Biliary cystadenoma and cystadenocarcinoma differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Suveenkrishna Pothuru, M.B,B.S. [2]

Overview

Biliary cystadenoma and cystadenocarcinoma must be differentiated from simple liver cysts, liver hematoma, hepatic echinococcal cyst, hepatic abscess, post-traumatic cysts, and bilomas.

Differenting Biliary cystadenoma and cystadenocarcinoma from other Diseases

Biliary cystadenoma and cystadenocarcinoma must be differentiated from: ^[1]^[2]^[3]

Simple liver cysts
Hepatic echinococcal cyst
Hepatic abscess
Hematoma
Post-traumatic cysts
Metastatic ovarian or pancreatic adenocarcinoma
Bilomas
Cystic hamartoma
Embryonal sarcoma
Polycystic liver disease
Caroli disease

Disease	Causes	Symptoms									Lab Findings	Imaging Findings	Other Findings
		Fever	Pain		Cough	Hepatomegaly	Jaundice	Weight loss	Diarrhea or Dysentry	Nausea and vomiting
		Fever	Abdominal pain (right upper quadrant pain)	Pleuritic pain	Cough	Hepatomegaly	Jaundice	Weight loss	Diarrhea or Dysentry	Nausea and vomiting
Echinococcal (hydatid) cyst	Echinococcus granulosus		✔		✔		✔ (Obstructive jaundice)	✔			Histology: Hydatid cyst with three layers: The outer pericyst: Corresponds with compressed and fibrosed liver tissue The endocyst: An inner germinal layer The ectocyst: A thin, translucent interleaved membrane	Ultrasound: Cystic to solid-appearing pseudotumors Water lily sign Calcifications seen peripherally	Blood or liquid from the ruptured cyst may be coughed up Pruritis
Amoebic liver abscess	Entamoeba histolytica	✔✔✔	✔✔✔	✔/✘	✔	✔✔/✘	✔ (late stages)	✔ (late stages)	✔	✔	Hypoalbuminemia (✔) Histology: Multiple neutrophilic abscess with areas of necrosis A rim of connective tissue, with few inflammatory cells and amoebic trophozoites	Ultrasound: Homogenous hypoechoic areas that can be single or multiple with round edges Round or oval in shape with variable size (around 2-6 cm in diameter) An incomplete rim of edema	Respond well to chemotherapy and rarely require drainage Marked male predominance More common in developing countries Sero-positive Right lobe is more frequently involved
Pyogenic liver abscess	Bacteria Gram-positive aerobes Gram-negative enterics Anaerobic organisms Acid fast bacilli	✔	✔	✔✔	✔✔	✔/✘	✔✔✔	✔ (acute loss)	Pale/dark stool	✔	Hypoalbuminemia(✔✔✔) Histology: Multiple neutrophilic abscesses with areas of necrosis in the liver parencyma^[4]^[5]	CT scan shows cluster sign Aggregation of multiple low attenuation liver lesions in a localized area to form a solitary larger abscess cavity	Abnormal pulmonary findings Diabetes mellitus increases the risk Medical-surgical approach is indicated More common in developed countries Culture positive and sero-negative Both lobes are commonly involved
Fungal liver abscess	Candida species Aspergillus species	✔	✔	✔/✘	✔	✔	✔	✔	✔	✔		CT and Us findings with four patterns of presentation: Wheel-within-a-wheel pattern Bull’s-eye configuration pattern Uniformly hypoechoic nodule Echogenic foci with variable degrees of posterior acoustic shadowing	Less common Pure fungal abscess or associated with pyogenic abscess Candida and Aspergillus are commonly found in the culture of aspirated pus Associated with underlying malignancy or DM
Malignancy (hepatocellular carcinoma/metastasis)	Hepatitis B and C Aflatoxins Alcohol Hemochromatosis Alpha 1 antitrypsin deficiency Non alcoholic fatty liver disease	✔	✔ (uncommon)			✔	✔	✔✔	Pale/Chalky stool	✔✔	High levels of AFP in serum Abnormal liver function tests	Liver biopsy	Other symptoms: Splenomegaly Variceal bleeding Ascites Spider nevi Asterixis

