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Prolapse into the bile duct and expansive growth is characteristic behavior of mucinous cystic neoplasm of the liver: report of two cases and review of the literature.

Takano Y, Nagahama M, Yamamura E, Maruoka N, Mizukami H, Tanaka J, Ohike N, Takahashi H - Clin J Gastroenterol (2015)

Bottom Line: Both cases exhibited MCN-L that originated from the left hepatic lobe (Segment 4) and then prolapsed into the left hepatic duct and common bile duct, resulting in obstructive jaundice due to expansive growth.Prolapse into the bile duct and expansive growth appear to be characteristic behavior of MCN-L.In the future, additional data on more cases needs to be collected to further elucidate MCN-L pathophysiology.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Yokohama, Kanagawa, 227-8501, Japan, yuichitakano1028@yahoo.co.jp.

ABSTRACT
Mucinous cystic neoplasm of the liver (MCN-L) is a very rare tumor whose detailed behavior is still unknown. We describe two cases of MCN-L that exhibited extremely interesting growth patterns, and discuss the characteristics of MCN-Ls. Both cases exhibited MCN-L that originated from the left hepatic lobe (Segment 4) and then prolapsed into the left hepatic duct and common bile duct, resulting in obstructive jaundice due to expansive growth. Endoscopic retrograde cholangiopancreatographies showed the characteristic oval-shaped filling defects in the bile ducts. Endoscopic ultrasound and intraductal ultrasound were useful for differentiating the tumors from stones, since multiple septal formations were observed inside the tumors. A literature search revealed that, over the past 10 years, 15 cases of MCN-L (biliary cystadenomas with ovarian-like stroma) that showed expansive growth in the bile duct had been reported. Prolapse into the bile duct and expansive growth appear to be characteristic behavior of MCN-L. In the future, additional data on more cases needs to be collected to further elucidate MCN-L pathophysiology.

No MeSH data available.


Related in: MedlinePlus

a Contrast abdominal CT revealed a multi-locular cystic lesion in the left hepatic lobe (S4), with multiple septal formations (arrow). Intrahepatic bile ducts were dilated. b, c MRI showed high signal intensities on T2-weighted images of the components inside the cyst (arrow). The septal formation was connected to the left hepatic duct and common bile duct (arrow), and thus the spread of the tumor into the bile duct was suspected. d ERCP revealed an oval-shaped filling defect that appeared to fill the common bile duct (arrow). e Cholangioscopy enabled a direct observation of the tumor filling the common bile duct. f EUS revealed that the tumor occupied the lumen of the common bile duct, and many septal formations were observed
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Fig1: a Contrast abdominal CT revealed a multi-locular cystic lesion in the left hepatic lobe (S4), with multiple septal formations (arrow). Intrahepatic bile ducts were dilated. b, c MRI showed high signal intensities on T2-weighted images of the components inside the cyst (arrow). The septal formation was connected to the left hepatic duct and common bile duct (arrow), and thus the spread of the tumor into the bile duct was suspected. d ERCP revealed an oval-shaped filling defect that appeared to fill the common bile duct (arrow). e Cholangioscopy enabled a direct observation of the tumor filling the common bile duct. f EUS revealed that the tumor occupied the lumen of the common bile duct, and many septal formations were observed

Mentions: Contrast abdominal computed tomography (CT) revealed a 83 × 80 mm multi-locular cystic lesion with an internal septal formation in the left hepatic lobe (Segment 4: S4) (Fig. 1a). No nodular components, ductal invasion, or distant metastases were found. Magnetic resonance imaging (MRI) showed low signal intensities on T1-weighted images and high signal intensities on T2-weighted images inside the cystic lesion (Fig. 1b). The septal formation was connected to the left hepatic duct and common bile duct, and spread of the tumor to the bile duct was suspected (Fig. 1c). Endoscopic retrograde cholangiopancreatography (ERCP) was performed, and no excretion of mucin from the papilla of Vater was observed. Cholangiography revealed an oval-shaped filling defect in the common bile duct (Fig. 1d). There were no findings indicating malignancy in the bile cytology. Cholangioscopy enabled a direct observation of the smooth tumor wall inside the common bile duct (Fig. 1e). Endoscopic ultrasound (EUS) revealed that the tumor occupied the lumen of the common bile duct, and many septal formations were observed (Fig. 1f). On the basis of the above findings, the patient was diagnosed with benign MCN-L that had prolapsed into the bile duct. The patient underwent a laparoscopy-assisted left lobectomy, a cholecystectomy, and a right hepaticojejunostomy. The patient progressed well following the surgical procedures and was discharged from the hospital 14 days postoperatively.Fig. 1


Prolapse into the bile duct and expansive growth is characteristic behavior of mucinous cystic neoplasm of the liver: report of two cases and review of the literature.

