Biliary cystadenoma and cystadenocarcinoma: 11cases and review of the literature

Öz

Biliary cystadenoma and cystadenocarcinomas are very rare neoplasms of the liver. The 15-year experience of the University of Ege Faculty of Medicine was retrospectively evaluated for this tumor type, which has particularities with respect to diagnosis and therapy. The clinical, histologic and surgical therapeutic features were retrospectively evaluated for 11 cases (9 female, 2 male) operated between 1989 and 2004. The mean age of the patients was 52 (range, 33-70). In six of 11 cases (56%) the initial diagnosis was hydatid cyst and three patients had undergone external drainage. All cases were totally excised. The mean tumor diameter was 8.3 cm. Differential diagnosis of this tumor group from the other cystic lesions of the liver is difficult in the initial diagnosis stage. They constitute an important disease process as they can be misinterpreted as hydatid cysts, which is an important health problem in our country, and because they have a high rate of recurrence unless they are totally resected.

Anahtar Kelimeler

• Biliary cystadenoma, biliary cystadenocarcinoma, liver, cyst

Biliyer kistadenom ve kistadenokarsinom: 11 olgu ve literatürün gözden geçirilmesi

Öz

Biliyer kistadenomlar ve kistadenokarsinomlar karaciğerin nadir kistik tümörlerindendir. Gerek tanı gerekse de tedavi sürecinde özellik gerektiren bu tümör tipi için 15 yıllık Ege Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilimdalı'nın deneyimi değerlendirildi. 1989-2004 tarihleri arasında tetkik ve tedavi edilen 11 olgu retrospektif olarak klinik ve histolojik parametreleri ve cerrahi tedavileri açısından tekrar gözden geçirildi. 11 olgunun 9'u kadın, 2'si erkek iken yaş ortalamaları 52 (33-70) olarak izlendi. Klinik ön tanı açısından 11 olgunun 6'sının (%54) kist hidatik olarak değerlendirildiği ve bu olgulardan 3'üne daha önceden drenaj prosedürlerinin uygulanmış olduğu görüldü. Tüm olgulara total eksizyon uygulandı. Tümör çapı ortalaması 8.3 cm olarak saptandı. Tanı aşamasında preoperatif dönemde, bu tümörlerin diğer kistik karaciğer tümörlerinden ayırıcı tanısını yapmak oldukça güçtür. Ülkemiz için ciddi sağlık sorunu oluşturan kist hidatik lezyonları ile klinik olarak karışabilmeleri ve tam rezeksiyon yapılmadığı takdirde nüks oranlarının yüksek olması nedeniyle özellikli bir hastalık grubunu oluşturmaktadırlar.

Anahtar Kelimeler

• Biliyer kistadenom, biliyer kistadenokarsinom, karaciğer, kist

Kaynakça

1. Ishak KG, Willis WG, Cummins SD, et al. Biliary cystadenoma and cystadenocarsinoma: report of 14 cases and review of literature. Cancer 1977; 38: 322-38.
2. Wheeler DA, Edmondson HA. Cystadenoma with mesenchymal stro- ma in the liver and bile ducts. A clinicopathologic study of 17 cases, 4 with malignant change. Cancer 1985; 56: 1434.
3. Organ B, Pertek J. Biliary cystadenoma. Cancer 77: 262-265.
4. Kyunsig K, Jinsub C, et al. Biliary cystadenoma of the liver. J hepa- tobiliary Pancreat Surg 1998; 5: 348-352.
5. Takayasu K, Muramatsu Y, Moriyama N, et al. Imaging diagnosis of bile duct cystadenocarsinoma. Cancer 1988; 61: 941-6.
6. Willis RA. Carsinoma arising in congenital cyst of the liver. J Pat- hol Bacteriol 1943; 50: 492-5.
7. Lauffer JM, Maurer CA, Stoupis C, et al. Biliary cystadenocarsino- ma of the liver: the need for complete resection. Eur J Cancer 1998; 34: 1845-51.
8. Devaney K, Goodman Z, Ihsak K. (1994) Hepatobiliary cystadeno- ma and cystadenocarsinoma: a light microscopic and immunohis- tochemical study of 70 patients. Am J Surg Pathol 18: 1078-1091.

