[A case of perforated biliary cystadenocarcinoma]

Biliary cystadenocarcinoma is a rare malignancy, and only one preoperatively perforated case was recorded among 36 cases documented in the literature. A 48-year-old female was admitted with chief complaints of right epigastralgia and a right upper abdominal mass. CT scan revealed a well-defined low density area with calcification in the right hepatic lobe. On postcontrast CT, the septa and an internal papillary projection were well enhanced. Angiography demonstrated displacement and stretching of the right hepatic artery encircling a hypovascular lesion with some tumor stain and pooling. At laparotomy, a child-head size multilocular cyst was found in the right hepatic lobe; cyst excision was performed. Pathological analysis showed both benign cystadenoma and cystadenocarcinoma, suggesting a transition from the benign to the malignant state. At 17 months after the procedure, the patient is in good condition.