Diagnosis and treatment experience of atypical hepatic cystic echinococcosis type 1 at a tertiary center in China

BACKGROUND Some hydatid cysts of cystic echinococcosis type 1(CE1)lack well-defined cyst walls or distinctive endocysts,making them difficult to differentiate from simple hepatic cysts.AIM To investigate the diagnostic methods for atypical hepatic CE1 and the clinical efficacy of laparoscopic surgeries.METHODS The clinical data of 93 patients who had a history of visiting endemic areas of CE and were diagnosed with cystic liver lesions for the first time at the People's Hospital of Xinjiang Uygur Autonomous Region(China)from January 2018 to September 2023 were retrospectively analyzed.Clinical diagnoses were made based on findings from serum immunoglobulin tests for echinococcosis,routine abdominal ultrasound,high-frequency ultrasound,abdominal computed tomography(CT)scan,and laparoscopy.Subsequent to the treatments,these patients underwent reexaminations at the outpatient clinic until October 2023.The evaluations included the diagnostic precision of diverse examinations,the efficacy of surgical approaches,and the incidence of CE recurrence.RESULTS All 93 patients were diagnosed with simple hepatic cysts by conventional abdominal ultrasound and abdominal CT scan.Among them,16 patients were preoperatively diagnosed with atypical CE1,and 77 were diagnosed with simple hepatic cysts by high-frequency ultrasound.All the 16 patients preoperatively diagnosed with atypical CE1 underwent laparoscopy,of whom 14 patients were intraoperatively confirmed to have CE1,which was consistent with the postoperative pathological diagnosis,one patient was diagnosed with a mesothelial cyst of the liver,and the other was diagnosed with a hepatic cyst combined with local infection.Among the 77 patients who were preoperatively diagnosed with simple hepatic cysts,4 received aspiration sclerotherapy of hepatic cysts,and 19 received laparoscopic fenestration.These patients were intraoperatively diagnosed with simple hepatic cysts.During the followup period,none of the 14 patients with CE1 experienced recurrence or implantation of hydatid scolices.One of the 77 patients was finally confirmed to have CE complicated with implantation to the right intercostal space.CONCLUSION Abdominal high-frequency ultrasound can detect CE1 hydatid cysts.The laparoscopic technique serves as a more effective diagnostic and therapeutic tool for CE.

Giant complex hepatic cyst causing pseudocystitis:A case report

BACKGROUND Hepatic cysts are common benign liver tumors that are typically asymptomatic.However,larger cysts,particularly giant liver cysts,can potentially induce symptoms.If the diameter of the cyst exceeds 10 cm,it can exert pressure on adjacent organs,leading to manifestations of corresponding symptoms.Here,we report the case of a complex giant hepatic cyst that caused pseudocystitis.CASE SUMMARY A 16-year-old girl was admitted to our hospital with frequent and urgent urination.Ultrasonography revealed no obvious uterine adnexal abnormalities but showed a hypoechoic,cystic mass(173 mm×84 mm×138 mm)with clear boundaries,and an unclear blood flow signal in the abdominal cavity(extending from the lower edge of the left lobe of liver to the upper edge of the bladder).Abdominal contrast-enhanced computed tomography revealed a giant cystic mass in the abdominal and pelvic cavities,possibly originating from the liver,and a small amount of free fluid in the pelvic cavity,which subsequent magnetic resonance imaging confirmed.The imaging characteristics were consistent with a benign lesion.The patient underwent laparoscopic resection of the giant liver cyst with partial liver resection.Post-surgery her symptoms urinary symptoms were relieved completely and she was discharged on the sixth postoperative day.CONCLUSION Our patient presented with symptoms suggestive of pseudocystitis,stressing the need for considering possibilities of other etiologies and differential diagnoses.

