Radiologic Reporting of Simple Hepatic Cyst Versus Biliary Cystadenoma May Lead to Unnecessary Surgery

2021 ◽  
pp. 000313482110540
Author(s):  
Aman Kumar ◽  
Alex Zendel ◽  
Michael Batres ◽  
David A. Gerber ◽  
Chirag S. Desai
Keyword(s):  
Differential Diagnosis ◽  
Cyst Wall ◽  
Cystic Lesion ◽  
Liver Cyst ◽  
Hepatic Cyst ◽  
Preoperative Imaging ◽  
Imaging Studies ◽  
Biliary Cystadenoma ◽  
Benign Condition ◽  
Simple Hepatic Cyst

Background and Aims Simple liver cyst (SHC) is a benign condition with no malignant potential. They are typically discovered incidentally due to the increased use of abdominal imaging, but some patients may present with abdominal pain. A radiologist’s differential diagnosis in cases of SHC will often include “rule out biliary cystadenoma.” Under these circumstances, patients and surgeons are more likely to pursue surgical options even in asymptomatic cases. The aim of this study is to conduct a retrospective analysis of presentation, radiologic reporting, management plan, and histopathology of patients referred to a tertiary hospital in order to determine the correlation between radiology and histology. Methods We retrospectively analyzed the clinical, radiological, and histopathological data of 20 patients operated for a diagnosis of a cystic lesion in the liver. Result The CT/MRI of 6 (30%) patients was reported as a biliary cystadenoma, 13 (65%) were reported as a simple hepatic cyst and 1 patient (5%) had hepatocellular carcinoma (HCC) with the additional diagnosis of multiple hepatic cysts. The lesion reported as HCC on the scan was separate from the cystic lesions. The modality of imaging for these cysts was evenly split, 50% of patients had a CT scan, and 50% had an MRI performed. All imaging studies were interpreted by an attending radiologist and most of them were discussed in multidisciplinary meetings. Nineteen patients (95%) had an intraoperative diagnosis of a simple liver cyst based on its visual appearance and clear fluid within the cyst. These patients underwent cyst wall fenestration and de-roofing with the cyst wall sent for histopathology. One patient (5%) with HCC underwent a non-anatomical liver resection. Histopathology was conclusive for a benign hepatic cystic lesion from the cyst wall biopsy. All 20 patients in this study underwent surgery, either due to symptoms or due to radiologic diagnosis of BCA. Four of the 20 cases (20%) were asymptomatic and out of these four cases, 3 (75%) were diagnosed as cystadenoma on the preoperative imaging studies. All 19 cases were diagnosed as a simple liver cyst on pathology. Conclusion In summary, there is a growing trend of “ruling-out the diagnosis of biliary cystadenoma” in patients who present with liver cysts. Patients are appropriately more anxious after this preoperative diagnosis and the treating surgeons have medico-legal concerns regarding conservative management in asymptomatic patients diagnosed as BCA. This single center experience draws attention to the radiology criteria utilized for diagnosing a biliary cystadenoma and suggests that it is time to revisit the imaging interpretation and differential diagnosis.

scholarly journals Giant simple hepatic cyst mimicking as hydatid cyst: diagnostic dilemma

2021 ◽  
Vol 8 (6) ◽  
pp. 1931
Author(s):  
Keerti R. ◽  
Ramanathan Manickam ◽  
Siddhartha Gowthamen
Keyword(s):  
Hydatid Cyst ◽  
Abdominal Mass ◽  
Mass Effect ◽  
Liver Cyst ◽  
Hepatic Cyst ◽  
Diagnostic Dilemma ◽  
Liver Cysts ◽  
Adjacent Structures ◽  
Simple Hepatic Cyst ◽  
Significant Mass Effect

Giant liver cysts are uncommon. Hepatic cysts are usually asymptomatic and are found incidentally but they can become symptomatic and cause bleeding, infection, mass effect to adjacent structures or rupture. We described two cases of symptomatic liver cysts described suspected clinically and radiologically reported as hydatid cyst but were revealed to be simple liver cysts following surgery. Two elderly men presented with an enlarging abdominal mass and abdominal pain for 1 week. Both patients on radiology had large cysts in the liver causing significant mass effect on adjacent structures and characteristics were suggestive of hydatid cyst. Diagnostic laparoscopy with drainage was done for both patients and revealed as simple hepatic cyst. Hence simple liver cyst can mimic as hydatid cyst attaining giant dimensions and should be considered as an important differential diagnosis. 

