Biliary Cystadenoma Causing Esophageal Varices

Article information

Kosin Med J. 2016;31(2):191-196

Publication date (electronic) : 2016 January 20

doi : https://doi.org/10.7180/kmj.2016.31.2.191

Sung Ju Kang , Tae Hee Lee ^,, Min Gyu Seok , Hyo Jin Yun , Ye Seul Jang , Jun Hyun Byun

Department of Internal Medicine, College of Medicine, Konyang University, Daejeon, Korea

Corresponding Author: Tae Hee Lee, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon 35365, Korea Tel: +82-42-600-9370 Fax: +82-42-600-9090 E-mail: green740@naver.com

Received 2015 August 18; 2015 September 18; Accepted 2015 September 21.

Abstract

Biliary cystadenomas are benign but potentially malignant cystic neoplasm. The preferred treatment is radical resection because it is difficult to differentiate a benign from a malignant biliary cystadenoma. A 40 year-old woman presented with moderate abdominal discomfort. Esophageal varix was found up to mid-esophagus on endoscopy. She has no prior history of liver disease or chronic alcohol ingestion. About 15cm sized biliary cystadenoma was diagnosed by ultrasonography, computed tomography and magnetic resonance imaging. Serum level of bilirubin, alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase and tumor marker were elevated. The patient underwent US-guided aspiration. Tumor markers from the aspirated fluid are increased. Left hepatectomy was performed to completely remove the cyst. Histology of the resected specimen confirmed a biliary cystadenoma of the liver with ovary-like stroma. Without prior history of liver disease or chronic alcoholic ingestion, incidental finding of esophageal varix could show an important clue for diagnosis of biliary cystadenoma.

Keywords: Biliary; Cystadenoma; Esophageal varix

Fig. 1.

Abdomen ultrasonography shows a large cystic mass with septae in liver left lobe.

Fig. 2.

Computed tomography shows a large cystic lesion with multiple-enhancing septae (arrow).

Fig. 3.

Postoperative picture shows large thick walled cystic lesion in left lobe of liver.

Fig. 4.

Cyst histology typical of a mucinous cystadenoma(A) Biliary cyst shows ovary like stroma (H &E stain, x400). (B) Arrow demonstrating ovary like stroma.

Fig. 5.

Endoscopy image before operation demonstrating esophageal varix upto midesophagus.(A) Follow up endoscopy after lobectomy shows disappearance of esophageal varix.

References

1. Del Poggio P, Buonocore M. Cystic tumors of the liver: a practical approach. World J Gastroenterol 2008;14:3616–20.

2. Ratti F, Ferla F, Paganelli M, Cipriani F, Aldrighetti L, Ferla G. Biliary cystadenoma: short- and longterm outcome after radical hepatic resection. Updates Surg 2012;64:13–8.

3. Grubor NM, Colovic RB, Atkinson HD, Micev MT. Giant biliary mucinous cystadenoma of the liver. Ann Hepatol 2013;12:979–83.

4. Erdogan D, Kloek J, Lamers WH, Offerhaus GJ, Busch OR, Gouma DJ, et al. Mucinous cystadenomas in liver: management and origin. Dig Surg 2010;27:19–23.

5. Gamblin TC, Holloway SE, Heckman JT, Geller DA. Laparoscopic resection of benign hepatic cysts: a new standard. J Am Coll Surg 2008;207:731–6.

6. Choi HK, Lee JK, Lee KH, Lee KT, Rhee JC, Kim KH, et al. Differential diagnosis for intrahepatic biliary cystadenoma and hepatic simple cyst: significance of cystic fluid analysis and radiologic findings. J Clin Gastroenterol 2010;44:289–93.

7. Ryu KH, Lee TH, Kwon TG. Vascular lesion in an adult mimicking esophageal varix. Gastroenterololy 2013;144:35.

Article information Continued

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.