Giant infected hepatic cyst causing exclusion pancreatitis:A case report

BACKGROUND An infected hepatic cyst causes clinical symptoms,such as fever and abdominal pain.A cyst with a diameter>10 cm increases the likelihood of exclusion symptoms in adjacent organs.Herein,we report a case of pancreatitis caused by an infected hepatic cyst.CASE SUMMARY The patient was an 88-year-old woman with a history of polycystic liver disease and a cyst>10 cm in diameter.She was referred to our hospital for upper abdominal pain that persisted for four days before consultation.She had a fever of 37.4℃,and a blood test showed a C-reactive protein level of 23 mg/dL.An infected hepatic cyst was diagnosed by abdominal ultrasonography,computed tomography,and magnetic resonance imaging.Antibacterial therapy and percutaneous cyst puncture did not elicit sufficient therapeutic effects.As the cyst growth continued,laparoscopic hepatic cyst fenestration was performed on hospitalization day 20.Thereafter,symptoms improved,and she was discharged on hospital day 31.CONCLUSION To our knowledge,this is the second case report of pancreatitis associated with hepatic cyst growth.Percutaneous cyst puncture and drainage or surgical therapy can be considered if a slight improvement with antibiotic therapy alone or exclusion of surrounding organs is observed.Further,attention is needed to avoid potential recurrence.

Treatment of hepatic cysts by B-ultrasound-guided radiofrequency ablation

BACKGROUND: The traditional therapy for hepatic cysts has limited success because of recrudescence. Radiofrequency ablation (RFA) has become popular because of its advantages including little damage, therapeutic effect and reduced suffering. This report describes the effects and reliability of RFA in the treatment of 29 patients with hepatic cysts. METHODS: B-ultrasound-guided REA was used to treat hepatic mono-cyst or multi-cysts of 29 patients (63 tumors). Ablative efficiency and complications were assessed by imaging and clinical symptoms. RESULTS: The tumors were abated completely in 34 cysts with a diameter <5 cm and no recurrence was seen after 3 months. In 21 cysts with a diameter of 5-10 cm, tumor volume was decreased by over 70%, then reduction and fiberosis were found. In 8 cysts with a diameter greater than 10 cm, tumor volume was decreased by more than 60%, and in 2 cysts it was increased more slightly than that at I month after REA. In subsequent follow-up (6 and 12 months after REA), tumors <10 cm in diameter were fully ablated. No significant discomfort and complications were found in any patient. CONCLUSION: RFA for the treatment of hepatic cysts is safe, and free from complications.

Giant simple hepatic cyst with multiple elevated serum tumormarkers: A case report

BACKGROUND Simple hepatic cysts are relatively common in adults, and mostly appear asasymptomatic incidental radiologic findings. Occasionally, a large cyst will causesymptoms. Elevations in the serum biomarkers protein induced by vitamin Kabsence (PIVKA)-II, cancer antigen (CA) 12-5, and CA19-9 are often associatedwith malignant tumors in the liver or bile ducts. This is the first report to describea case of hepatic cyst with elevated levels of PIVKA-II and CA12-5.CASE SUMMARY An 84-year-old Chinese woman was admitted with gradual abdominal distension.Her symptoms started 1 year ago, and she had poor appetite and a weight loss of5 kg within the past 2 wk. She denied any symptoms associated with abdominalpain, fever and chills, nausea and vomiting, etc. The abdomen was enlarged, morein the right upper quadrant, without tenderness. Laboratory examination showedsignificantly increased serum levels of PIVKA-II, CA12-5, and CA19-9. Acomputed tomography scan revealed multiple round cysts in the liver with clearboundaries. The largest cyst was 20.1 cm × 12.2 cm × 19.6 cm in size, located in theright lobe of the liver with mild dilatation of the intrahepatic bile duct, but therewas no contrast enhancement. Percutaneous drainage on the largest hepatic cystand polycinnamol sclerosing agent injection into the cyst cavity were performed.After treatment, the patient’s symptoms relieved and the elevated serum tumormakers reduced to the normal levels dramatically.CONCLUSION The present report identifies an unusual case of a giant hepatic cyst with markedelevation of serum tumor marker levels of PIVKA-II, CA12-5, and CA19-9. Aftertreatment, these three serum markers dramatically decreased to normal levels.The mechanisms for the elevation of these tumor markers may be as follows: (1) Agiant hepatic cyst compresses the liver, causing injury to the hepatocytes, whichmay lead to secretion of a large amount of PIVKA-II;and (2) Some tumorassociatedantigens, such as carcinoembryonic antigen, CA19-9, CA12-5, andCA15-3, are expressed on inflammatory cells.

