Biliary Cystadenomas: Hormone Receptor Expression and Clinical Management

Abstract

Biliary cystadenomas with mesenchymal stroma are neoplasms whose growth may be hormone sensitive. This study profiled the immunohistochemistry of these lesions to clarify the pathophysiology and define clinical management. Twelve patients with biliary cystadenomas were identified. Tissue was tested with a panel of probes including estrogen and progesterone receptors and compared to pancreatic and ovarian cystadenomas. Epithelial ER, PR, CD117, or SMA expression was negative in all three tumors. Epithelial CD10 expression was seen in 60% biliary, 75% pancreatic, and 0% ovarian tumors. Biliary cystadenoma stromal expression was ER+ (70%), PR+ (60%), CD10+ (40%), and c-kit+ (0%). Symptoms were seen in 92% patients. Percutaneous sclerotherapy and incomplete resection were associated with recurrence. Enucleation was the least morbid surgical technique. A role for hormonally mediated growth of biliary cystadenomas occurring through the stroma, rather than the epithelium, is suggested. Management remains complete surgical resection.

Expression of estrogen and progesterone receptors and inhibin-α in hepatobiliary cystadenoma: an immunohistochemical study

“…This could explain the positive staining sometimes detected in the adjacent hepatocytes. Daniels et al [4] reported the same finding in 43% of their cases. Recently, Moon et al [17] reported that cytoplasmic and nuclear immunoreactivity for ER was present in hepatocellular carcinoma specimens in 46 and 12% respectively.…”

“…PedramCanihac et al [20] reported the immunostaining of stromal mesenchymal cells in three of five cases and PR in all five cases. Recently, Daniels et al [4] reported 12 cases of biliary cystadenoma with mesenchymal stroma that showed stromal ER and PR positivity in 70 and 60% of cases, respectively. In all the four reports, the positive immunoreactivity was in the form of nuclear staining.…”

“…As hepatobiliary mucinous cystic neoplasms with mesenchymal stroma occurred only in women, this led them to suggest a sex-specific factor in the pathogenesis of the tumors. Recently, there have been reports of expression of estrogen receptors (ER) and progesterone receptors (PR) in the stromal cells in formalin-fixed tissue from several cases of hepatobiliary cystadenomas [4,6,20,23], and both ER and PR as well as luteinized inhibin-α positive stromal cells have been demonstrated in the closely related mucinous cystic tumors of the pancreas [10,28], further supporting the hypothesis that these are hormonally dependant.…”

Cystic formations of liver

“…Другие авторы считают, что в случае кистозных опухолей печени, даже при больших размерах образования, доста-точно выполнения энуклеации [32]. Эта методика подра-зумевает, что хирург использует псевдокапсулу как ориен-тир для границы разделения паренхимы.…”

“…Такие проблемы ча-ще всего возникают, когда мезенхимальная строма отсут-ствует и без нее трудно дифференцировать границу раз-деления паренхимы и фиброзной капсулы [36]. Кроме того, некоторые авторы утверждают, что энуклеация не гарантирует полного удаления опухоли, так как по краю резекции может остаться опухолевая ткань, особенно в случае гепатобилиарной ЦАК [32]. При наличии прямой связи опухолевого образования с внутрипеченочными желчными протоками выполнение энуклеации становит-ся довольно трудной задачей, в таких ситуациях целесо-образно расширить объем операции до резекции сегмен-тов печени, вовлеченных в опухолевый процесс [40].…”