Giant Hepatic Cyst with Septal Structure: Diagnosis and Management

Abstract

The hepatic cyst is a common benign liver tumor, and no surgical treatment is necessary. However, it is difficult to correctly diagnose the giant hepatic cyst containing the solid septal structures inside, from the malignant cystadenocarcinomas. The various imaging modalities such as computed tomography, magnetic resonance imaging, and ultrasonography, have been developed and are useful for the diagnosis of these liver tumors. Reviewing the other reports in this paper, the combination of more than 2 modalities will help to diagnose these tumors; however, the malignant potential is unable to be excluded if the tumor is huge. Therefore, the surgical resection should be considered for the huge hepatic cysts with septal structures if the correct diagnosis is unable to be made. For example, when the hemorrhages cause the granulation in the septa which often shows neovascularization, the imaging modalities are unable to define this situation from the malignant tissue with hypervascularity. Therefore, with the careful review of other reports, we conclude that if the imaging studies show the possible malignant potential or the sizing-up is marked, the surgical treatment should be considered with the consent from the patients.

Endoscopic ultrasonography-guided transmural drainage of an infected hepatic cyst due to Edwardsiella tarda: a case report

“…Several authors have included complicated cyst (e.g. hemorrhage or infection) and biliary cystadenoma [6,10,19] in the differential diagnosis of a thickened hepatic cyst wall, but the present case did not have a thickened hepatic cyst wall. Contrast-enhanced CT [6,8,[10][11][12] and MRI [6] are useful for providing more objective information than US, especially when the differential diagnosis includes infected cyst and intracystic hemorrhage [2][3][4].…”

Giant hepatic cyst causing lower extremity edema and scoliosis

“…Hepatic cysts usually do not cause symptoms and may be detected incidentally during abdominal imaging. 1 However, they may cause pain in the right upper quadrant. When these cysts compress on the surrounding organs, symptoms including portal hypertension and jaundice may develop.…”

A case of a giant simple hepatic cyst incidentally diagnosed on a health checkup

“…It has been reported previously that the majority of benign hepatic cysts are often multiple, usually asymptomatic, only a few centimeters in size, and usually required no treatment 9) . Treatment becomes necessary, however, when the cysts larger than 10 cm in diameter cause pressure symptoms in the surrounding organs, or if accompanied by infection and hemorrhage, or if diagnostic imaging shows evidence of malignancy [9][10][11] . In our case, the cyst was giant, larger than 10 cm in diameter, caused pressure symptoms in the surrounding organs, but not accompanied by infection, hemorrhage, or malignancy.…”