Skip to main content

Advertisement

SpringerLink
Log in

Hepatobiliary mucinous cystic neoplasms and mimics

  • Special Section: Benign Biliary Disease
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

This review will provide an overview of hepatobiliary mucinous cystic neoplasms and their mimics such as complex appearing benign cysts, intraductal papillary neoplasm of bile ducts, choledochal cysts, infectious cysts, and other cystic neoplasms. Preoperative imaging, particularly abdominal MRI with MRCP, plays a key role in differentiating these entities which differ widely in management. Familiarity with the differentiating imaging features of mucinous cystic neoplasms and their mimics allows radiologists to provide management-guiding reports.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. 1. Caremani M, Vincenti A, Benci A, et al (1993) Ecographic epidemiology of non-parasitic hepatic cysts. J Clin Ultrasound 21:115–118. https://doi.org/https://doi.org/10.1002/jcu.1870210207

    Article  CAS  Google Scholar 

  2. 2. Carrim ZI, Murchison JT (2003) The prevalence of simple renal and hepatic cysts detected by spiral computed tomography. Clin Radiol 58:626–629. https://doi.org/https://doi.org/10.1016/s0009-9260(03)00165-x

    Article  CAS  Google Scholar 

  3. 3. Walt AJ (1977) Cysts and Benign Tumors of the Liver. Surg Clin North Am 57:449–464. https://doi.org/https://doi.org/10.1016/S0039-6109(16)41194-1

    Article  CAS  Google Scholar 

  4. 4. Soares KC, Arnaoutakis DJ, Kamel I, et al (2014) Cystic Neoplasms of the Liver: Biliary Cystadenoma and Cystadenocarcinoma. J Am Coll Surg 218:119–128. https://doi.org/https://doi.org/10.1016/j.jamcollsurg.2013.08.014

    Article  Google Scholar 

  5. Aaltonen LA, Hamilton SR, World Health Organization, International Agency for Research on Cancer (2000) Pathology and genetics of tumours of the digestive system. IARC Press ; Oxford University Press (distributor,), Lyon : Oxford

  6. Bosman FT, Carneiro F, Hruban RH. et al eds (2010) Geneva: International Agency for Research on Cancer. WHO Classification of Tumours of the Digestive System., Fourth. World Health Organization Classification of Tumours.

  7. 7. Kim HJ, Yu ES, Byun JH, et al (2014) CT Differentiation of Mucin-Producing Cystic Neoplasms of the Liver From Solitary Bile Duct Cysts. Am J Roentgenol 202:83–91. https://doi.org/https://doi.org/10.2214/AJR.12.9170

    Article  Google Scholar 

  8. 8. Lim JH, Jang K-T, Rhim H, et al (2007) Biliary cystic intraductal papillary mucinous tumor and cystadenoma/cystadenocarcinoma: differentiation by CT. Abdom Imaging 32:644–651. https://doi.org/https://doi.org/10.1007/s00261-006-9161-5

    Article  Google Scholar 

  9. 9. Anderson MA, Dhami RS, Fadzen CM, et al (2021) CT and MRI features differentiating mucinous cystic neoplasms of the liver from pathologically simple cysts. Clin Imaging 76:46–52. https://doi.org/https://doi.org/10.1016/j.clinimag.2021.01.036

    Article  Google Scholar 

  10. 10. Devaney K, Goodman ZD, Ishak KG (1994) Hepatobiliary cystadenoma and cystadenocarcinoma. A light microscopic and immunohistochemical study of 70 patients. Am J Surg Pathol 18:1078–1091

    Article  CAS  Google Scholar 

  11. 11. Arnaoutakis DJ, Kim Y, Pulitano C, et al (2015) Management of Biliary Cystic Tumors: A Multi-institutional Analysis of a Rare Liver Tumor. Ann Surg 261:361–367. https://doi.org/https://doi.org/10.1097/SLA.0000000000000543

