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CORRESPONDENCE
Year : 2022  |  Volume : 55  |  Issue : 6  |  Page : 242-243

Differentiating hepatic mucinous cystic neoplasms from hydatid cyst of the liver


Department of Surgery, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia

Date of Submission03-Jul-2022
Date of Acceptance05-Jul-2022
Date of Web Publication22-Nov-2022

Correspondence Address:
Ian Chik
Department of Surgery, 8th Floor, Hospital Canselor Tuanku Muhriz, Jalan Yaakob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur
Malaysia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/fjs.fjs_146_22

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How to cite this article:
Low NY, Chik I, Zuhdi Z, Azman A. Differentiating hepatic mucinous cystic neoplasms from hydatid cyst of the liver. Formos J Surg 2022;55:242-3

How to cite this URL:
Low NY, Chik I, Zuhdi Z, Azman A. Differentiating hepatic mucinous cystic neoplasms from hydatid cyst of the liver. Formos J Surg [serial online] 2022 [cited 2022 Nov 26];55:242-3. Available from: https://www.e-fjs.org/text.asp?2022/55/6/242/361701



Dear Editor,

We would like to report a recent case in our facility which initially was mistaken as a hydatid cyst based on computed tomography (CT) scan, but the final diagnosis was mucinous cystic lesion of the liver (MCN-L).

A 72-year-old woman presented with increasing abdominal fullness and discomfort for 1 week but had no other significant history. On examination, there was a firm, nontender abdominal mass. After initial workup, multidisciplinary meeting discussion concluded that it was a hydatid cyst as CT abdomen showed a large cystic liver mass measuring 11.7 cm × 19.3 cm × 22.9 cm with multiple daughter cysts within [Figure 1]. The patient underwent treatment and subsequently excision of cyst, which revealed itself to be MCN-L on histopathology.
Figure 1: Liver cyst with daughter cyst appearance (red arrow)

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Most MCN-L gives a false impression of hydatid cyst, which leads to incomplete excision. This is important as 20% of MCN-L has a risk of malignant transformation with invasive features.[1] Hence, differentiation should be done between the two to determine the appropriate management. One of the features of MCN-L is its change in size influenced by hormones.[2] Another key history is risk factor, like exposure to livestock that may carry Echinococcus granulosus.

Only radiological examination can be useful to differentiate, with ultrasound showing hypoechoic mass with thin separation and occasional internal echoes representing debris, wall nodularity, and previous bleeding. On a CT or magnetic resonance imaging scan, MCN-L appears as multiloculated or multiseptated, while benign cysts appear as aseptate, non-enhancing lesion with smooth margin.[3]

While MCN-L may have daughter cyst appearance, it is worth to note that they are mainly in the left lobe, while hydatid cysts appear more on the right lobe.[4]

Preoperative multidisciplinary team discussion on suspicious cystic lesions for diagnosis is important in deciding the most appropriate surgical approach, as some cases may not be straightforward. The best surgical approach when hydatid cyst is ruled out is complete excision, as imaging is unable to differentiate the invasive form. Incomplete resection may lead to relapse and worse prognosis.[5] The indications for resection are a large lesion, rapid increase in size, and manifestation of symptoms.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initial will not be published and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Simo KA, Mckillop IH, Ahrens WA, Martinie JB, Iannitti DA, Sindram D. Invasive biliary mucinous cystic neoplasm: A review. HPB (Oxford) 2012;14:725-40.  Back to cited text no. 1
    
2.
Van Treeck BJ, Lotfalla M, Czeczok TW, Mounajjed T, Moreira RK, Allende DS, et al. Molecular and immunohistochemical analysis of mucinous cystic neoplasm of the liver. Am J Clin Pathol 2020;154:837-47.  Back to cited text no. 2
    
3.
Boyum JH, Sheedy SP, Graham RP, Olson JT, Babcock AT, Bolan CW, et al. Hepatic mucinous cystic neoplasm versus simple biliary cyst: Assessment of distinguishing imaging features using CT and MRI. AJR Am J Roentgenol 2021;216:403-11.  Back to cited text no. 3
    
4.
Botezatu C, Mastalier B, Patrascu T. Hepatic hydatid cyst-Diagnose and treatment algorithm. J Med Life 2018;11:203-9.  Back to cited text no. 4
    
5.
Emre A, Serin KR, Ozden I, Tekant Y, Bilge O, Alper A, et al. Intrahepatic biliary cystic neoplasms: Surgical results of 9 patients and literature review. World J Gastroenterol 2011;17:361-5.  Back to cited text no. 5
    


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