scholarly journals Biliary Cystadenoma: An Unusual Cause of Acute Pancreatitis and Indication for Mesohepatectomy

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Bilal Munir ◽  
Michael Meschino ◽  
Ashley Mercado ◽  
Roberto Hernandez-Alejandro
Keyword(s):  
Acute Pancreatitis ◽  
Surgical Resection ◽  
Cystic Lesion ◽  
Imaging Studies ◽  
Biliary Cystadenoma ◽  
Complete Surgical Resection ◽  
Suspected Diagnosis

The classic presentation of cystic hepatobiliary lesions is usually nonspecific and often identified incidentally. Here we describe the case of a patient presenting with acute pancreatitis resulting from a large centrally located biliary cystadenoma compressing the pancreas. Determination of the origin of the cystic lesion was difficult on imaging studies. Due to the difficult location of the lesion, a complete surgical resection was achieved with mesohepatectomy and the suspected diagnosis confirmed by pathology. The patient continues to do well 2 years post-op with no signs of recurrence.

scholarly journals Laparoscopic management of a giant simple hepatic cyst

2020 ◽  
Vol 1 (2) ◽  
pp. 137-142
Author(s):  
Vuk Aleksić ◽  
Vladimir Špica ◽  
Zorana Bokun-Vukašinović ◽  
Radmila Ćulafić ◽  
Svetlana Mijatović ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Randomized Clinical Trials ◽  
Laparoscopic Approach ◽  
Liver Cyst ◽  
Hepatic Cyst ◽  
Rapid Weight Loss ◽  
Scientific Debate ◽  
Simple Hepatic Cyst ◽  
The Subject ◽  
Giant Liver Cyst

Introduction: Congenital simple hepatic cysts are extremely rare and are usually asymptomatic. The best therapeutic approach to treating simple liver cysts remains the subject of scientific debate. Case report: We present the case of a giant liver cyst removed with a minimally invasive, laparoscopic approach in a 68-year-old woman, who presented with rapid weight loss. Conclusion: Due to the lack of randomized clinical trials comparing minimally invasive (laparoscopic) and open surgery approaches in liver cyst treatment, we recommend a personalized medical approach, applied after analyzing the characteristics of both the cyst and the patient.

Classifications and Clinical Assessment of Haemorrhoids:The Proctologist’s Corner

2020 ◽  
Vol 15 ◽  
Author(s):  
Arcangelo Picciariello ◽  
Petr Tsarkov ◽  
Vincenzo Papagni ◽  
Sergey Efetov ◽  
Daniel Markaryan ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Clinical Evaluation ◽  
Clinical Assessment ◽  
Adult Population ◽  
Preoperative Assessment ◽  
Classification Systems ◽  
Patient Treatment ◽  
Benign Condition ◽  
Haemorrhoidal Disease ◽  
Therapeutic Choice

BACKGROUND: Haemorrhoidal disease (HD) is a benign condition affecting a considerable part of adult population. HD can be considered a social and economic burden with high impact on patient lifestyle. Several new techniques and devices have been proposed for HD treatment; however, preoperative assessment is essential and the use of classification system is recommended. METHODS: In the last two decades many studies described the preoperative assessment and several attempts of classification for HD. This review focuses on the most relevant studies found in literature where classification systems and clinical evaluation with differential diagnosis have been evaluated. RESULTS: The knowledge of classification systems and differential diagnosis for HD has been shown to play a central role in the clinical assessment and in the best treatment choice. Although there are new challenging techniques and devices for HD treatment, a preoperative assessment is always mandatory. CONCLUSION: Preoperative clinical evaluation is essential for HD patient treatment and outcome. Classification systems are useful for the therapeutic choice and for researches on new medical or surgical treatments. In fact, the international guidelines advise several therapeutic options depending on the severity of the HD.

Leiomyoma with Bizarre Nuclei (Symplastic Leiomyoma) in the Paratubal Cyst Wall: Report of a Rare Case

2021 ◽  
pp. 106689692199779
Author(s):  
Murat Celik
Keyword(s):  
Differential Diagnosis ◽  
Smooth Muscle ◽  
Cyst Wall ◽  
Rare Case ◽  
Clinical Behavior ◽  
Uterine Smooth Muscle ◽  
Smooth Muscle Neoplasm ◽  
Histological Variants ◽  
Eosinophilic Cytoplasm ◽  
Paratubal Cyst