Congenital hepatic cyst:Eleven case reports

BACKGROUND Liver cysts in infants are uncommon.With modern diagnostic imaging,we can achieve an early diagnosis of congenital hepatic cysts.Our purpose was to investigate the clinical features,surgical treatment methods and prognosis of infants with congenital hepatic cysts.Herein,we report a case series of congenital hepatic cysts.CASE SUMMARY Eleven infants with hepatic cysts were retrospectively analysed.Ten of them had simple hepatic cysts,and a girl with a large hepatic mass was diagnosed with a solitary intrahepatic biliary cyst accompanied by a choledochal cyst.Among the ten simple hepatic cysts,eight were solitary and two were multiple.A total of 87.5%(7 of 8)of infants with solitary hepatic cysts were detected before delivery,and 86%(6 of 7)of those cysts were located in the right lobe of the liver.Surgical intervention was required for symptomatic hepatic cysts.Cyst resection or unroofing with fulguration of the cyst bed was employed.No recurrence of cysts was observed in these infants.CONCLUSION Congenital hepatic cyst is a condition with a narrow differential diagnosis.Accurate diagnosis is essential for appropriate management.Unroofing is the favoured treatment in infants with symptomatic cysts.Most infants with congenital hepatic cysts have a good prognosis.

Repeated bacteremia and hepatic cyst infection lasting 3 years following pancreatoduodenectomy:A case report

BACKGROUND Simple hepatic cysts are commonly occurring lesions that are usually asymptomatic and require no treatment.Hepatic cyst infection,however,is considered a severe complication.We report a case of hepatic cyst infection following pancreatoduodenectomy with repeated fever lasting for almost 3 years,and two cysts were infected successively.CASE SUMMARY A 72-year-old woman diagnosed with adenocarcinoma of duodenal papilla underwent pancreatoduodenectomy with Child reconstruction.She then suffered repeated occurrences of bacteremia and hepatic cyst infection for 3 years.Blood cultures were positive for Klebsiella pneumoniae and Escherichia coli a total of 7 times and 4 times,respectively.During the early stage,we suspected that postoperative reflux cholangitis was the cause of fever and bacteremia.Multiple cysts were observed,so it was difficult to determine which cyst was infected.Through repeat examination,we found the focus of infection,and we treated the patient with antimicrobials and performed percutaneous cyst drainage.The patient did not experience another cyst infection for more than 4 years.CONCLUSION Biliary reconstruction inducing hepatic cyst infection is easily misdiagnosed as biliary reflux infection,Repeated imaging examination is a method for identifying the infected focus.

Percutaneous aspiration and sclerotherapy of a giant simple hepatic cyst causing obstructive jaundice:A case report and review of literature

BACKGROUND Giant simple hepatic cysts causing intrahepatic duct dilatation and obstructive jaundice are uncommon.A variety of measures with different clinical efficacies and invasiveness have been developed.Nonsurgical management,such as percutaneous aspiration and sclerotherapy,is often applied.CASE SUMMARY The case is a 39-year-old female with a 5-mo history of cutaneous and scleral icterus,loss of appetite,and dark urine.Lab tests showed jaundice and liver function abnormalities.Imaging revealed a giant simple hepatic cyst obstructing the intrahepatic bile ducts.A combination of percutaneous catheter aspiration and lauromacrogol sclerotherapy was successfully performed and the effects were satisfactory with the size of cyst decreasing from 13.7 cm×13.1 cm to 3.0 cm×3.0 cm.Further literature review presented the challenges of managing giant simple hepatic cysts that cause obstructive jaundice and compared the safety and efficacy of a combination of percutaneous aspiration and lauromacrogol sclerotherapy with other management strategies.CONCLUSION Giant simple hepatic cysts can cause obstructive jaundice,and a combination of percutaneous catheter aspiration and sclerotherapy with lauromacrogol are suggested to treat such cases.

