Complete subadventicial laparoscopic pericystectomy of a cystic segment III-IVb liver lesion.
EAES Academy. Fierro Aguilar A. 07/05/22; 366534; P277
CLICK HERE TO LOGIN
REGULAR CONTENT
REGULAR CONTENT
Login now to access Regular content available to all registered users.
Abstract
Discussion Forum (0)
Rate & Comment (0)
Aim: To report and discuss the case of a 69-year-old female patient diagnosed with hydatic cyst by image preoperatively in III-IVb liver segments. Laparoscopic surgery was performed successfully.
Method: A 69-year-old female patient attended for consultation due to abdominal pain, weight loss and asthenia. An abdominal CT (Computed Tomography) scan was performed, revealing a cystic lesion compatible with a 6cm CE2 hydatid cyst (multifolliculated, fertile; Gharbi Classification) in segments III-IVb, that displaced the left posterior portal branch. Echinococcus granulosus antibodies were negative and MRI (Magnetic Resonance Imaging) ruled out any communication with the biliary duct. The patient was offered laparoscopic surgery which she accepted. During surgery, a lesion that looked like a hidatic cyst was observed lying above the left portal pedicle and a laparoscopic subadventitial pericystectomy was performed, as seen on the video. We used three 12mm trocars (two working ports and one optical port) and two 5mm accessory trocars. A difficult resection due to intense fibrosis was performed with CUSA (Cavitron Ultrasonic Surgical Aspiration) and hi-energy-device energy. A cholecystectomy and an intraoperative cholangiography were also performed, showing no signs of bile leak.
Results: The patient was discharged on the 7th day without any complications (Clavien-Dindo 1). The pathologist analysis showed a cystic lesion that showed lumens of different calibers delimited with cylindrical/cubic epithelium without atypia, PAS positive, and positive immunohistochemical expression for CK19 and CAM5.2. The underlying stroma was positive for estrogen and progesterone receptors expression. No signs of histological malignancy or hydatid cyst were observed, and it was diagnosed as biliary cystadenoma (hepatic mucinous cystic neoplasm).
Conclusion: Biliary cystoadenoma is an infrequent cystic neoplasm which can become malignant, usually diagnosed in female around 50-years-old with abdominal pain, weight loss or jaundice. Laboratory tests are normally of no use and image techniques such as CT or ultrasonography can help in the differential diagnosis. Colangio-RM can help showing possible communication between the cyst and the bile duct. If there is doubt of a possible cystoadenoma, surgery is mandatory. Deffinitive diagnosis will only be done by the pathologist.
Method: A 69-year-old female patient attended for consultation due to abdominal pain, weight loss and asthenia. An abdominal CT (Computed Tomography) scan was performed, revealing a cystic lesion compatible with a 6cm CE2 hydatid cyst (multifolliculated, fertile; Gharbi Classification) in segments III-IVb, that displaced the left posterior portal branch. Echinococcus granulosus antibodies were negative and MRI (Magnetic Resonance Imaging) ruled out any communication with the biliary duct. The patient was offered laparoscopic surgery which she accepted. During surgery, a lesion that looked like a hidatic cyst was observed lying above the left portal pedicle and a laparoscopic subadventitial pericystectomy was performed, as seen on the video. We used three 12mm trocars (two working ports and one optical port) and two 5mm accessory trocars. A difficult resection due to intense fibrosis was performed with CUSA (Cavitron Ultrasonic Surgical Aspiration) and hi-energy-device energy. A cholecystectomy and an intraoperative cholangiography were also performed, showing no signs of bile leak.
Results: The patient was discharged on the 7th day without any complications (Clavien-Dindo 1). The pathologist analysis showed a cystic lesion that showed lumens of different calibers delimited with cylindrical/cubic epithelium without atypia, PAS positive, and positive immunohistochemical expression for CK19 and CAM5.2. The underlying stroma was positive for estrogen and progesterone receptors expression. No signs of histological malignancy or hydatid cyst were observed, and it was diagnosed as biliary cystadenoma (hepatic mucinous cystic neoplasm).
Conclusion: Biliary cystoadenoma is an infrequent cystic neoplasm which can become malignant, usually diagnosed in female around 50-years-old with abdominal pain, weight loss or jaundice. Laboratory tests are normally of no use and image techniques such as CT or ultrasonography can help in the differential diagnosis. Colangio-RM can help showing possible communication between the cyst and the bile duct. If there is doubt of a possible cystoadenoma, surgery is mandatory. Deffinitive diagnosis will only be done by the pathologist.
