Invasive biliary mucinous cystic neoplasm: a review

Simo, Kerri A.; McKillop, Iain H.; Ahrens, William A.; Martinie, John B.; Iannitti, David A.; Sindram, David

doi:10.1111/j.1477-2574.2012.00532.x

Cited by 55 publications

(81 citation statements)

References 79 publications

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“…Given the challenges in diagnosing BCT preoperatively, it may be a prudent approach to perform a frozen section examination at the time of performing an unroofing/fenestration for a presumed simple hepatic cyst to exclude BCT. 23 …”

Section: Discussionmentioning

confidence: 99%

Management of Biliary Cystic Tumors

et al. 2015

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Objective To characterize clinical and radiological features associated with biliary cystic tumors (BCTs) of the liver, and to define recurrence-free and overall survival. Background Biliary cystadenoma (BCA) and biliary cystadenocarcinoma (BCAC) are rare tumors that arise in the liver. Methods Between 1984 and 2013, 248 patients who underwent surgical resection of BCA or BCAC were identified. Clinical and outcome data were analyzed. Results Median total bilirubin, CA19–9, and carcinoembryonic antigen (CEA) levels were 0.6 mg/dL, 15.0 U/mL, and 2.7 ng/mL, respectively. Preoperative imaging included computed tomography only (62.5%), magnetic resonance imaging only (6.9%), or CT + MRI (18.5%). Features on cross-sectional imaging included multiloculation (56.9%), mural nodularity (16.5%), and biliary ductal dilatation (17.7%). The presence of these factors did not reliably predict BCAC versus BCA (sensitivity, 81%; specificity, 21%). Median biliary cyst size was 10.0 cm (interquartile range, 7–13 cm). Operative interventions included unroofing/partial excision of the lesion (14.1%), less than hemihepatectomy (48.8%), or hemi-/extended hepatectomy (36.3%). On pathology most lesions were BCA (89.1%), whereas 27 (10.9%) were BCAC. At last follow-up, there were 46 (18.3%) recurrences; 2 patients who initially had BCA recurred with BCAC. Median overall survival was 18.1 years; 1-year, 3-year, and 5-year survival was 95.0%, 86.8%, and 84.2%, respectively. Long-term outcomes were associated with BCAC versus BCA, as well as the presence of spindle cell/ovarian stroma (both P < 0.05). Conclusions Among patients undergoing surgery for BCT, associated malignancy was uncommon (10%) and no preoperative findings reliably predicted underlying BCAC. After excision of BCA, long-term outcomes were good; however, patients with BCAC had a worse long-term prognosis.

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Section: Discussionmentioning

confidence: 99%

Management of Biliary Cystic Tumors

et al. 2015

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“…The cytoplasm of bile duct adenoma and biliary papilomatosis is scant and not granular. Mucinous cystic neoplasm does not communicate with the bile ducts, is composed of cuboidal to columnar cells with mucinous or delicate cytoplasm and may form papillary architecture, which can be seen in IOPN. However, the stroma of mucinous cystic neoplasm is ovarian‐like stroma, which is not seen in IOPN.…”

Section: Discussionmentioning

confidence: 99%

Cytomorphology of intraductal oncocytic papillary neoplasm of the liver

Jurczyk

Zhu

Villa

et al. 2013

Diagnostic Cytopathology

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We describe the first cytology case report of an intraductal oncocytic papillary neoplasm (IOPN) of the liver. A 51-year-old male presented with recurrent cholangitis. Magnetic resonance imaging and endoscopic retrograde cholangiopancreatogram revealed a 1.1 × 0.9 cm polypoid lesion within the left intrahepatic bile duct. Fine-needle aspiration and needle core biopsy (NCB) revealed nests, 3-dimensional or papillary clusters of columnar or cuboidal cells with loss of polarity. The nuclei were uniform with even chromatin, and cytoplasm was granular or vacuolated. No mitosis or necrosis was seen. The cytologic and histologic diagnosis was "consistent with Intraductal Oncocytic Papillary Neoplasm (IOPN), intermediate grade (borderline)." The patient then underwent a left lateral liver segmentectomy. Microscopic examination showed histology similar to the NCB with no stromal invasion identified. Hepatic IOPN poses a diagnostic challenge due to its broad differential diagnoses. Both malignant and non-malignant IOPNs may present with similar clinical symptoms, pathology, histology, cytomorphology, and immunohistochemistry. Hepatic IOPN should be excised as it is a precursor lesion of adenocarcinoma.

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“…According to their behavior, MCNs are considered as noninvasive (characterized by low-, intermediate-, and high-grade dysplasia) or invasive tumors [ 6 ]. The incidence of MCNs is estimated in less than 5 % of all liver cystic lesions; it is important to notice that there is a prevalence in female, usually around the fi fth decade [ 11 ]. Symptoms are aspecifi c and include upper right pain, jaundice, cholangitis, fever, and weight loss; liver function tests are usually abnormal.…”

Section: Mucinous Cystic Neoplasm (Mcn)mentioning

confidence: 99%

“…In literature are reported some cases of major symptoms due to portal or caval compression. It has to be considered that, in 30-56 % of cases, these patients are asymptomatic, and the diagnosis is done incidentally [ 11 ].…”

Section: Mucinous Cystic Neoplasm (Mcn)mentioning

confidence: 99%