Division of Abdominal Transplant, Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.
Am Surg. 2023 May;89(5):1392-1395. doi: 10.1177/00031348211054077. Epub 2021 Nov 22.
Simple liver cyst (SHC) is a benign condition with no malignant potential. They are typically discovered incidentally due to the increased use of abdominal imaging, but some patients may present with abdominal pain. A radiologist's differential diagnosis in cases of SHC will often include "rule out biliary cystadenoma." Under these circumstances, patients and surgeons are more likely to pursue surgical options even in asymptomatic cases. The aim of this study is to conduct a retrospective analysis of presentation, radiologic reporting, management plan, and histopathology of patients referred to a tertiary hospital in order to determine the correlation between radiology and histology.
We retrospectively analyzed the clinical, radiological, and histopathological data of 20 patients operated for a diagnosis of a cystic lesion in the liver.
The CT/MRI of 6 (30%) patients was reported as a biliary cystadenoma, 13 (65%) were reported as a simple hepatic cyst and 1 patient (5%) had hepatocellular carcinoma (HCC) with the additional diagnosis of multiple hepatic cysts. The lesion reported as HCC on the scan was separate from the cystic lesions. The modality of imaging for these cysts was evenly split, 50% of patients had a CT scan, and 50% had an MRI performed. All imaging studies were interpreted by an attending radiologist and most of them were discussed in multidisciplinary meetings. Nineteen patients (95%) had an intraoperative diagnosis of a simple liver cyst based on its visual appearance and clear fluid within the cyst. These patients underwent cyst wall fenestration and de-roofing with the cyst wall sent for histopathology. One patient (5%) with HCC underwent a non-anatomical liver resection. Histopathology was conclusive for a benign hepatic cystic lesion from the cyst wall biopsy. All 20 patients in this study underwent surgery, either due to symptoms or due to radiologic diagnosis of BCA. Four of the 20 cases (20%) were asymptomatic and out of these four cases, 3 (75%) were diagnosed as cystadenoma on the preoperative imaging studies. All 19 cases were diagnosed as a simple liver cyst on pathology.
In summary, there is a growing trend of "ruling-out the diagnosis of biliary cystadenoma" in patients who present with liver cysts. Patients are appropriately more anxious after this preoperative diagnosis and the treating surgeons have medico-legal concerns regarding conservative management in asymptomatic patients diagnosed as BCA. This single center experience draws attention to the radiology criteria utilized for diagnosing a biliary cystadenoma and suggests that it is time to revisit the imaging interpretation and differential diagnosis.
单纯性肝囊肿（SHC）是一种无恶变潜能的良性病变。它们通常因腹部影像学检查的广泛应用而偶然发现，但有些患者可能会出现腹痛。在 SHC 的情况下，放射科医生的鉴别诊断通常包括“排除胆管囊腺瘤”。在这种情况下，即使在无症状的情况下，患者和外科医生也更倾向于选择手术治疗。本研究的目的是对转诊至三级医院的患者进行回顾性分析，以确定其临床表现、影像学报告、治疗计划和组织病理学特征，从而确定影像学与组织病理学之间的相关性。
我们对 20 例因囊性肝病变而行手术治疗的患者的临床、放射学和组织病理学数据进行了回顾性分析。
6 例（30%）患者的 CT/MRI 报告为胆管囊腺瘤，13 例（65%）报告为单纯性肝囊肿，1 例（5%）患者为肝细胞癌（HCC），并伴有多个肝囊肿的额外诊断。扫描报告为 HCC 的病变与囊性病变分开。这些囊肿的影像学检查方式平均分配，50%的患者行 CT 检查，50%的患者行 MRI 检查。所有影像学研究均由主治放射科医生解读，其中大部分在多学科会议上进行了讨论。19 例（95%）患者根据其外观和囊肿内的清亮液体在术中诊断为单纯性肝囊肿。这些患者行囊肿壁开窗和去顶术，并将囊肿壁送检组织病理学检查。1 例（5%）HCC 患者行非解剖性肝切除术。组织病理学检查结果显示，从囊肿壁活检中得出的良性肝囊性病变的结论。本研究中的 20 例患者均因症状或胆管囊腺瘤的影像学诊断而行手术治疗。其中 4 例（20%）无症状，这 4 例中，3 例（75%）术前影像学检查诊断为囊腺瘤。所有 19 例患者的病理诊断均为单纯性肝囊肿。
总之，在出现肝囊肿的患者中，存在一种“排除胆管囊腺瘤诊断”的趋势。在这种术前诊断后，患者的焦虑情绪会增加，对于术前诊断为胆管囊腺瘤的无症状患者，治疗外科医生也会因医疗法律方面的顾虑而考虑保守治疗。本单中心经验提请注意用于诊断胆管囊腺瘤的放射学标准，并表明现在是重新审视影像学解读和鉴别诊断的时候了。
