Nonparasitic solitary huge liver cysts causing intracystic hemorrhage or obstructive jaundice

Abstract

We report two cases of a nonparasitic solitary huge liver cyst. The first case, that of a 42-year-old woman, was admitted with a chief complaint of upper abdominal pain. Computed tomography (CT) scans revealed a huge cyst, 10 cm in diameter, in segments 4 and 5 of the liver, and spontaneous rupture of the cyst with intracystic hemorrhage. Her general condition was improved by transcatheter arterial embolization (TAE). Percutaneous cystic needle aspiration cytological examination revealed no malignant cells, so she was discharged. After 3 weeks, however, the cyst had increased in size, and simple cystectomy was performed. Histological examination proved the cyst to be benign. The patient in the second case, a 70-year-old man, was admitted with epigastric discomfort and obstructive jaundice. CT scans revealed a huge liver cyst, 18 x 15 cm, in the right lobe of the liver, with dilation of the bile duct in the lateral segment. Magnetic resonance cholangiopancreatography showed compression of the left hepatic duct by the cyst and dilation of the bile duct in the lateral segment. Endoscopic retrograde cholangiopancreatography disclosed no communication between the bile duct and the cyst. Percutaneous transhepatic cyst drainage was performed, and minocycline hydrochloride was infused. The cyst was reduced in size, and the reduction has been maintained for 20 months since treatment.

Hemorrhagic hepatic cysts mimicking biliary cystadenoma

“…Generally the patients might have acute or chronic upper abdomen pain, but some patients have no symptoms [1][2][3][4] . Extra attention should be paid to patients whose symptoms are relative to the severe complications caused by the intracystic hemorrhage.…”

“…For poorly conditioned patients, transcatheter arterial embolization, transhepatic cyst drainage, intracystic ethanol injection or noninvasive methods are indicated. These methods can obtain therapeutic effect in some patients, though the bleeding may recur afterwards [3][4][5]14,15] . Surgery should be performed for most well conditioned patients, especially those whose diagnosis does not preclude malignancy.…”

“…The operations can include partial hepatectomy, cystectomy, and fenestration. Partial hepatectomy and cystectomy can remove the whole cyst and reach curative effect [1][2][3][4]8,9,11,13,16] . Occasionally, a fenestration operation is performed to simplify the procedure, which can also obtain a good therapeutic effect [6] .…”

Hepatic Intracystic Organizing Hematoma Mimicking Biliary Cystadenocarcinoma in a Patient with Polycystic Liver Disease

“…Conversely, Park et al (16) reported that an elevated serum CA 19-9 level may not be helpful in the preoperative diagnosis of biliary cystic neoplasm. In other reports, elevated serum CA19-9 levels were observed in one patient with an infected simple hepatic cyst complicated by an intracystic hemorrhage (17) and also in another patient with a ruptured hepatic cyst (18). The serum and cystic fluid CEA levels were similar in both entities (15).…”

Rapidly enlarging solitary nonparasitic cyst of the liver in a child presenting as acute abdomen

“…When present, symptoms include fullness or upper abdominal mass, nausea, and occasional vomiting. Jaundice is an infrequent symptom [3,5,6]. Rapid enlargement of the cyst presenting as acute abdomen has been reported in some English publications [7].…”