9. Marcial MA, Hauser SC, Cibas ES, et al. (1994) Intrahepatic bili- ary cystadenoma: Clinical, radiological and pathological findings. Dig Dis Sci 31: 884-888.
10. Fans ST, Fung KS. Cystadenocarsinoma of the liver-a case for re- section. Asian J Surgery 1989; 12: 183-5.
11. Cheung YK, Chan FL, Leong LL, et al. Biliary cystadenoma and cystadenocarsinoma: some unusual features. Clin Radiol 1991; 43: 183-5.
12. Iemoto Y, Kondo Y, Nakano T, et al. Biliary cystadenocarsinoma di- agnosed by liver biopsy performed under ultrasonographic guidan- ce. Gastroenterology 1983; 84: 399-403.
13. Berjian RA, Nime F, Douglass HO Jr, et al. Biliary cystadenocarsi- noma: report of a case presenting with osseus metastasis and revi- ew of literature. J Surg Oncol 1981; 18: 305-15.
14. Nakajima T, Sugano I, Matsuzaki O, et al. Biliary cystadenocarsino- ma of the liver. A clinicopathologic and histochemical evaluation of nine cases. Cancer 1992; 69: 2426-32.
15. Asahara T, Itamoto T, Katayama K, et al. A case of biliary cystade- nocarsinoma of the liver. Hiroshima J Med Sci 1999; 48: 45-8.
16. Hara H, Shinshou M, Sako S, et al. Hepatobiliary cystadenoma combined with multipl liver cyst: Report of a case. Surg. Today 2001; 31: 651-654.
17. Woods GL. Biliary cystadenocarsinoma: case report of the hepatic malignancy, originating in benign cystadenoma. Cancer 1981; 47: 2936.
18. Tsiftis D, Christodoulakis M, De Bree E, et al. Primary intrahepatic biliary cystadenomatous tumors. J Surg Oncol 1997; 64: 341.
19. Den Hoed PT, Lameris H, Klooswijk B, et al. Biliary cystadenoma: an uncommon cause of cholestatic jaundice. Eur J Surg Oncol l999; 25: 325.
20. Grayson W, Teare J, Myburgh JA, et al. Immunohistochemical de- mostration of progesterone receptor in hepatobiliary cystadenoma with mesenchymal stroma. Histopathology 1996; 29: 461.
21. Pedram-Canihac M, Le Bail B, Rivel J, et al. Bioulac –Sage P. [he- patobiliary cystadenoma with mesenchymal stroma: a hormone de- pendent tumor. Report of five cases with immunohistochemical study of hormone receptors]. Ann Pathol 2000; 20: 14.
22. Suyama Y, Horrie Y, Suou T, et al. Oral contraceptives and intrahe- patic biliary cystadenoma having an increased level of estrogen re- ceptor. Hepatogastroenterology 1988; 35: 171.
23. Korobkin M, Stephens DH, Lee JK, et al. Biliary cystadenoma and cystadenocarsinoma: CT and sonographic findings. AJP Am J Ro- entgenol. 1989; 153: 507.
24. Choi BI, Lim JH, Han MC, et al. Biliary cystadenoma and cystade- nocarsinoma: CT and sonographic findings. Radiology 1989; 171: 57.
25. Hanazaki K, Makuuchi M, Wakabayashi M, et al. Intrahepatic bili- ary cystadenoma demosntrated by cholangiography. Hepatogastro- enterology 1996 ; 43: 1024-8.
26. Iemoto Y, Kondo Y, Fukamachi S. Biliary cystadenocarinoma with peritoneal carsinomatosis. Cancer 1981; 48: 1664-7.
27. Craig JR, Peters RL, Edomonson HA. Tumors of the liver and intra- hepatic bile ducts. Atlas of tumor pathology. Second series, fascicle 26. Washington DC: Armed Forces Institute of Pathology 1989.
28. Organ B., Petrek J. (1984) Biliary cystadenoma. South Med J.77: 262-265.
29. Short WF, Nedwick A, Levy HA, et al. (1971) Biliary cystadenoma: report of a case and review of the literature. Arch Surg 102: 78-80.
30. Lewis WD, Jenkins RL, Rossi RL. et al. Surgical treatment of biliary cystadenoma. A report of 15 cases. Arch Syrg 1988; 123: 565-568.