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Rare monolocular intrahepatic biliary cystadenoma: A case report
Chen-Hao Che1, Zhen-Hua Zhao2, Hui-Ming Song3
1The First Clinical Medical School, Southern Medical University, Guangzhou 510515, Guangdong Province, China.
Insights
Intrahepatic biliary cystadenoma (IBC) can appear as a simple cyst. Contrast-enhanced ultrasound (CEUS) is crucial for diagnosing this rare liver tumor, even without internal septations.
Area of Science:
- Hepatobiliary surgery
- Diagnostic imaging
- Gastroenterology
Background:
- Intrahepatic biliary cystadenoma (IBC) is a rare benign hepatic tumor frequently misdiagnosed as other cystic liver diseases.
- Accurate preoperative diagnosis of IBC necessitates advanced imaging techniques.
- Contrast-enhanced ultrasound (CEUS) is a valuable screening tool for IBC due to its specific performance characteristics.
Observation:
- A 45-year-old male presented with epigastric pain and an upper abdominal mass.
- Imaging revealed a large, thick-walled, monolocular cystic mass in the liver, lacking internal septations.
- Elevated CA19-9 levels were noted, but other laboratory tests were unremarkable.
Findings:
- CEUS demonstrated a peripheral ring enhancement in the arterial phase with no central enhancement.
- The enhanced portion subsided in the portal phase but remained visible.
- Pathological examination confirmed IBC after surgical resection.
Implications:
- Monolocular cystic features on imaging do not exclude the diagnosis of IBC.
- CEUS plays a vital role in characterizing IBC, particularly in atypical monolocular presentations.
- This case highlights the importance of considering IBC in the differential diagnosis of cystic liver lesions.
Background:
Intrahepatic biliary cystadenoma (IBC) is a rare benign hepatic tumor that is often misdiagnosed as other hepatic cystic diseases. Therefore, imaging examinations are required for preoperative diagnosis. Contrast-enhanced ultrasound (CEUS) has gained increasing popularity as an emerging imaging modality and it is considered the primary method for screening IBC because of its specificity of performance. We describe an unusual case of monolocular IBC and emphasize the performance of CEUS.
Case Summary:
A 45-year-old man complained of epigastric pain lasting 1 wk. He had no medical history of hepatitis, liver cirrhosis or parasitization. Physical examination revealed a mass of approximately 6 cm in size in the upper abdomen below the subxiphoid process. Tumor marker tests found elevated CA19-9 levels (119.3 U/mL), but other laboratory tests were unremarkable. Ultrasound and computerized tomography revealed a round thick-walled mass measuring 83 mm × 68 mm located in the left lateral lobe of the liver that lacked internal septations and manifested as a monolocular cystic structure. CEUS demonstrated that in the arterial phase, the anechoic area manifested as a peripheral ring with homogeneous enhancement. The central part presented with no enhancement. During the portal phase, the enhanced portion began to subside but was still above the surrounding liver tissue. The patient underwent left partial liver lobectomy and recovered well without tumor recurrence or metastasis. Eventually, the results of pathological examination confirmed IBC.
Conclusion:
A few IBC cases present with monolocular characteristics, and the lack of intracystic septa in imaging performance cannot exclude IBC.