	Morphology	Septations	Wall character	Cyst contents
Hydatid cyst	Cyst with in cyst	–	Thick, uniform calcified	Daughter cysts
Congenital cyst	Single or multiple cysts	+/-	Thin	Low density
Cystedenoma	Single or multiple cysts	+/-	Mural nodules	Low density

References

↑ Biliary cystadenoma.Dr Yuranga Weerakkody and Radswiki et al.Radiopaedia.org 2015. http://radiopaedia.org/articles/biliary-cystadenoma
↑ Ahanatha Pillai, Sastha; Velayutham, Vimalraj; Perumal, Senthilkumar; Ulagendra Perumal, Srinivasan; Lakshmanan, Anand; Ramaswami, Sukumar; Ramasamy, Ravi; Sathyanesan, Jeswanth; Palaniappan, Ravichandran; Rajagopal, Surendran (2012). “Biliary Cystadenomas: A Case for Complete Resection”. HPB Surgery. 2012: 1–6. doi:10.1155/2012/501705. ISSN 0894-8569.
↑ Ramacciato, Giovanni; Nigri, Giuseppe R; D’Angelo, Francesco; Aurello, Paolo; Bellagamba, Riccardo; Colarossi, Cristina; Pilozzi, Emanuela; Del Gaudio, Massimo (2006). World Journal of Surgical Oncology. 4 (1): 76. doi:10.1186/1477-7819-4-76. ISSN 1477-7819. Missing or empty |title= (help)
↑ https://librepathology.org/wiki/Liver_pathology Accessed on February 22, 2017
↑ Lublin M, Bartlett DL, Danforth DN, Kauffman H, Gallin JI, Malech HL; et al. (2002). “Hepatic abscess in patients with chronic granulomatous disease”. Ann Surg. 235 (3): 383–91. PMC 1422444. PMID 11882760.

Template:WikiDoc Sources

[radio1-1] Biliary cystadenoma.Dr Yuranga Weerakkody and Radswiki et al.Radiopaedia.org 2015. http://radiopaedia.org/articles/biliary-cystadenoma

[Ahanatha_PillaiVelayutham2012-2] Ahanatha Pillai, Sastha; Velayutham, Vimalraj; Perumal, Senthilkumar; Ulagendra Perumal, Srinivasan; Lakshmanan, Anand; Ramaswami, Sukumar; Ramasamy, Ravi; Sathyanesan, Jeswanth; Palaniappan, Ravichandran; Rajagopal, Surendran (2012). “Biliary Cystadenomas: A Case for Complete Resection”. HPB Surgery. 2012: 1–6. doi:10.1155/2012/501705. ISSN 0894-8569.

[RamacciatoNigri2006-3] Ramacciato, Giovanni; Nigri, Giuseppe R; D’Angelo, Francesco; Aurello, Paolo; Bellagamba, Riccardo; Colarossi, Cristina; Pilozzi, Emanuela; Del Gaudio, Massimo (2006). World Journal of Surgical Oncology. 4 (1): 76. doi:10.1186/1477-7819-4-76. ISSN 1477-7819. Missing or empty |title= (help)

[abscess-4] ttps://librepathology.org/wiki/Liver_pathology Accessed on February 22, 2017

[pmid11882760-5] Lublin M, Bartlett DL, Danforth DN, Kauffman H, Gallin JI, Malech HL; et al. (2002). “Hepatic abscess in patients with chronic granulomatous disease”. Ann Surg. 235 (3): 383–91. PMC 1422444. PMID 11882760.

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Biliary cystadenoma and cystadenocarcinoma differential diagnosis

Overview

Differenting Biliary cystadenoma and cystadenocarcinoma from other Diseases

References

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