    Article  Google Scholar 

  12. 12. Pojchamarnwiputh S, Na Chiangmai W, Chotirosniramit A, Lertprasertsuke N (2008) Computed tomography of biliary cystadenoma and biliary cystadenocarcinoma. Singapore Med J 49:392–396

    CAS  Google Scholar 

  13. 13. Choi HK, Lee JK, Lee KH, et al (2010) Differential Diagnosis for Intrahepatic Biliary Cystadenoma and Hepatic Simple Cyst: Significance of Cystic Fluid Analysis and Radiologic Findings. J Clin Gastroenterol 44:289–293. https://doi.org/https://doi.org/10.1097/MCG.0b013e3181b5c789

    Article  Google Scholar 

  14. 14. Teoh AYB, Ng SSM, Lee KF, Lai PBS (2006) Biliary cystadenoma and other complicated cystic lesions of the liver: diagnostic and therapeutic challenges. World J Surg 30:1560–1566. https://doi.org/https://doi.org/10.1007/s00268-005-0461-7

    Article  Google Scholar 

  15. 15. Seo JK, Kim SH, Lee SH, et al (2010) Appropriate diagnosis of biliary cystic tumors: comparison with atypical hepatic simple cysts. Eur J Gastroenterol Hepatol 22:989–996. https://doi.org/https://doi.org/10.1097/MEG.0b013e328337c971

    Article  Google Scholar 

  16. 16. Kim JY, Kim SH, Eun HW, et al (2010) Differentiation Between Biliary Cystic Neoplasms and Simple Cysts of the Liver: Accuracy of CT. Am J Roentgenol 195:1142–1148. https://doi.org/https://doi.org/10.2214/AJR.09.4026

    Article  Google Scholar 

  17. 17. Kohno S, Arizono S, Isoda H, et al (2019) Imaging findings of hemorrhagic hepatic cysts with enhancing mural nodules. Abdom Radiol 44:1205–1212. https://doi.org/https://doi.org/10.1007/s00261-019-01898-4

    Article  Google Scholar 

  18. 18. Mortelé KJ, Ros PR (2001) Cystic Focal Liver Lesions in the Adult: Differential CT and MR Imaging Features. RadioGraphics 21:895–910. https://doi.org/https://doi.org/10.1148/radiographics.21.4.g01jl16895

    Article  Google Scholar 

  19. 19. Kovacs MD, Sheafor DH, Burchett PF, et al (2018) Differentiating biliary cystadenomas from benign hepatic cysts: Preliminary analysis of new predictive imaging features. Clin Imaging 49:44–47. https://doi.org/https://doi.org/10.1016/j.clinimag.2017.10.022

    Article  Google Scholar 

  20. Boyum JH, Sheedy SP, Graham RP, et al (2020) Hepatic Mucinous Cystic Neoplasm Versus Simple Biliary Cyst: Assessment of Distinguishing Imaging Features Using CT and MRI. AJR Am J Roentgenol 1–9. https://doi.org/10.2214/AJR.20.22768

  21. 21. Park HJ, Kim SY, Kim HJ, et al (2018) Intraductal Papillary Neoplasm of the Bile Duct: Clinical, Imaging, and Pathologic Features. Am J Roentgenol 211:67–75. https://doi.org/https://doi.org/10.2214/AJR.17.19261

    Article  Google Scholar 

  22. 22. Buetow PC, Buck JL, Pantongrag-Brown L, et al (1995) Biliary cystadenoma and cystadenocarcinoma: clinical-imaging-pathologic correlations with emphasis on the importance of ovarian stroma. Radiology 196:805–810. https://doi.org/https://doi.org/10.1148/radiology.196.3.7644647

    Article  CAS  Google Scholar 

  23. 23. Williams DM, Vitellas KM, Sheafor D (2001) Biliary cystadenocarcinoma: seven year follow-up and the role of MRI and MRCP. Magn Reson Imaging 19:1203–1208. https://doi.org/https://doi.org/10.1016/S0730-725X(01)00453-2

