Biliary cystadenocarcinoma diagnosed with real-time contrast-enhanced ultrasonography: report of a case with diagnostic features

Abstract

Biliary cystadenocarcinoma is a very rare malignant cystic tumor of the liver, which is often misdiagnosed due to a poor recognition of it. We report a case of a 60-year-old man with biliary cystadenocarcinoma with his real time contrast enhanced ultrasound (CEUS) characteristics compared to those of computed tomography (CT) and magnetic resonance imaging (MRI), which were correlated with the surgical and pathologic findings. Cystic wall enhancement, internal septations and intra-cystic solid portions in the arterial phase were observed on CEUS after contrast agent injection. The enhancement was washed out progressively and depicted as hypo-enhancement in the portal and late phases. CT revealed a large irregular cystic lesion in the left liver lobe with no clear septations and solid components. MRI showed an irregular cystic occupying lesion with septations.

Figure 1

Biliary cystadenocarcinoma. Computed tomography shows a huge cystic tumor (arrowheads) in the left liver lobe, with no clear septations and solid components.

Figure 2

Biliary cystadenocarcinoma. A: Conventional sonography shows a multilocular cystic lesion in left lobe of the liver with nodular thickening of internal septa and mural nodules projecting into the cyst (arrow); B: Conventional sonography shows septal calcifications or stones (arrowhead); C: Color doppler flow imaging (CDFI) shows affluent vascularity in the internal septa (arrows).

Figure 3

Biliary cystadenocarcinoma. A: Contrast enhanced ultrasound (CEUS) shows hyperenhancement of the cystic wall, internal septations and intracystic solid portions during the arterial phase (arrows); B: CEUS shows hypoenhancement of the cystic wass, internal septations and intracystic solid portions during the portal and late phases (arrowheads).

Figure 4

Biliary cystadenocarcinoma. A and B: Magnetic resonance imaging (MRI) scans showing a multilocular cyst in the left lobe of the liver.

Figure 5

Biliary cystadenocarcinoma. A: Gross appearance of a cross-section of the formalin fixed specimen showing a multilocular mucinous cyst; B: Microscopically, tumor tissues showing moderately differentiated adenocarcinoma with a papillary growth pattern (HE, original magnification × 100).