Nonparasitic hepatic cysts constitute a heterogeneous group of disorders. " proper diagnosis of hepatic cyst is necessary in order to adopt the best treatment. The term hepatic cyst usually refers to simple hepatic cysts. Nonparasitic hepatic cysts are also linked to genetic disorders such as polycystic liver disease PLD with/ without autosomal dominant polycystic kidney disease "DPKD or Caroli disease.Generally, patients with nonparasitic hepatic cysts less than cm are asymptomatic. These cysts become symptomatic when are large, multiple, or complicated.Percutaneous abdominal ultrasound is the best imaging modality to diagnose hepatic cysts but must be completed by other imaging and serological tests. It is important to differentiate simple hepatic cyst from hydatid cyst, cystadenoma, and cystadenocarcinoma before proceeding with the treatment. Sometimes the diagnosis is very challenging. "symptomatic single liver cysts need only surveillance, but symptomatic and complicated ones require therapeutic intervention.Percutaneous aspiration of the cyst under ultrasound guidance is a mini-invasive procedure generally associated with sclerotherapy. The highest success rates were reported for laparoscopic or open cyst fenestration. Liver transplantation is indicated for patients with severe PLD.

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Introduction: Cirrhotic patients are difficult patients to operate on and are generally considered unsuitable for laparoscopy (1,2). We present the clinical case of a cirrhotic patient with comorbidities that was diagnosed with a hepatic nodule and cortisol secreting right adrenal tumor, for which a multidisciplinary team decided to submit him for laparoscopic intervention.Case report: N.D. is a 59 y.o. male, diagnosed in 2010 with alcoholic Child-Pugh B liver cirrhosis (score 9). In February 2019, a hepatic nodule in segment IV-A (2 cm) and cortisol secreting right adrenal tumor (6/4/4 cm) were found. He is also diagnosed with essential arterial hypertension grade II, mild diastolic dysfunction of the left ventricle, aortic sclerosis, chronic ischemic cardiomyopathy, type 2 diabetes mellitus and chronic gastritis. He had laparoscopic cholecystectomy in 2000. The hepatic nodule in segment IV-A was highly suggestive of hepatocellular carcinoma due to imaging characteristics. Subclinical secretion of cortisol was present (low ACTH 4.18 pg/ml, normal plasmatic cortisol, metanephrine, normetanephrine). AFP, CEA, CA 19-9 were normal. The patient underwent surgery on 27 May 2019. Adhesiolysis, transperitoneal laparoscopic right adrenalectomy and alcoholization of hepatic tumor have been performed. Radiofrequency ablation of the hepatic tumor was preoperatively anticipated but was intraoperatively abandoned in favor of in situ hepatic tumor ablation with percutaneous ethanol injection due to encountered metabolic acidosis and cardiac arrhythmia. Results: Postoperatively the patient developed hemorrhagic ascites and abdominal wall hematoma that were successfully controlled by conservative measurements. He was discharged on the 15 th postoperative day. Histopathology found cortical-adrenal adenoma with clear cells. The patient was completely withdrawn from corticosteroids in October 2019. On October 1st, 2019, transarterial chemoembolization (TACE) with Gelaspon, Lipidol and Doxorubicin was performed to completely ablate the hepatic nodule. After two years the patient had Child-Pugh B cirrhosis (score 7) with no tumor recurrence. Conclusion: Laparoscopic right adrenalectomy could be safely performed for a right adrenal tumor in a Child-Pugh B cirrhotic patient with other comorbidities but the percutaneous alcoholization of the hepatic nodule under video and ultrasound guidance needed TACE for its complete destruction.

Hepatic adenoma is known as a benign lesion encountered mainly in female patients and classically linked to the administration of oral contraceptives. In the last decade, the risk factors for its occurrence have changed and so did the sex ratio. The histopathological classification of hepatic adenomas was found to be related with certain genetic mutations that determine the risk for malignancy. The diagnosis of hepatic tumor is correlated with clinical and imaging data in an effort not only to rule out other tumors but also to distinguish the subtype of adenoma, which is very important for the management of the patient. The ultimate diagnosis is established by pathologists by routine histopathological and specific immunohistochemical staining. There are two major issues that pathologists need to recognize: the presence of β-catenin gene mutation and/or malignant degeneration. The best imaging examination is considered to be MRI. However, along with MRI, ultrasound and computer tomography have proved themselves to be effective not only in evaluating the number, size, localization, and complications of hepatic adenomas, but also in identifying their subtype. A detailed presentation of characteristics of all groups of hepatic adenoma is provided. The means of management of hepatic adenomas are documented and decisional algorithm is explained, based on certain criteria.