Mucinous cystadenoma of the liver with ovarian-like stroma: the need for complete resection

Abstract

Cystadenoma of the liver is a rare neoplasm. Although many cystadenomas are asymptomatic, symptoms can include abdominal pain, postprandial epigastric discomfort, and nausea. Dramatic changes in hepatic imaging techniques have been helpful for diagnosing cystic lesions of the liver, such as simple cyst, hydatid cyst, cystadenoma, cystadenocarcinoma, and metastatic neuroendocrine tumors. However, it remains difficult to differentiate cystadenoma from cystadenocarcinoma for multiseptated cystic hepatic lesions with papillary projection on computed tomography (CT) and magnetic resonance imaging (MRI). Here we report the case of a 47-year-old woman with several months of postprandial discomfort and abdominal fullness. CT and MRI revealed multiseptated cystic lesions with papillary excrescences. A left hemihepatectomy was performed. Histology showed a benign mucinous cystic tumor with ovarian-like stroma.

Keywords: Liver; Ovarian-like stroma; Papillary cystadenoma.

Fig. 1

Contrast-enhanced computed tomography showing a cystic lesion in liver segments II and III.

Fig. 2

Magnetic resonance imaging showing a cystic lesion in liver segments II and III with papillary projections.

Fig. 3

Gross photograph of a typical formalin-fixed resected specimen of a biliary cystadenoma, showing a trabecular, multilocular cystic lesion with a thickened wall.

Fig. 4

Cut section of the specimen revealing a large cystic mass filled with gray-brown mucinous fluid and multiple communicating loculations of different sizes.

Fig. 5

The loculations were lined by columnar, cuboidal, or even flattened epithelium, which was surrounded by a layer of highly cellular, mesenchymal tissue that resembled ovarian stroma (H&E, ×400).