Takano Y, Nagahama M, Yamamura E, Maruoka N, Mizukami H, Tanaka J, Ohike N, Takahashi H - Clin J Gastroenterol (2015)

a Contrast abdominal CT revealed a multi-locular cystic lesion in the left hepatic lobe (S4), with multiple septal formations (arrow). Intrahepatic bile ducts were dilated. b, c MRI showed high signal intensities on T2-weighted images of the components inside the cyst (arrow). The septal formation was connected to the left hepatic duct and common bile duct (arrow), and thus the spread of the tumor into the bile duct was suspected. d ERCP revealed an oval-shaped filling defect that appeared to fill the common bile duct (arrow). e Cholangioscopy enabled a direct observation of the tumor filling the common bile duct. f EUS revealed that the tumor occupied the lumen of the common bile duct, and many septal formations were observed
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4481294&req=5

Fig1: a Contrast abdominal CT revealed a multi-locular cystic lesion in the left hepatic lobe (S4), with multiple septal formations (arrow). Intrahepatic bile ducts were dilated. b, c MRI showed high signal intensities on T2-weighted images of the components inside the cyst (arrow). The septal formation was connected to the left hepatic duct and common bile duct (arrow), and thus the spread of the tumor into the bile duct was suspected. d ERCP revealed an oval-shaped filling defect that appeared to fill the common bile duct (arrow). e Cholangioscopy enabled a direct observation of the tumor filling the common bile duct. f EUS revealed that the tumor occupied the lumen of the common bile duct, and many septal formations were observed
Mentions: Contrast abdominal computed tomography (CT) revealed a 83 × 80 mm multi-locular cystic lesion with an internal septal formation in the left hepatic lobe (Segment 4: S4) (Fig. 1a). No nodular components, ductal invasion, or distant metastases were found. Magnetic resonance imaging (MRI) showed low signal intensities on T1-weighted images and high signal intensities on T2-weighted images inside the cystic lesion (Fig. 1b). The septal formation was connected to the left hepatic duct and common bile duct, and spread of the tumor to the bile duct was suspected (Fig. 1c). Endoscopic retrograde cholangiopancreatography (ERCP) was performed, and no excretion of mucin from the papilla of Vater was observed. Cholangiography revealed an oval-shaped filling defect in the common bile duct (Fig. 1d). There were no findings indicating malignancy in the bile cytology. Cholangioscopy enabled a direct observation of the smooth tumor wall inside the common bile duct (Fig. 1e). Endoscopic ultrasound (EUS) revealed that the tumor occupied the lumen of the common bile duct, and many septal formations were observed (Fig. 1f). On the basis of the above findings, the patient was diagnosed with benign MCN-L that had prolapsed into the bile duct. The patient underwent a laparoscopy-assisted left lobectomy, a cholecystectomy, and a right hepaticojejunostomy. The patient progressed well following the surgical procedures and was discharged from the hospital 14 days postoperatively.Fig. 1

Bottom Line: Both cases exhibited MCN-L that originated from the left hepatic lobe (Segment 4) and then prolapsed into the left hepatic duct and common bile duct, resulting in obstructive jaundice due to expansive growth.Prolapse into the bile duct and expansive growth appear to be characteristic behavior of MCN-L.In the future, additional data on more cases needs to be collected to further elucidate MCN-L pathophysiology.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Yokohama, Kanagawa, 227-8501, Japan, yuichitakano1028@yahoo.co.jp.

ABSTRACT
Mucinous cystic neoplasm of the liver (MCN-L) is a very rare tumor whose detailed behavior is still unknown. We describe two cases of MCN-L that exhibited extremely interesting growth patterns, and discuss the characteristics of MCN-Ls. Both cases exhibited MCN-L that originated from the left hepatic lobe (Segment 4) and then prolapsed into the left hepatic duct and common bile duct, resulting in obstructive jaundice due to expansive growth. Endoscopic retrograde cholangiopancreatographies showed the characteristic oval-shaped filling defects in the bile ducts. Endoscopic ultrasound and intraductal ultrasound were useful for differentiating the tumors from stones, since multiple septal formations were observed inside the tumors. A literature search revealed that, over the past 10 years, 15 cases of MCN-L (biliary cystadenomas with ovarian-like stroma) that showed expansive growth in the bile duct had been reported. Prolapse into the bile duct and expansive growth appear to be characteristic behavior of MCN-L. In the future, additional data on more cases needs to be collected to further elucidate MCN-L pathophysiology.

No MeSH data available.


Related in: MedlinePlus