Mucinous cystic neoplasm of the liver with biliary prolapse mimicking intraductal papillary neoplasm of the bile duct: a case report.
Naotoshi Hatsuda, Toshiyuki Sato, Suzune Tsukamoto et al.
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Case in brief
A 39-year-old woman receiving fertility treatment presented with recurrent hyperbilirubinemia and predominantly cholestatic liver test abnormalities. MRI showed a 10.5-cm multilocular cystic lesion in liver segment 4 with downstream biliary dilatation; septa were visible within the dilated duct. CT showed enhancement of the cyst wall and septa, and cholangiography demonstrated a smooth oval filling defect. Biopsy identified mucin-producing columnar epithelium over ovarian-like stroma, confirming mucinous cystic neoplasm of the liver. She underwent extended left hepatectomy with extrahepatic bile duct resection and reconstruction. Pathology showed low-grade intraepithelial neoplasia; she remained recurrence-free for 20 months.
What made this case unusual
The neoplasm extended into the bile duct, with cyst-wall or septal components mimicking cystic intraductal papillary neoplasm of the bile duct despite the usual lack of biliary communication in hepatic mucinous cystic neoplasms.
Diagnostic / clinical pearl
Biliary communication does not exclude hepatic mucinous cystic neoplasm. Intraductal extension of cyst wall or septa in a dilated bile duct may help distinguish it from cystic intraductal papillary neoplasm.