Biliary mucinous cystic neoplasm mimicking a hydatid cyst: a case report and literature review

Abstract

Background Biliary mucinous cystic neoplasms are rare cystic lesions of the liver which carry pre-malignant potential. Given the scarcity of reports in the literature, they pose a considerable challenge to clinical management, particularly with regards to accurate pre-operative diagnosis. Case presentation We present the case of a 37-year-old Tunisian woman who presented with subacute right upper quadrant pain and a large multi-loculated cystic lesion, most consistent with a hydatid cyst. She underwent an open right hepatectomy, and pathology surprisingly revealed a biliary mucinous cystadenoma. Herein, we review the current literature on biliary mucinous cystic neoplasms, with a particular emphasis on diagnostic investigations, key radiological features and optimal treatment modalities. Conclusion Biliary mucinous cystic neoplasms require a high index of suspicion and should be managed with complete surgical resection, as conservative techniques are associated with high recurrence rates. Considering the potential for malignant transformation, periodical surveillance imaging is recommended in the post-operative period.

Biliary cystadenoma a case report

“…Biliary cystadenomas are commonly multilocular, in this patient it was a unilocular which was a very rare entity, usually occurring in middle aged female with 4:1 female: male ratio, and cystadenomas are known to increase in size during pregnancy and with oral contraceptive pills suggest its hormonal dependence. 6,13,14 In this patient she was old age and had not taken any kind of hormonal supplements. BCA usually do not have communication with the biliary tree, but luminal communication was reported in some.…”

“…Moreover, both procedures have risk of dissemination of tumour cells. [1][2][3]6,14,19 BCA were historically treated with aspiration, marsupialization, internal Roux-en-Y anastomosis, sclerosis or partial resection all these associated with high complication rates including sepsis, continued growth and progression to malignancy and recurrence (90%), which were lower in total ablative and resection procedure. 6,13,14,17,18,20,21 So, in this patient we tried omentopexy additional to the deroofing of the cyst.…”

“…[1][2][3]6,14,19 BCA were historically treated with aspiration, marsupialization, internal Roux-en-Y anastomosis, sclerosis or partial resection all these associated with high complication rates including sepsis, continued growth and progression to malignancy and recurrence (90%), which were lower in total ablative and resection procedure. 6,13,14,17,18,20,21 So, in this patient we tried omentopexy additional to the deroofing of the cyst. Final diagnosis of the which is mainly done by HPE, BCA are usually of two types based on the stroma, one with the mesenchymal ovarian like stroma consist of compact spindle shaped cells usually immunoreactive with vimentin, alpha-smooth muscle actin, and musclespecific actin and less frequently with desmin, estrogen and progesterone receptors and support the epithelium seen exclusively in women.…”

“…BCA has higher recurrence rate (nearly 90%) after incomplete removal, all suspicious lesions must be completely removed. 3,6 Deroofing with omentopexy has low recurrence rate. In 2009, Ishizawa et al reported the first application an indocyanine green-fluorescent image (ICG-FI) navigation system in the surgical treatment of liver tumour.…”

A rare case of extrahepatic biliary mucinous cystic neoplasm in a middle‑aged woman: A case report

“…Besides their more common localization in the intrahepatic biliary tree, they can also develop in the extrahepatic biliary tract (9,10). According to current literature, BMCNs represent less than 5% of non-parasitic hepatic cystic lesions and so far, only few case reports of these rare lesions have been published (11,12). In 85-95% of cases, patients diagnosed with BMCNs are middle-aged women commonly asymptomatic or presenting with non-specific symptoms and signs, thus, the clinical diagnosis is highly incredibly challenging (11,13,14).…”