A Case of Biliary Cystadenocarcinoma Followed up for Five Years

Abstract

We report on a case of an 80‐year‐old male with autopsy‐confirmed biliary cystadenocarcinoma. The tumor's growth was followed up for five years. CT findings on first admission revealed that the cyst walls of the tumor were smooth. However, a CT taken four years later showed large cysts with irregular walls which were growing invasively and expanding beyond the liver. The patient died of liver dysfunction caused by obstructive jaundice due to the liver tumor, and an autopsy was performed. Histologic examination of the autopsy material revealed a multilocular tumor that was identified as being a biliary cystadenocarcinoma and microscopic lung metastases were seen. The character of the multilocular cyst with septations covered by papillary proliferation of atypical columnar epithelium and many remaining portions with low grade dysplasia led us to suspect the tumor was derived from a cystadenoma.

Invasive biliary mucinous cystic neoplasm: a review

“…In 1970, this transformation was demonstrated in rats fed on an aflatoxin diet 36 . The potential for malignant transformation from non‐invasive to invasive BMCN has also been documented retrospectively on review of serial CT imaging in a few individuals 15,37–39 . This type of invasive BMCN is noted to have a characteristic mesenchymal stroma and a much higher predilection for females, and to follow a relatively indolent course in most patients 2,40 …”

“…The natural history of invasive BMCN has been observed in a few patients followed for 5–22 years via serial imaging studies which have indicated that the BMCN may take up to 12 years to become malignant 38,39 . Patients who receive an initial correct diagnosis and undergo appropriate complete surgical resection would be expected to achieve the best outcomes.…”

“…36 The potential for malignant transformation from non-invasive to invasive BMCN has also been documented retrospectively on review of serial CT imaging in a few individuals. 15,[37][38][39] This type of invasive BMCN is noted to have a characteristic mesenchymal stroma and a much higher predilection for females, and to follow a relatively indolent course in most patients. 2,40 The presence of ovarian stroma in BMCNs suggests a correlation with ovarian MCNs and has led to the hypothesis of an embryonal origin.…”

“…The natural history of invasive BMCN has been observed in a few patients followed for 5-22 years via serial imaging studies which have indicated that the BMCN may take up to 12 years to become malignant. 38,39 Patients who receive an initial correct diagnosis and undergo appropriate complete surgical resection would be expected to achieve the best outcomes. However, this is difficult to determine as longterm follow-up results for these patients are often combined with those of patients who have undergone prior procedures or have non-invasive BMCN.…”