18 January 2007 - Case #70
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This case was contributed by Dr. Hanni Gulwani, Sir Ganga Ram Hospital, New Delhi, India.
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Case #70
Clinical history:
A 47 year old woman presented with pain in the right hypochondrium (upper lateral abdomen). CT scan showed a cystic space occupying lesion in the liver measuring 6 x 5 cm, which was excised.
Microscopic images:
What is your diagnosis?
Diagnosis: Biliary mucinous cystadenoma of liver
Stain images:
Discussion:
The low power images show a cystic, multiloculated lesion with adjacent normal liver (L). The high power images show a cyst lined by benign mucinous columnar epithelium. Image 7 shows ovarian type stroma. The epithelium is immunoreactive for CA19-9 and the stromal nuclei stain for progesterone receptor.
Biliary cystadenomas represent 5% of hepatic solitary cysts. Over 90% occur in women, with a mean age of 45 years. Although most (84%) are intrahepatic, they also occur within the common bile duct (6%), hepatic ducts (4%), cystic duct (4%) and gallbladder (2%). They may be associated with polycystic liver disease or abnormal hepatobiliary anatomy.
They are usually encapsulated, large (mean diameter: 15 cm), mucinous and multilocular, and may contain up to several liters of fluid. The inner lining is smooth, with few trabeculations or polypoid cystic projections. The presence of nodules of solid tissue suggests malignancy, which occurs in up to 25% of cases.
Histologically, they are lined by a single layer of columnar cuboidal mucinous epithelium with basal nuclei and apical mucin. Tumors in women have spindle cell ovarian type stroma, similar to that in pancreatic mucinous cystic neoplasms. The spindle cells may contain fat and smooth muscle. Although typically bland, there may be dysplastic foci. The uncommon serous tumors have clear, glycogen rich cytoplasm but no mucin or spindle cell stroma.
The epithelium in biliary cystadenomas is immunoreactive for cytokeratin, EMA, CA19-9 and CEA. The stromal cells are immunoreactive for muscle specific actin, vimentin and usually for estrogen and progesterone receptor (Dig Dis Sci 2006;51:623).
These tumors are usually slow growing and have a good prognosis after surgical excision.
The differential diagnosis includes borderline tumors (with high grade dysplasia and complex architecture) and invasive tumors, which must be ruled out by taking numerous sections.
References: World J Gastroenterol 2006;12:6062 (case report)
All cases are archived on our website. To view them sorted by case number, diagnosis or category, visit our main Case of the Month page. To subscribe or unsubscribe to Case of the Month or our other email lists, click here.
This case was contributed by Dr. Hanni Gulwani, Sir Ganga Ram Hospital, New Delhi, India.
Practice management services to increase your income
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(1) This case is sponsored by Vachette Pathology. Imagine someone that solves your billing and payment problems, someone who guarantees to help you put more money back into your pocket. You do not have to change billing agents to increase your income. You simply have to manage the process. Who's watching your wallet?
Vachette Pathology is a Pathology Practice Management Firm, we are not a billing agency; what we do is manage your financial bloodline. We will push your billing process to optimum performance, renegotiate your manage care contracts and help with the business of pathology, all to ensure your financial future. For further information, please contact Mick Raich at: mraich@vachettepathology.com or call at 866-407-0763.
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(1) This case is sponsored by Vachette Pathology. Imagine someone that solves your billing and payment problems, someone who guarantees to help you put more money back into your pocket. You do not have to change billing agents to increase your income. You simply have to manage the process. Who's watching your wallet?
Vachette Pathology is a Pathology Practice Management Firm, we are not a billing agency; what we do is manage your financial bloodline. We will push your billing process to optimum performance, renegotiate your manage care contracts and help with the business of pathology, all to ensure your financial future. For further information, please contact Mick Raich at: mraich@vachettepathology.com or call at 866-407-0763.
Visit and follow our Blog to see recent updates to the website.
Case #70
Clinical history:
A 47 year old woman presented with pain in the right hypochondrium (upper lateral abdomen). CT scan showed a cystic space occupying lesion in the liver measuring 6 x 5 cm, which was excised.
Microscopic images:
Low power
High power
High power
High power
What is your diagnosis?
Click here for diagnosis and discussion:
Diagnosis: Biliary mucinous cystadenoma of liver
Stain images:
CA19-9
Progesterone receptor
Discussion:
The low power images show a cystic, multiloculated lesion with adjacent normal liver (L). The high power images show a cyst lined by benign mucinous columnar epithelium. Image 7 shows ovarian type stroma. The epithelium is immunoreactive for CA19-9 and the stromal nuclei stain for progesterone receptor.
Biliary cystadenomas represent 5% of hepatic solitary cysts. Over 90% occur in women, with a mean age of 45 years. Although most (84%) are intrahepatic, they also occur within the common bile duct (6%), hepatic ducts (4%), cystic duct (4%) and gallbladder (2%). They may be associated with polycystic liver disease or abnormal hepatobiliary anatomy.
They are usually encapsulated, large (mean diameter: 15 cm), mucinous and multilocular, and may contain up to several liters of fluid. The inner lining is smooth, with few trabeculations or polypoid cystic projections. The presence of nodules of solid tissue suggests malignancy, which occurs in up to 25% of cases.
Histologically, they are lined by a single layer of columnar cuboidal mucinous epithelium with basal nuclei and apical mucin. Tumors in women have spindle cell ovarian type stroma, similar to that in pancreatic mucinous cystic neoplasms. The spindle cells may contain fat and smooth muscle. Although typically bland, there may be dysplastic foci. The uncommon serous tumors have clear, glycogen rich cytoplasm but no mucin or spindle cell stroma.
The epithelium in biliary cystadenomas is immunoreactive for cytokeratin, EMA, CA19-9 and CEA. The stromal cells are immunoreactive for muscle specific actin, vimentin and usually for estrogen and progesterone receptor (Dig Dis Sci 2006;51:623).
These tumors are usually slow growing and have a good prognosis after surgical excision.
The differential diagnosis includes borderline tumors (with high grade dysplasia and complex architecture) and invasive tumors, which must be ruled out by taking numerous sections.
References: World J Gastroenterol 2006;12:6062 (case report)
