A HEPATIC CYST! IS THIS ALWAYS A TRIVIAL DIAGNOSIS?
Ninos Anestis, Papaevangelou Ageliki³, Dimopoulou Ekaterini², Papakonstantinou Eleni², Douridas Gerasimos, Maletsikopoulos Stavros,
Vidali Maria, Pougouras Ioannis, Iordanou Christos, Antonakas Panagiotis, Farazi Christos, Papandrikos John, Pierrakakis Stefanos
Thriassion General Hospital, Department of Surgery
²Department of Pathology, ³Radiology Department
We present a case of a hepatic biliary cystadenoma, focusing on its distinct
characteristics which can differentiate it from other benign lesions
CT showing a complex cyst and a cholangiography revealing a small bile leak
Although very rare (200 cases reported in the literature), hepatic
biliary cystadenomas must be included in the differential
diagnosis of a complex cystic mass, as this premalignant entity
needs excision even when it is asymptomatic. Excision or
unroofing of such complex lesions is mandatory, as pathological
examination can only provide definitive diagnosis
A 35-year-old woman presented in our
accident and emergency department with
abdominal pain of sudden onset. On clinical
examination there were signs of diffuse
peritonitis together with a palpable epigastric
mass. Abdominal CT revealed free
intraperitoneal fluid and a multiloculated
cystic hepatic mass in its quadrate lobe. An
urgent laparotomy was performed with a
presumptive diagnosis of a ruptured hydatid
cyst. Intraoperative findings included a
perforated duodenal ulcer and a large
multiloculated intact hepatic cyst. After
closing the perforation, an unroofing of the
mass was performed. Because a direct biliary
communication was found, a cholocystectomy
was done and a T-tube was placed in the
CBD. The biliary communication was sealed
with a fine absorbable suture.
Histological examination concluded that the
cyst was a hepatic cystadenoma.
Retrospective study of CT films revealed a
multiloculated mass with a regular thin wall
and fine intracystic septa, compatible with
the definitive pathologic diagnosis.
Postoperative cholangiography showed a
normal intahepatic tree and excluded the
rarer intraductal papillary neoplasm with
cystic dilatation.