Arrangements of hepatobiliary cystadenoma complicated with congenital choledochal cyst: a case report and literature review

Abstract

Hepatobiliary cystadenoma complication with congenital choledochal cyst is extremely rare and has never been reported in literatures so far.The aim of the study was to investigate the disease arrangements by analyzing the case and performing a systematic review of the literature.This case report documents the details and clear patterns of the patient. A 65-year-old woman with fever (39.2°C), nausea, vomiting, and chronic hepatitis B imaging demonstrated a left hepatic multilocular cystic mass and cystic dilated common bile duct.A regular left hemihepatectomy was performed with resection of the entire tumor and choledochal cyst.The surgical margins were negative and a final diagnosis of hepatobiliary cystadenoma complicated with congenital choledochal cyst was established. The patient had an uneventful postoperative recovery and liver function returned to normal levels.Main lessons learned from this case are: the awareness should be raised about the disease to avoid misdiagnosis; preoperative ultrasonography, computed tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography play an important role in detecting the lesion; the scope and timing of the surgery should be determined, which provide the chance of cure to complete resection of the tumor.

Figure 1

An abdominal computed tomography (CT) imaging demonstrated a left hepatic multiloculated cystic mass measuring 9.5 × 8.6 cm; local cystic wall could show high-intensity shadows projecting into the intracavitary, less clear boundaries, and dilated left intrahepatic biliary tree.

Figure 2

Magnetic resonance cholangiopancreatography (MRCP) demonstrated a multiloculated cystic lesion measuring 9.4 cm and cystic dilated common bile duct 8.6 cm in diameter, and the dilation of both right and left intrahepatic bile ducts lacked asymmetry.

Figure 3

On gross examination, the resected left liver specimen showed a multilocular cystic lesion measuring 11 × 8 × 3.5 cm, covered with bullate nodules on the cutting surface.

Figure 4

Intrahepatic biliary lesion was lined by a single layer of cuboidal and columnar epithelial cells, arrangement of papillary and adenoid, and some epithelial hyperplasia with severe atypia were observed microscopically.