Imaging Pearls ❯ Liver ❯ Cystic Liver Tumors
|
-- OR -- |
|
- “Biliary cystadenomas are uncommon multilocular potentially premalignant cystic tumors. They are nearly exclusively seen in women of middle age and are typically intrahepatic, more commonly found in the right hepatic lobe (55%). They can vary in size, ranging up to 35 cm . Patients can present with pain or biliary obstruction. At pathologic analysis, the cyst wall is similar to ovarian stroma (single layer of mucin-secreting cells) . The internal fluid is usually simple but can be proteinaceous, mucinous, or hemorrhagic. At CT, these lesions appear as a well-circumscribed cystic mass with internal crisscrossing septa and a thick fibrous capsule, which rarely calcifies (mural calcification).”
Liver Calcifications and Calcified Liver Masses: Pattern Recognition Approach on CT Madhavi Patnana et al AJR 2018; 211:76–86 - “Hepatic epithelioid hemangioendothelioma is an uncommon low-to-intermediate grade malignant vascular endothelial tumor with a frequency of 1:100,000 in middle-aged patients, with a higher frequency among women. The 5-year survival rate is 43–55. In a study by Gan et al., in which 14 cases of hepatic epithelioid hemangioendothelioma were analyzed, 50% of patients had no symptoms, 21% (n = 3) had right upper quadrant pain, and 29% (n = 4) presented with weight loss.”
Liver Calcifications and Calcified Liver Masses: Pattern Recognition Approach on CT Madhavi Patnana et al AJR 2018; 211:76–86 - “At CT, these tumors may be seen as a single nodule or multiple masses. At late stages, they have a propensity to grow and coalesce (striplike sign) in a subcapsular or peripheral location. At unenhanced CT, these lesions are hypodense. Capsular retraction, central hypodensity, and dystrophic calcification can also be observed with these lesions at CT. Makhlouf et al detected dystrophic calcifications in approximately 20% of lesions.”
Liver Calcifications and Calcified Liver Masses: Pattern Recognition Approach on CT Madhavi Patnana et al AJR 2018; 211:76–86
- “Simple hepatic cysts are common nonmalignant lesions that have no biliary system communication, with an estimated 2.5% frequency in the general population [26]. They are typically asymptomatic, are more common among women, and can be solitary or multiple. They have smooth thin walls with absent internal nodularity or septation. At histologic analysis, they consist of serous uid lined by a cuboidal epithelium and a thin rim of fibrous stroma. At CT, simple cysts are typically well delineated and homogeneous, with no internal or peripheral enhancement. Cyst wall calcification is uncommon.”
Liver Calcifications and Calcified Liver Masses: Pattern Recognition Approach on CT Madhavi Patnana et al AJR 2018; 211:76–86
- “The presence of septa, central septa, mural nodules, upstream bile duct dilatation, and downstream bile duct dilatation were found to be significant CT findings for differentiating mucinous cystic neoplasms and cyst forming intraductal papillary neoplasms of the bile duct from solitary bile duct cysts.”
CT Differentiation of Mucin-Producing Cystic Neoplasms of the Liver Solitary Bile Duct Cysts
Kim HJ et al.
AJR 2014;202:83-91 - “When two of these five criteria were used in combination, the sensitivity and specificity for diagnosing mucin producing cystic neoplasms and cyst forming intraductal papillary neoplasms of the bile duct were 87% (27 of 31) and 87% (27 of 31) respectively. When three of the five criteria were used in combination, the sensitivity and specificity were 58% (18 of 31) and 100%.”
CT Differentiation of Mucin-Producing Cystic Neoplasms of the Liver Solitary Bile Duct Cysts
Kim HJ et al.
AJR 2014;202:83-91 - CT Findings for Mucin-Producing Cystic Neoplasms of the Liver
- Presence of septa
- Central septa
- Mural nodule
- Upstream bile duct dilatation
- Downstream duct dilatation
- “We propose a practical algorithm that can simplify the approach for the diagnosis of these lesions. By apply- ing these workup strategies, one can prevent unnecessary tests, avoid a delay in initiating the appropriate management, and improve the cost-effectiveness of diagnostic tests.”
Cystic hepatic lesions: a review and an algorithmic approach.