    Article  CAS  Google Scholar 

  24. 24. Chen TC, Nakanuma Y, Zen Y, et al (2001) Intraductal papillary neoplasia of the liver associated with hepatolithiasis. Hepatol Baltim Md 34:651–658. https://doi.org/https://doi.org/10.1053/jhep.2001.28199

    Article  CAS  Google Scholar 

  25. Nakanuma Y, Uesaka K, Miyayama S, et al (2017) Intraductal neoplasms of the bile duct. A new challenge to biliary tract tumor pathology. Histol Histopathol 32:1001–1015. https://doi.org/10.14670/HH-11-892

  26. 26. Nakanuma Y, Jang K-T, Fukushima N, et al (2018) A statement by the Japan-Korea expert pathologists for future clinicopathological and molecular analyses toward consensus building of intraductal papillary neoplasm of the bile duct through several opinions at the present stage. J Hepato-Biliary-Pancreat Sci 25:181–187. https://doi.org/https://doi.org/10.1002/jhbp.532

    Article  Google Scholar 

  27. 27. Rocha FG, Lee H, Katabi N, et al (2012) Intraductal papillary neoplasm of the bile duct: a biliary equivalent to intraductal papillary mucinous neoplasm of the pancreas? Hepatol Baltim Md 56:1352–1360. https://doi.org/https://doi.org/10.1002/hep.25786

    Article  CAS  Google Scholar 

  28. 28. Tan Y, Milikowski C, Toribio Y, et al (2015) Intraductal papillary neoplasm of the bile ducts: A case report and literature review. World J Gastroenterol 21:12498–12504. https://doi.org/https://doi.org/10.3748/wjg.v21.i43.12498

    Article  CAS  Google Scholar 

  29. 29. Tsen A, Barbara M, Rosenkranz L (2018) Dilemma of elevated CA 19-9 in biliary pathology. Pancreatol Off J Int Assoc Pancreatol IAP Al 18:862–867. https://doi.org/https://doi.org/10.1016/j.pan.2018.09.004

    Article  CAS  Google Scholar 

  30. 30. Luvira V, Pugkhem A, Bhudhisawasdi V, et al (2017) Long-term outcome of surgical resection for intraductal papillary neoplasm of the bile duct. J Gastroenterol Hepatol 32:527–533. https://doi.org/https://doi.org/10.1111/jgh.13481

    Article  Google Scholar 

  31. 31. Ying S, Ying M, Liang W, et al (2018) Morphological classification of intraductal papillary neoplasm of the bile duct. Eur Radiol 28:1568–1578. https://doi.org/https://doi.org/10.1007/s00330-017-5123-2

    Article  Google Scholar 

  32. 32. Kang MJ, Jang J-Y, Lee KB, et al (2013) Impact of macroscopic morphology, multifocality, and mucin secretion on survival outcome of intraductal papillary neoplasm of the bile duct. J Gastrointest Surg Off J Soc Surg Aliment Tract 17:931–938. https://doi.org/https://doi.org/10.1007/s11605-013-2151-3

    Article  Google Scholar 

  33. 33. Lee SS, Kim M-H, Lee SK, et al (2004) Clinicopathologic review of 58 patients with biliary papillomatosis. Cancer 100:783–793. https://doi.org/https://doi.org/10.1002/cncr.20031

    Article  Google Scholar 

  34. 34. Yoon HJ, Kim YK, Jang K-T, et al (2013) Intraductal papillary neoplasm of the bile ducts: description of MRI and added value of diffusion-weighted MRI. Abdom Imaging 38:1082–1090. https://doi.org/https://doi.org/10.1007/s00261-013-9989-4

    Article  Google Scholar 

  35. 35. Hong G-S, Byun JH, Kim JH, et al (2016) Thread sign in biliary intraductal papillary mucinous neoplasm: a novel specific finding for MRI. Eur Radiol 26:3112–3120. https://doi.org/https://doi.org/10.1007/s00330-015-4158-5

