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. 2022 Sep 23;8(1):177.
doi: 10.1186/s40792-022-01511-9.

Mucinous cystic neoplasm of the liver with polypoid nodule prolapsing into the bile duct: a case report and review of literature

Yasuhiro Fukui  1 , Akihiro Murata  2 , Sadatoshi Shimizu  2 , Kayo Sai  2 , Takuma Okada  2 , Tetsuzo Tashima  2 , Shintaro Kodai  2 , Akishige Kanazawa  2 , Takahiro Okuno  3
Affiliations

Mucinous cystic neoplasm of the liver with polypoid nodule prolapsing into the bile duct: a case report and review of literature

Yasuhiro Fukui et al. Surg Case Rep. .

Abstract

Background: Mucinous cystic neoplasm of the liver (MCN-L) is a rare cystic tumor as defined by the 2010 World Health Organization classification. MCN-L usually does not communicate with or grow into the bile duct. Herein, we present a rare case of MCN-L with a polypoid nodule protruding into the bile duct.

Case presentation: A 69-year-old woman was referred to our hospital for elevated serum liver enzyme levels and obstructive jaundice. The patient also complained of abdominal pain in the right hypochondriac region. Abdominal ultrasonography showed a cystic lesion in segment 4 (S4) of the liver. Computed tomography revealed a 4-cm multilocular cystic lesion with a thick wall and multiple septal formations, showing a cyst-in-cyst appearance in S4. Endoscopic retrograde cholangiography showed a contrast defect between the left hepatic duct and the common bile duct, which was suspected to be a nodular lesion in the bile duct. Bile cytology and biopsy of the nodular lesion showed no malignant findings. Based on these findings, the differential diagnosis in this patient included intraductal papillary neoplasm of the bile duct and MCN-L, which had malignant potential. The patient underwent left hemihepatectomy, including caudate lobe excision with bile duct resection and right hepatocholangiojejunostomy. Macroscopic findings showed a 40 × 29 mm multilocular cystic lesion with a polypoid nodule that protruded into the left intrahepatic bile duct. As an ovarian-like stroma was observed in both cystic and polypoid lesions microscopically, the histopathological diagnosis was MCN-L. The postoperative course was uneventful, and the patient was discharged 24 days after surgery. The patient is currently alive without recurrence 22 months after the surgery.

Conclusion: Although MCN-L rarely communicates with the bile duct, it is necessary to consider that MCN-L could grow into the bile duct, occasionally causing obstructive jaundice.

Keywords: Bile duct; Growth; Mucinous cystic neoplasm of the liver; Ovarian-like stroma.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Imaging examination findings. a Abdominal ultrasonography showed a 49 × 29-mm cystic lesion with a septum in Segment 4 (S4). b Computed tomography (CT) revealed a 4-cm multilocular cystic lesion with multiple septal formations showing a cyst-in-cyst appearance in S4 (arrow). c CT revealed polypoid nodule (oval) protruded in the left hepatic duct from the cystic lesion (arrow). d Endoscopic retrograde cholangiography showed a contrast defect in the left hepatic duct to common bile duct which was suspected to be a nodular lesion in the bile duct (arrow)
Fig. 2
Fig. 2
Macroscopic findings of the resected tumor. a Macroscopic findings showed a 40 × 29-mm multilocular cystic lesion. b, c Cystic lesion protruding into the left intrahepatic bile duct, and forming a polypoid lesion (arrow). The polypoid lesion was derived from cystic wall
Fig. 3
Fig. 3
Microscopic findings of the resected tumor. a The cyst wall was covered with columnar epithelium, and ovarian-like stroma (OLS) was observed extensively in the cyst wall stroma. b Immunostaining showed the sample was positive for estrogen receptors (ER). c In the polypoid lesion, OLS was observed as well as cyst wall. d Immunostaining also showed that the polypoid lesion was ER positive
See this image and copyright information in PMC

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