Aim: To report and discuss the case of a 69-year-old female patient diagnosed with hydatic cyst by image preoperatively in III-IVb liver segments. Laparoscopic surgery was performed successfully.
Method: A 69-year-old female patient attended for consultation due to abdominal pain, weight loss and asthenia. An abdominal CT (Computed Tomography) scan was performed, revealing a cystic lesion compatible with a 6cm CE2 hydatid cyst (multifolliculated, fertile; Gharbi Classification) in segments III-IVb, that displaced the left posterior portal branch. Echinococcus granulosus antibodies were negative and MRI (Magnetic Resonance Imaging) ruled out any communication with the biliary duct. The patient was offered laparoscopic surgery which she accepted. During surgery, a lesion that looked like a hidatic cyst was observed lying above the left portal pedicle and a laparoscopic subadventitial pericystectomy was performed, as seen on the video. We used three 12mm trocars (two working ports and one optical port) and two 5mm accessory trocars. A difficult resection due to intense fibrosis was performed with CUSA (Cavitron Ultrasonic Surgical Aspiration) and hi-energy-device energy. A cholecystectomy and an intraoperative cholangiography were also performed, showing no signs of bile leak.
Results: The patient was discharged on the 7th day without any complications (Clavien-Dindo 1). The pathologist analysis showed a cystic lesion that showed lumens of different calibers delimited with cylindrical/cubic epithelium without atypia, PAS positive, and positive immunohistochemical expression for CK19 and CAM5.2. The underlying stroma was positive for estrogen and progesterone receptors expression. No signs of histological malignancy or hydatid cyst were observed, and it was diagnosed as biliary cystadenoma (hepatic mucinous cystic neoplasm).
Conclusion: Biliary cystoadenoma is an infrequent cystic neoplasm which can become malignant, usually diagnosed in female around 50-years-old with abdominal pain, weight loss or jaundice. Laboratory tests are normally of no use and image techniques such as CT or ultrasonography can help in the differential diagnosis. Colangio-RM can help showing possible communication between the cyst and the bile duct. If there is doubt of a possible cystoadenoma, surgery is mandatory. Deffinitive diagnosis will only be done by the pathologist.
Method: A 69-year-old female patient attended for consultation due to abdominal pain, weight loss and asthenia. An abdominal CT (Computed Tomography) scan was performed, revealing a cystic lesion compatible with a 6cm CE2 hydatid cyst (multifolliculated, fertile; Gharbi Classification) in segments III-IVb, that displaced the left posterior portal branch. Echinococcus granulosus antibodies were negative and MRI (Magnetic Resonance Imaging) ruled out any communication with the biliary duct. The patient was offered laparoscopic surgery which she accepted. During surgery, a lesion that looked like a hidatic cyst was observed lying above the left portal pedicle and a laparoscopic subadventitial pericystectomy was performed, as seen on the video. We used three 12mm trocars (two working ports and one optical port) and two 5mm accessory trocars. A difficult resection due to intense fibrosis was performed with CUSA (Cavitron Ultrasonic Surgical Aspiration) and hi-energy-device energy. A cholecystectomy and an intraoperative cholangiography were also performed, showing no signs of bile leak.
Results: The patient was discharged on the 7th day without any complications (Clavien-Dindo 1). The pathologist analysis showed a cystic lesion that showed lumens of different calibers delimited with cylindrical/cubic epithelium without atypia, PAS positive, and positive immunohistochemical expression for CK19 and CAM5.2. The underlying stroma was positive for estrogen and progesterone receptors expression. No signs of histological malignancy or hydatid cyst were observed, and it was diagnosed as biliary cystadenoma (hepatic mucinous cystic neoplasm).
Conclusion: Biliary cystoadenoma is an infrequent cystic neoplasm which can become malignant, usually diagnosed in female around 50-years-old with abdominal pain, weight loss or jaundice. Laboratory tests are normally of no use and image techniques such as CT or ultrasonography can help in the differential diagnosis. Colangio-RM can help showing possible communication between the cyst and the bile duct. If there is doubt of a possible cystoadenoma, surgery is mandatory. Deffinitive diagnosis will only be done by the pathologist.
Code of conduct/disclaimer available in General Terms & Conditions
{{ help_message }}
{{filter}}