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PubMed1997

Endocrine cells in hepatobiliary cystadenomas and cystadenocarcinomas.

We investigated the distribution of endocrine cells in hepatobiliary cystadenoma (n = 5, two associated with mesenchymal stroma) and cystadenocarcinoma (n = 3) immunohistochemically. In normal livers (n = 20) and livers affected by hepatolithiasis (n = 15) used as controls, endocrine cells revealed by chromogranin immunostaining were located exclusively in normal or proliferating intrahepatic peribiliary glands. In the eight cases of hepatobiliary cystadenoma and cystadenocarcinoma, endocrine cells were present in four cases (50%) (1 cystadenoma, 1 cystadenoma with mesenchymal stroma, and 2 cystadenocarcinomas). Endocrine cells tended to be located beneath and among the columnar epithelial cells. Intrahepatic peribiliary glands were located in the vicinity of cystadenoma or cystadenocarcinoma in six (75%) of the eight cases, and they frequently showed cystic dilatation and contained endocrine cells. Intrahepatic peribiliary glands were located in the vicinity of the endocrine cells in all cystadenomas and cystadenocarcinomas that were positive for endocrine cells. These data show that about 50% of hepatobiliary cystadenomas and cystadenocarcinomas contain endocrine cells and suggest that hepatobiliary cystadenoma and cystadenocarcinoma may originate from intrahepatic peribiliary glands.

Aged↗
PubMed2006

Biliary cystadenoma and other complicated cystic lesions of the liver: diagnostic and therapeutic challenges.

INTRODUCTION: Biliary cystadenomas are complicated cystic lesions of the liver. They are rare and pose considerable diagnostic and therapeutic challenges. METHODS: We present our experience managing these lesions by performing a retrospective review of all patients with a preoperative diagnosis of or histologically proven biliary cystadenoma who underwent surgery between January 1995 and January 2005 at our institution. Altogether, 20 patients (16 women, 4 men) with a mean age of 58 years underwent a total of 22 operations. The diagnosis of biliary cystadenoma was based on exclusion of other pathologic entities and the presence of radiologic characteristics of biliary cystadenoma. Abdominal ultrasonography (US), computed tomography, or both were performed in all patients. US-guided fine-needle aspiration cytology was performed in seven patients and all of them were negative for malignancy. A preoperative diagnosis of biliary cystadenoma was made in 16 patients based on clinical and radiologic features and was correct in 6 of them. Diagnosis of biliary cystadenoma was not suspected in four patients. RESULTS: The overall diagnostic accuracy was 30%. Enucleation was the most common surgical procedure and was performed in 10 patients. The mean follow-up period was 5.5+/-2.8 years. No recurrence was detected in patients with confirmed biliary cystadenoma after adequate excision. CONCLUSIONS: The findings of this study highlight the difficulty with preoperative diagnosis of biliary cystadenoma, which has seldom been discussed in the literature. Preoperative differentiation by means of radiologic imaging is inaccurate (30%). Any therapy short of complete excision leads to local recurrence and risk of malignant transformation. Complete excision of any suspicious lesion remains the best method of diagnosis and treatment.

Adenocarcinoma, Papillary↗
PubMed1995

Extrahepatic biliary cystadenomas and cystadenocarcinoma. Report of seven cases and review of the literature.

OBJECTIVE: The aim of this investigation was to describe the clinical features, diagnosis, pathologic characteristics, and optimal surgical management for patients with extrahepatic biliary cystadenomas. SUMMARY BACKGROUND DATA: Extrahepatic biliary cystadenomas are rare epithelial neoplasms. The clinical features and optimal surgical management for these lesions have not been defined clearly. The usual presenting symptom is jaundice. These lesions should be considered premalignant and necessitate resection. Sporadic case studies have reported instances of recurrence with local excision. To the authors' knowledge, this study represents the largest collected single series of extrahepatic biliary cystadenomas and reviews previously reported cases. METHODS: The authors reviewed and reported their institutional experience from 1950 to 1993 in treating seven patients with extrahepatic biliary cystadenomas as well as 19 previously reported cases in the literature. RESULTS: A strong female predominance (96.3% of patients reviewed) was associated with extrahepatic biliary cystadenomas. Obstructive jaundice was the most common presenting symptom (85%). Abdominal pain occurred in 50% of patients; other symptoms included fever and hemobilia. The most common site of occurrence was the common hepatic duct (32%). Papillary cystadenoma with foci of invasive adenocarcinoma, thus supporting the malignant potential of cystadenomas, occurred in one patient. Local excision from the wall of the bile duct was performed in 18 patients and was associated with 50% recurrence within a mean follow-up of 13 months (range, 4-24 months). No recurrence was reported after formal sleeve resection and bilioenteric reconstruction. CONCLUSIONS: Extrahepatic biliary cystadenomas can become malignant, and in this study, local surgical excision was associated with a 50% local recurrence rate. Sleeve resection with negative histologic resection margins followed by bilioenteric reconstruction, therefore, is recommended.

