Hemorrhagic Hepatic Cyst Mimicking a Cystic Neoplasm: Case Report

I. Koti, A. Benhamdane, S. Mrabti, R. Chaibi, S. Hdiye, I. Mouslim, T. Addajou, F. Rouibaa, H. Seddik
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Abstract

Background: Intracystic hemorrhage is an extremely rare complication of simple hepatic cysts. Clinical symptomatology is non-specific, and imaging frequently mimics a biliary cystadenoma or cystadenocarcinoma, which makes it challenging from a diagnostic point of view to an appropriate therapeutic approach. In this report, we present a case of a simple hemorrhagic hepatic cyst mimicking a cystic neoplasm. Case Report: 48-year-old men was referred to our hospital for periumbilical abdominal pain with asthenia and 11 kg weight loss. His physical examination and laboratory findings were unremarkable. Carcinoembryonic antigen concentration was three times higher than normal. Abdominal ultrasonography demonstrated an impure cystic mass measuring 120 x 96 x 108 mm on hepatic segments VI and VII. Abdominal CT showed a cystic mass at the liver possibly related to a cystadenocarcinoma. Abdominal MRI revealed a cystic mass with lobulated contours, located in segments VII, VIII and part of VI, measuring 11.8 x11.4 cm long axis, heterogeneous signal with intense fluid towards the top in T1 and T2 and intense fluid towards the decline in T2 and T1, with the appearance of a small inferior septum slightly enhanced after injection. These findings did not exclude the possibility of malignant cystic tumor, such as biliary cystadenocarcinoma. Therefore, endoscopic ultrasound showed a cystic lesion developing in the liver, with a thickened wall in places, mainly adjacent to an intracystic nodule of 25 mm, this nodule continued with the wall. Biopsy performed using a 22G ultrasound. Aspiration of liquid: string test negative. Pathological examination confirmed a hemorrhagic biliary cyst and there was no tumor tissue. We observed a significant improvement in symptoms and reduction in cyst size after needle aspiration and we decided to adopt a conservative approach. The patient was followed and one year later, the patient remained in good condition without any complaints. ................
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模仿囊性肿瘤的出血性肝囊肿:病例报告
背景:囊内出血是单纯性肝囊肿极为罕见的并发症。临床症状无特异性,影像学表现常模仿胆囊腺瘤或胆囊腺癌,这使得从诊断角度到适当的治疗方法都具有挑战性。在本报告中,我们介绍了一例模仿囊性肿瘤的单纯出血性肝囊肿病例。病例报告:48 岁的男性因脐周腹痛、气喘和体重下降 11 公斤而被转诊至我院。他的体格检查和实验室检查结果均无异常。癌胚抗原浓度是正常值的三倍。腹部超声波检查显示,肝脏 VI 和 VII 段有一个 120 x 96 x 108 毫米的不纯囊性肿块。腹部 CT 显示肝脏处有一个囊性肿块,可能与囊腺癌有关。腹部核磁共振成像显示,位于肝脏第VII、VIII节段和第VI节段部分的囊性肿块呈分叶轮廓,长轴尺寸为11.8 x 11.4厘米,T1和T2呈异质信号,顶部有较强的液体,T2和T1呈较弱的液体,注射后出现小的下隔膜,略有增强。这些发现并不排除恶性囊性肿瘤的可能性,如胆囊腺癌。因此,内镜超声检查显示肝脏内出现囊性病变,局部囊壁增厚,主要与一个 25 毫米的囊内结节相邻,该结节与囊壁相连。使用 22G 超声波进行了活检。抽取液体:串联试验阴性。病理检查证实为出血性胆道囊肿,没有肿瘤组织。我们观察到针吸术后症状明显改善,囊肿缩小,因此决定采取保守治疗。我们对患者进行了随访,一年后,患者情况依然良好,没有任何不适。................
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