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Ovarian Cyst Miracle

Ovarian Cyst Miracle Guide Book By Carol Foster

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Fig. 8.43 Combined hepatocellular and cholangio-cellular carcinoma. A Microtrabecular HCC and cholangiocarcinoma with desmoplastic response. B Border zone between HCC and cholangiocarci-noma.

Bile duct cystadenoma and cystadenocarcinoma

C. Wittekind H.P. Fischer T. Ponchon

Definition

A cystic tumour either benign (cystade-noma) or malignant (cystadenocarcino-ma), lined by epithelium with papillary infoldings that may be mucus-secreting or, less frequently, serous. Lesions arise from ducts proximal to the hilum of the liver. They differ from tumours that arise in cystic congenital malformation and in parasitic infections and hepatolithiasis.

Epidemiology

Bile duct cystadenoma and cystadeno-carcinoma are rare {809}. Cystadenoma is seen almost exclusively in females, with cystadenocarcinoma appearing equally in males and females. The average age of patients is 50-60 years.

Clinical features

Patients often present with abdominal pain and mass. A few patients have jaundice. Elevated serum levels of tumour marker CA 19-9 may occur. Imaging techniques show multilocular cystic tumour(s), occasionally with tiny papillary folds in the cystic wall.

Macroscopy

The cysts are usually multilocular and typically range from 5 to 15 cm diameter {809}. In cystadenocarcinoma, a large papillary mass may occur as well as solid areas of grey-white tumour in a thickened wall.

Tumour spread and staging

Cystadenocarcinomas show intrahepatic spread and metastasis to regional lymph nodes in the hepatoduodenal ligament. Distant metastases occur most frequent in the lungs, the pleura and the peritoneum. Staging is performed according to the TNM Classification of liver tumours {66}.

Histopathology

Cystadenomas are usually multilocular and are well defined by a fibrous capsule, which may contain smooth muscle fibres. The contents of the locules are either thin, opalescent or glairy fluid, or mucinous semisolid material. Two histological variants are recognized. The mucinous type is more common and is lined by columnar, cuboidal, or flattened mucus-secreting epithelial cells resting on a basement membrane; polypoid or papillary projections may be present. About 5% of the tumours reveal neuroendocrine differentiation, as identified by expression of chromogranin and synaptophysin. Subjacent to the basement membrane is a cellular, compacted mesenchymal stroma, which in turn is surrounded by looser fibrous tissue. This mesenchymal component is seen only in females and has been likened to ovarian stroma. The stromal cells express vimentin, and there are many cells that express smooth muscle actin. A xan-

Fig. 8.44 Biliary cystadenoma. The lining epithelium is cuboidal and lies on ovarian-like stroma, beneath which is a band of dense tissue.
Fig. 8.45 Severe dysplasia in the epithelium of an intrahepatic large bile duct in a case of hepatolithi-

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