    Article  Google Scholar 

  36. 36. Lewis VA, Adam SZ, Nikolaidis P, et al (2015) Imaging of choledochal cysts. Abdom Imaging 40:1567–1580. https://doi.org/https://doi.org/10.1007/s00261-015-0381-4

    Article  Google Scholar 

  37. 37. Tu Z, Yang Y, Ruan J, Tu J (2020) FDG PET/CT Findings in Biliary Papillomatosis. Clin Nucl Med 45:798–799. https://doi.org/https://doi.org/10.1097/RLU.0000000000003243

    Article  Google Scholar 

  38. 38. Takanami K, Hiraide T, Kaneta T, et al (2010) FDG PET/CT findings in malignant intraductal papillary mucinous neoplasm of the bile ducts. Clin Nucl Med 35:83–85. https://doi.org/https://doi.org/10.1097/RLU.0b013e3181c7bff0

    Article  Google Scholar 

  39. 39. Katabathina VS, Kapalczynski W, Dasyam AK, et al (2015) Adult choledochal cysts: current update on classification, pathogenesis, and cross-sectional imaging findings. Abdom Imaging 40:1971–1981. https://doi.org/https://doi.org/10.1007/s00261-014-0344-1

    Article  Google Scholar 

  40. Mavilia MG, Pakala T, Molina M, Wu GY (2018) Differentiating Cystic Liver Lesions: A Review of Imaging Modalities, Diagnosis and Management. J Clin Transl Hepatol 6:208–216. https://doi.org/10.14218/JCTH.2017.00069

  41. 41. Borhani AA, Wiant A, Heller MT (2014) Cystic hepatic lesions: a review and an algorithmic approach. AJR Am J Roentgenol 203:1192–1204. https://doi.org/https://doi.org/10.2214/AJR.13.12386

    Article  Google Scholar 

  42. Vilgrain V, Boulos L, Vullierme MP, et al (2000) Imaging of atypical hemangiomas of the liver with pathologic correlation. Radiogr Rev Publ Radiol Soc N Am Inc 20:379–397. https://doi.org/10.1148/radiographics.20.2.g00mc01379

  43. 43. Gupta R, Parelkar SV, Sanghvi B (2009) Mesenchymal hamartoma of the liver. Indian J Med Paediatr Oncol Off J Indian Soc Med Paediatr Oncol 30:141–143. https://doi.org/https://doi.org/10.4103/0971-5851.65338

    Article  Google Scholar 

  44. Frick M, Feinberg S Biliary cystadenoma. CASE Rep 3

  45. Martins-Filho SN, Putra J (2020) Hepatic mesenchymal hamartoma and undifferentiated embryonal sarcoma of the liver: a pathologic review. Hepatic Oncol 7:HEP19. https://doi.org/10.2217/hep-2020-0002

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White Building, Room 270, Boston, MA, 02114, USA

    Mark A. Anderson

  2. Department of Surgery, Virginia Commonwealth University, Richmond, VA, 23298, USA

    Chandra S. Bhati

  3. Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA

    Dhakshinamoorthy Ganeshan

  4. Mallinckrodt Institute of Radiology, St. Louis, MO, 63110, USA

    Malak Itani

Authors
  1. Mark A. Anderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chandra S. Bhati
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dhakshinamoorthy Ganeshan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Malak Itani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark A. Anderson.

Ethics declarations

Conflict of interest

All authors declare they have no conflicts of interest.

Ethical approval

This retrospective study involving human participants was in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was waived for individual participants included in the study. The study was approved by the local Institutional Review Board (IRB) and HIPAA compliant.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Anderson, M.A., Bhati, C.S., Ganeshan, D. et al. Hepatobiliary mucinous cystic neoplasms and mimics. Abdom Radiol 48, 79–90 (2023). https://doi.org/10.1007/s00261-021-03303-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-021-03303-5

Keywords

Search

Navigation