Case report

A 26-year-old female with a recurrent hepatic cyst and persistent abdominal pain had undergone two previous surgical interventions due to the cyst. Laboratory findings showed an increased level of CA 19-9 (94.6 U/ml); the rest of parameters, including liver function tests and blood count, were within the normal limits. An abdominal computed tomography (CT) scan revealed a hepatic cystic lesion of 176 x 297 x 208 mm in the left hepatic lobe, with an irregular and thickened wall and the presence of internal septa.

The patient underwent a left hemihepatectomy with the following intraoperatory findings: hepatic cyst which involved the II, III and IV segments. The histopathological study reported a hepatobiliary cystadenoma with mucinous epithelium and the presence of ovarian-like stroma. The patient was discharged three days after surgery.

Fig. 1 A. CT scan showing a hepatic cyst measuring 176 x 297 x 208 mm in the left hepatic lobe with internal septa and a thickened wall. B. Microscopic view of hepatobiliary cystadenoma. The image shows the epithelium with a mucinoid appearance and stroma with submucosal increased cellularity that resemble ovarian stroma. 

Discussion

Due to the initial suspicion, it was possible to establish the recommended treatment, which resulted in a remission of the symptoms and a recurrence free period of 12 months. Thus, this diagnosis must be taken into account in any patient with a recurrent hepatic cyst after surgical treatment. An imaging test, preferably a CT or magnetic resonance imaging (MRI), should be performed not only for their diagnostic value but also to aid the surgical plan. We also recommend to routinely measure CA 19-9 levels as this has been shown to be a valuable marker for the differential diagnosis with other hepatic cystic lesions.