An Asymptomatic Hemorrhagic Hepatic Cyst with Solid Contents

Abstract

We describe a patient who had an asymptomatic hemorrhagic hepatic cyst with solid contents that mimicked a malignancy. An 85-year-old woman was referred to our hospital because a hypoechoic mass was detected. She had no complications. The past medical history included hypertension and left femoral artery aneurysm. The results of initial laboratory tests were as follows: serum aspartate aminotransferase, 28 IU/L; serum alanine aminotransferase, 23 IU/L; serum C-reactive protein, 0.11 mg/dL; and serum hemoglobin concentration, 13.1 g/dL. The serum platelet count (17.3×104/μL) was slightly decreased. The serum concentration of carcinoembryonic antigen was 3.0 ng/mL, that of CA19-9 was 12.2 u/ml, and that of AFP was 3.8 ng/ml. The serum concentration of hyaluronic acid (147 ng/mL) was elevated. Hepatitis B virus antigen and hepatitis C virus antibody were negative. Ultrasonography revealed a protruding hypoechoic mass, 6 cm in diameter, with a central isoechoic structure in segment 7, accompanied by multiple hepatic cysts. The edge of the liver was dull, and the liver parenchymal echo was mildly rough. Computed tomography (CT) showed a slightly high-density area with calcification of the margin. Magnetic resonance imaging revealed a hypointense lesion with central hyperintensity on T1-weighted sequences and hyperintensity on T2-weighted sequences. On positron emission tomography-CT, there was no uptake of fluorodeoxyglucose in the liver. We diagnosed an old hemorrhagic cyst or abscess, but could not rule out a malignant neoplasm because of the damaged liver. A right lateral sectionectomy was therefore performed. The resected specimen had black solid contents, and the capsule lacked fluid. Pathological examination revealed an old hemorrhage with a thick fibrous capsule without epithelial components. The liver showed mild fibrosis with fatty changes. The lesion was considered an old hemorrhagic hepatic cyst because a nearby hepatic cyst had simple columnar epithelium.