A paradigm shift in diagnosis and treatment innovation for mucinous cystic neoplasms of the liver

Abstract

This study comprehensively explores the clinical characteristics, diagnostic approaches, and treatment methods for liver mucinous cystic neoplasms (MCN). A retrospective analysis was conducted on seven individuals diagnosed with MCN, admitted to the Fifth Medical Center of the PLA General Hospital between October 2016 and May 2023. Preoperative AFP was negative, while CA19-9 was elevated in two cases. Surgical resection was performed for all patients. The patients showed favorable postoperative recovery. Follow-up revealed an excellent overall survival rate, except for one case of invasive carcinoma resulting in tumor recurrence and metastasis 6 months after surgery. MCN poses a diagnostic challenge due to the absence of distinct clinical and radiological features, leading to potential misdiagnosis and inappropriate treatment. Patients with suspected liver cystic diseases should consider the possibility of MCN. Surgical resection has proven to be a practical approach with satisfactory therapeutic outcomes.

Keywords: Diagnosis; Invasive carcinoma; Liver; Mucinous cystic neoplasms; Surgical resection; Treatment.

Figure 1

(Patient 1) Abdominal contrast-enhanced CT scan reveals a 2.8 * 2.5 cm slightly low-density circular lesion in the left lobe of the liver. Mild enhancement is seen at the lesion edges during the arterial phase, while mild infiltration of the contrast agent leads to slightly lower-density appearance in the portal venous phase. Adjacent left hepatic lobe shows bile duct dilation. Images (A), (B), and (C) correspond to the non-contrast, arterial, and venous phases, respectively.

Figure 2

(Patient 3) Abdominal contrast-enhanced CT scan shows a non-enhancing, circular, fluid-density lesion with multiple septations and partial calcifications in the non-contrast phase. The contrast-enhanced scan reveals enhancement confined to the relatively thick septations within the lesion.

Figure 3

(Patient 6) Image (A) shows multiple circular liver lesions with long T1 and long T2 signals, some with septations. The largest lesion, located in the left lobe of the liver, communicates with the intrahepatic bile duct and measures approximately 3.3 × 2.6 cm. Image (B) shows a cystic filling defect in the common bile duct. Image (C) displays an intraoperative view of a cystic outgrowth extending from the left hepatic duct into the common bile duct. Image (D) presents the resected specimen of the gallbladder and left lobe of the liver.

Figure 4

(Patient 6) The pathological image shows a lining of tall columnar cells, with areas of cuboidal and squamous cells, and cellular-rich ovarian-like stroma.