Borhani AA, Wiant A, Heller MT
AJR Am J Roentgenol. 2014 Dec;203(6):1192-204 - Cystic Hepatic Lesions
- Developmental
- Inflammatory
- Neoplastic
- Trauma related - Cystic Hepatic Lesions
- Developmental
- Hepatic cysts
- Biliary hamartoma
- Polycystic liver disease
- Caroli disease
- Ciliated hepatic foregut duplication cyst - Cystic Hepatic Lesions
- Inflammatory
- Pyogenic liver abscess
- Amebic liver abscess
- Hydatid cyst
- Fungal microabscesses - Cystic Hepatic Lesions
- Neoplastic
- Biliary cystadenoma/cystadenocarcinoma
- Cystic liver metastases
- Cystic hepatocellular carcinoma
- Cystic Hepatic Lesions - Trauma related
- Hematoma
- Biloma
- Seroma - Cystic Hepatic Lesions
- Miscellaneous Lesions
- Peribiliary cyst
- Intrahepatic pseudocyst
- Hematoma from underlying tumor like hepatic adenoma
- Pseudoaneurysm (on noncontrast CT)
- Focal fat - “A multilocular cystic hepatic lesion detected at computed tomography (CT) and magnetic resonance (MR) imaging is a common but nonspecific radiologic finding that can cause potential challenges for differential diagnosis. This imaging pattern may be observed in a wide spectrum of common and uncommon neoplastic or nonneoplastic entities.”
Spectrum of multilocular cystic hepatic lesions: CT and MR imaging findings with pathologic correlation.
Qian LJ et al.
Radiographics. 2013 Sep-Oct;33(5):1419-33. - “Neoplastic lesions include cystadenoma, cystadenocarcinoma, hepatocellular carcinoma (HCC), metastases, mesenchymal hamartoma, and inflammatory myofibroblastic tumor. Nonneoplastic lesions include hepatic abscess, echinococcal cyst, intrahepatic hematoma, and biloma.”
Spectrum of multilocular cystic hepatic lesions: CT and MR imaging findings with pathologic correlation.
Qian LJ et al.
Radiographics. 2013 Sep-Oct;33(5):1419-33. - “Inflammatory myofibroblastic tumor (IMT), also known as inflammatory pseudotumor, is a relatively rare entity characterized by proliferation of myofibroblastic spindle cells mixed in with an inflammatory infiltrate of plasma cells, lymphocytes, and eosinophils. The cause of IMT is unclear. However, postinflammatory regenerative processes may be associated with the pathogenesis of the disease. IMT may manifest with nonspecific symptoms, including right upper quadrant pain, jaundice, and occasionally obliterative phlebitis. At gross examination, IMTs tend to be well circumscribed or multinodular with a fibrotic or myxoid cut surface. The surface may show a variegated appearance with focal areas of necrosis, hemorrhage, or calcification .”
Spectrum of multilocular cystic hepatic lesions: CT and MR imaging findings with pathologic correlation.
Qian LJ et al.
Radiographics. 2013 Sep-Oct;33(5):1419-33. - “The radiologic findings for IMT are nonspecific. Commonly, the tumors are hypoattenuating to liver parenchyma on unenhanced images, and variable patterns of enhancement are observed after contrast material enhancement, including peripheral enhancement or enhancement of multiple internal septa. The lesion occasionally appears as a mutilobular cystic mass with multiple enhancing internal septa. Delayed enhancement of part of the lesion, including the septa, is a typical finding, presumably due to delayed washout of contrast medium accumulating in the extravascular space.”
Spectrum of multilocular cystic hepatic lesions: CT and MR imaging findings with pathologic correlation.
Qian LJ et al.
Radiographics. 2013 Sep-Oct;33(5):1419-33. - “Mesenchymal hamartoma of the liver is a rare type of neoplasm. However, it is the second most common benign hepatic tumor in children, after infantile hemangioendothelioma. It usually occurs in male children younger than 2 years of age. The exact pathogenesis is unknown. However, several theories have been proposed, including developmental ductal plate malformation, regional hepatic lobe ischemia, toxic injury to sinusoidal fat-storing cells, an imprinting defect due to chromosomal abnormalities, and a genuine neoplastic lesion. Depending on tumor size, clinical presentation may include a palpable abdominal mass, anorexia, nausea, and vomiting. Jaundice, portal vein hypertension, and lower extremity edema may also develop because of compression of the bile duct and hepatic vein by the tumor.”
Spectrum of multilocular cystic hepatic lesions: CT and MR imaging findings with pathologic correlation.
Qian LJ et al.
Radiographics. 2013 Sep-Oct;33(5):1419-33. - “The radiologic features of mesenchymal hamartoma largely depend on the predominance of cystic or solid components. At CT, mesenchymal hamartoma appears as a complex cystic mass with avascular cystic portions of fluid attenuation and stromal portions that are relatively hypovascular to the surrounding hepatic parenchyma. Enhancement of the septa and solid (stromal) elements is observed after contrast material enhancement. At MR imaging, solid portions may appear hypointense relative to the adjacent liver on both T1- and T2-weighted images because of fibrotic tissue. Cystic portions demonstrate signal intensity generally close to water signal intensity on T2-weighted images and variable signal intensity on T1-weighted images, depending on the protein content of the fluid in the cystic component.”
Spectrum of multilocular cystic hepatic lesions: CT and MR imaging findings with pathologic correlation.
Qian LJ et al.
Radiographics. 2013 Sep-Oct;33(5):1419-33.