Preoperative differential diagnosis between intrahepatic biliary cystadenoma and cystadenocarcinoma: a single-center experience

Abstract

Aim: To investigate preoperative differential diagnoses made between intrahepatic biliary cystadenoma and intrahepatic biliary cystadenocarcinoma.

Methods: A retrospective analysis of patient data was performed, which included 21 cases of intrahepatic biliary cystadenoma and 25 cases of intrahepatic biliary cystadenocarcinoma diagnosed between April 2003 and April 2013 at the General Hospital of PLA. Potential patients were excluded whose diagnoses were not confirmed pathologically. Basic information (including patient age and gender), clinical manifestation, duration of symptoms, serum assay results (including tumor markers and the results of liver function tests), radiological features and pathological results were collected. All patients were followed up.

Results: Preoperative levels of cancer antigen 125 (12.51 ± 9.31 vs 23.20 ± 21.86, P < 0.05) and carbohydrate antigen 19-9 (22.56 ± 26.30 vs 72.55 ± 115.99, P < 0.05) were higher in the cystadenocarcinoma subgroup than in the cystadenoma subgroup. There were no statistically significant differences in age or gender between the two groups, or in pre- or post-operative levels of alanine aminotransferase, aspartate aminotransferase, total bilirubin (TBIL), and direct bilirubin (DBIL) between the two groups. However, eight of the 21 patients with cystadenoma and six of the 25 patients with cystadenocarcinoma had elevated levels of TBIL and DBIL. There were three cases in the cystadenoma subgroup and six cases in the cystadenocarcinoma subgroup with postoperative complications.

Conclusion: Preoperative differential diagnosis relies on the integration of information, including clinical symptoms, laboratory findings and imaging results.

Keywords: Intrahepatic biliary cystadenocarcinoma; Intrahepatic biliary cystadenoma; Preoperative differential diagnosis.

Figure 1

Pathology of intrahepatic biliary cystadenoma and cystadenocarcinoma. A, B: Intrahepatic biliary cystadenoma (black diamond, hepatic tissue; hollow diamond, fibrous cyst wall; arrowhead, simple columnar epithelium; hollow arrowhead, cavity); C, D: Intrahepatic biliary cystadenocarcinoma. Mucinous cystadenocarcinoma with columnar epithelium, abundant cytoplasm, containing mucin, and nuclei located in the basal layer (C).