Ciliated hepatic foregut cyst:an increasingly diagnosed condition

BACKGROUND:Ciliated foregut cysts of the liver are rare, with only 96 cases diagnosed since the first description in 1857.They are being increasingly diagnosed recently;the majority of the cases have been reported in the last 15 years. Although they bear a close resemblance to the simple cyst of the liver which has essentially a benign course,ciliated hepatic foregut cysts(CHFCs)can progress to malignancy with devastating consequences.It is imperative that this group of conditions be diagnosed and treated adequately. DATA SOURCES:This review includes discussion of the data from all the 96 reported cases from English and non-English literature.Analysis of the incidence rates, embryogenesis,growth,clinical features,risk of malignancy and the prognosis are highlighted systematically.The roles of various diagnostic modalities including ultrasound, CT,MRI,fine needle aspiration cytology(FNAC), immunohistochemistry and surgery are further discussed. RESULTS:The mean age of patients with CHFC was 48± 12 years.The male/female ratio was 1.1∶1.The majority of patients with CHFC(62%)were asymptomatic,and the common mode of presentation was right upper abdominal pain.The cysts occurred in the left lobe in 51 patients, with sole location in segmentⅣin 44,and in the right lobe in 26.The average size of the cysts was 3.6±2.12 cm. The majority of the cysts were unilocular,and only 7 cases were multilocular.Cyst contents were described as viscous or mucinous in 73 patients,whereas bilious fluid was noted in 3.Large cysts having squamous carcinoma were cited in 3 patients,and 2 had extensive squamous metaplasia without malignancy.Others had benign histopathology. CONCLUSIONS:Clinicians have become increasingly aware of CHFC.Imaging alone is not diagnostic per se, but when considered in the context of the global picture does provide important clues to the diagnosis.FNAC is diagnostic by the presence of the ciliated columnar aspirate but lacks sensitivity.Infantile presentation is usually accompanied by biliary communication and mandates a different surgical approach.The demonstration of malignant transformation in 3 cases and its fatal course emphasizes the need for surgical resection in all cases once the diagnosis is made.

Bile duct hamartomas-the von Meyenburg complex

Hamartomas of the bile duct (von Meyenburg complex) are benign neoplasms of the liver, constituted histologically cystic dilatations of the bile duct, encompassed by fibrous stroma. We report a 42-year-old female patient with symptomatic cholecystitis, whose gross and ultrasonic appearance suggestive of multiple liver metastases. Magnetic resonance imaging and liver biopsy are the gold standards for diagnosis of this rare hepatobiliary condition.

Differentiating Cystic Liver Lesions:A Review of Imaging Modalities, Diagnosis and Management

Hepatic cysts(HCs)are frequently discovered incidentally on abdominal imaging.The prevalence of HCs has been reported as high as 15–18%in the United States.Although most cysts are benign,some are malignant or premalignant.It is impor-tant to diagnose cystic lesions in order to properly manage them.Imaging with conventional ultrasound,computed to-mography,magnetic resonance imaging,or contrast-enhanced ultrasound can be used to further characterize and diagnose HCs.Ultrasound is typically the first-line imaging modality,whereas more advanced imaging can help narrow down the specific lesion.Contrast-enhanced ultrasound is a newer mo-dality,recently approved in the United States,which offers non-invasive evaluation in real-time.The first step in diagnosis is stratifying risk by differentiating simple and complex cysts.There are several features that can help identify HCs,including septae,mural consistency,calcifications,and quality of cystic fluid.Simple cysts are mainly congenital cysts,but also occur in polycystic liver disease.Complex cysts include mucinous neoplasms,echinococcal cysts,hemorrhagic cysts,cystic hep-atocellular carcinoma and other rare lesions.Treatment is indicated in symptomatic cysts or those suspicious for malig-nant or premalignant features.Treatment modalities include fenestration,aspiration sclerotherapy,or surgical resection.

肝脏纤毛前肠囊肿:三例报道和影像学特征复习

Ciliated hepatic foregut cysts(CHFCs)are rare cystic lesions which are most commonly asymptomatic.They can be clinically important as they may,on rare occasions,undergo malignant transformation or cause mass effect if significantly enlarged.Three cases of CHFCs are presented in this article and their imaging features are reviewed.