection, with 1 cm margins. The results of no surgical treatment are still unknown (5). The prognosis after complete removal of a cystoadenoma is excellent, with prolonged survival (1,2).

 

 

Alba Manuel-Vázquez and Sagrario Fuerte-Ruiz
General and Digestive Surgery Department.
University Hospital of Getafe. Getafe, Madrid. Spain

 

References

1. Teoh AY, Ng SS, Lee KF, et al. Biliary cystoadenoma and other complicated cystic lesions of the liver: Diagnostic and therapeutic challenges. World J Surg 2006;30:1560-6. DOI: 10.1007/s00268-005-0461-7.         [ Links ]

2. Williamsion JM, Rees JR, Pope I, et al. Hepatobiliary cystadenomas. Ann R Coll Surg Engl 2013;95:507-10. DOI: 10.1308/003588413X13629960046633.         [ Links ]

3. Regev A, Reddy KR, Berho M, et al. Large cystic lesions of the liver in adults: A 15-year experience in a tertiary center. J Am Coll Surg 2001;193:36-45. DOI: 10.1016/S1072-7515(01)00865-1.         [ Links ]

4. Ishak KG, Willis GW, Cummins SD, et al. Biliary cystoadenoma and cyst adenocarcinoma: Report of 14 cases and review of the literature. Cancer 1977;39:322-38. DOI: 10.1002/1097-0142(197701)39:1<322::AID-CNCR2820390149>3.0.CO;2-P.         [ Links ]

5. Vogt DP, Henderson JM, Chmielewski E. Cystoadenoma and cystoadenocarcinoma of the liver: A single case center experience. J Am Coll Surg 2005;200:727-33. DOI: 10.1016/j.jamcollsurg.2005.01.005.         [ Links ]

6. Korobkin M., Stephens DH, Lee JK, et al. Biliary cystoadenoma and cystoadenocarcinoma: CT and sonographic findings. AJR Am J Roentgenol 1989;153:507-11 DOI: 10.2214/ajr.153.3.507.         [ Links ]

7. Hai S, Hirohashi K, Uenishi T, et al. Surgical management of cystic hepatic neoplasms. J Gastroenterol 2003;38:759-64. DOI: 10.1007/s00535-003-1142-7.         [ Links ]