Leiomyoma is a benign mesenchymal tumor that develops from smooth muscle cells. It can present in various histological variants. Leiomyoma with bizarre nuclei is an infrequent variant of uterine smooth muscle neoplasm. It is characterized by focally or diffusely distributed bizarre cells on the background of a typical leiomyoma. These bizarre cells are large, multinucleated, or multilobulated and have an eosinophilic cytoplasm. Even though leiomyomas with bizarre nuclei display benign clinical behavior, their differential diagnosis from leiomyosarcoma can sometimes be difficult. Leiomyoma has been described most commonly in the uterus. There is no case of leiomyoma originating from paratubal cysts described in the literature. In this article, we present a rare case of leiomyoma with bizarre nuclei originating from a paratubal cyst.

scholarly journals Differential Diagnosis of Azoospermia in Men with Infertility

2021 ◽  
Vol 10 (14) ◽  
pp. 3144
Author(s):  
Danilo L. Andrade ◽  
Marina C. Viana ◽  
Sandro C. Esteves
Keyword(s):  
Differential Diagnosis ◽  
Physical Examination ◽  
Detailed Analysis ◽  
Clinical Management ◽  
Semen Analysis ◽  
Testicular Biopsy ◽  
Nonobstructive Azoospermia ◽  
Sperm Cryopreservation ◽  
Imaging Studies ◽  
Detailed Medical History

The differential diagnosis between obstructive and nonobstructive azoospermia is the first step in the clinical management of azoospermic patients with infertility. It includes a detailed medical history and physical examination, semen analysis, hormonal assessment, genetic tests, and imaging studies. A testicular biopsy is reserved for the cases of doubt, mainly in patients whose history, physical examination, and endocrine analysis are inconclusive. The latter should be combined with sperm extraction for possible sperm cryopreservation. We present a detailed analysis on how to make the azoospermia differential diagnosis and discuss three clinical cases where the differential diagnosis was challenging. A coordinated effort involving reproductive urologists/andrologists, geneticists, pathologists, and embryologists will offer the best diagnostic path for men with azoospermia.

scholarly journals Gastric Schwannoma: A Rare but Important Differential Diagnosis of a Gastric Submucosal Mass

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
William Yoon ◽  
Kari Paulson ◽  
Paul Mazzara ◽  
Sweety Nagori ◽  
Mohammed Barawi ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Surgical Resection ◽  
Treatment Options ◽  
Partial Gastrectomy ◽  
Preoperative Imaging ◽  
Mesenchymal Tumors ◽  
Gastric Schwannoma ◽  
Gastric Mass ◽  
Submucosal Mass ◽  
Slow Growing

Schwannomas are generally slow growing asymptomatic neoplasms that rarely occur in the GI tract. However, if found, the most common site is the stomach. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, and 60–70% of them occur in the stomach. Owing to their typical presentation as submucosal neoplasms, gastric schwannomas and GISTs appear grossly similar. Accordingly, the differential diagnosis for a gastric submucosal mass should include gastric schwannomas. Furthermore, GI schwannomas are benign neoplasms with excellent prognosis after surgical resection, whereas 10–30% of GISTs have malignant behavior. Hence, it is important to distinguish gastric schwannomas from GISTs to make an accurate diagnosis to optimally guide treatment options. Nevertheless, owing to the paucity of gastric schwannomas, the index of suspicion for this diagnosis is low. We report a rare case of gastric schwannoma in 53-year-old woman who underwent laparoscopic partial gastrectomy under the suspicion of a GIST preoperatively but confirmed to have a gastric schwannoma postoperatively. This case underscores the importance of including gastric schwannomas in the differential diagnosis when preoperative imaging studies reveal a submucosal, exophytic gastric mass. For a gastric schwannoma, complete margin negative surgical resection is the curative treatment of choice.

scholarly journals Young child with painful edema and purpura: a case report

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Sarah Contorno ◽  
Giorgio Cozzi ◽  
Irene Berti ◽  
Egidio Barbi ◽  
Andrea Taddio
Keyword(s):  
Differential Diagnosis ◽  
Child Abuse ◽  
Case Report ◽  
Young Child ◽  
Sickle Cell ◽  
Benign Condition ◽  
Sickle Cell Crisis

Abstract Background We reported the case of a two-old-year boy with a painful acute hemorrhagic edema. This is a self-limited benign condition: usually, affected children are well appearing and this strongly support the diagnosis. In the opposite, in our case, we observed a painful presentation of the edema. Therefore, we demonstrated that rarely, this condition could have also a painful presentation. Conclusions This case report helps clinician to know that also acute hemorrhagic edema could have a painful presentation, so we must considered it in the differential diagnosis with sepsis, sickle cell crisis and child abuse. We believe that these findings will be of interest to pediatricians.

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