Adenoma, Bile Duct↗
PubMed1991

Clinicostatistical study of low potential malignancy ovarian cystadenoma (borderline cases).

The number of ovarian cystadenoma of low potential malignancy (abbreviation: LPM) was 31 (5.7%) among common epithelial tumors [benign cystadenoma = 400 (74.0%), carcinoma = 110 (20.3%)]. Their mean ages, bilaterlity, frequency of ascites and nulligravidity were situated intermediately between those of benign cystadenoma and carcinoma. Abdominal tumor, distention, pain and metromenorrhagia were the main symptoms, although gastrointestinal complaints were rare in LPM cystadenoma. With LPM cystadenoma, 19 (61.3%) patients were at stage I, 7 (22.6%) at stage II and 5 (16.1%) at stage III, but with carcinoma, 44 (40.0%) were at stage III-IV [33 (30.0%) at stage I, and 31 (28.2%) at stage II]. The 5-year actuarial survival rate was 90% for LPM cystadenoma, but 43% for carcinoma. These results suggest that the clinical and biological features as well as the histological definition of LPM cystadenoma are situated intermediately between those of benign cystadenoma and carcinoma.

Adult↗
PubMed2006

[Biliary cystic neoplasm: biliary cystadenoma and biliary cystadenocarcinoma].

Biliary cystic tumors, such as cystadenoma and cystadenocarcinoma, are rare cystic tumors of liver accounting for fewer than 5% of all intrahepatic cysts of biliary origin. Most biliary cystic tumors arise from intrahepatic bile duct and 10-20% arise from extrahepatic bile duct like common hepatic duct, common bile duct, and gallbladder. The first case report of biliary cystic neoplasm in Korea dated back to 1975 by Bae et al, and over 40 cases of cystadenoma and 35 cases of cystadenocarcinoma were reported since then. These tumors usually present in middle-aged women with a mean age of 50 years. Biliary cystadenomas are lined by single layer of cuboidal or columnar epithelium and are very often multilocular with septal or papillary foldings. Over 80% of cystadenoma have dense mesenchymal stroma composed of dense spindle cells, like ovary. The epithelial lining of cystadenocarcinoma exhibits cellular atypia, mitotic activity, and infiltrative growth, but part of lining epithelium retain the feature of cystadenoma, which support the adenoma-carcinoma sequence. The size of tumors varies from 1.5 to 35 cm. Many patients are asymptomatic, except for the presence of palpable mass. When symptoms are present, they include epigastric or right upper quadrant pain or jaundice by enlarged mass. Biliary cystic tumor should be considered when a single or multilocular cystic lesion with papillary infoldings is detected in the liver by computed tomogram (CT) or ultrasound (US). Cystic wall and internal foldings can be seen enhanced by enhanced CT. US reveals a hypoechoic cystic mass with echogenic septation or papillary infoldings. Cystadenocarcinoma should be suspected when there is elevated mass or nodule in the wall or foldings, or thickened cystic wall on CT or US. But it is extremely difficult to differentiate between cystadenoma and cystadenocarcinoma by imaging alone. Increased tumor markers, carcinoembryonic antigen and carbohydrate antigen 19-9, in serum or cystic fluid have been reported in biliary cystic tumor. But tumor markers cannot distinguish cystadenocarcinoma from cystadenoma or both from other cystic lesions of liver. Malignant cells are not usually recovered in patients with cystadenocarcinoma who underwent cystic fluid cytology before and during surgery. The treatment of choice is radical excision of the mass by means of lobectomy or wide tumor excision. Aspiration, marsupialization, and drainage must be avoided. Inadequate excision of both cystadenoma and cystadenocarcinoma may lead to recurrence. Prognosis after complete excision is excellent.

Adult↗
PubMed1999

Cystadenomas and cystadenocarcinomas of the pancreas: a multiinstitutional retrospective study of 398 cases. French Surgical Association.

OBJECTIVE: To review the features of patients with benign and malignant cystadenomas of the pancreas, focusing on preoperative diagnostic accuracy and long-term outcome, especially for nonoperated serous cystadenomas and resected cystadenocarcinomas. SUMMARY BACKGROUND DATA: Serous cystadenomas (SCAs) are benign tumors. Mucinous cystic neoplasms should be resected because of the risk of malignant progression. A correct preoperative diagnosis of tumor type is based on morphologic criteria. Despite the high quality of recent imaging procedures, the diagnosis frequently remains uncertain. Invasive investigations such as endosonography and diagnostic aspiration of cystic fluid may be helpful, but their assessment is limited to small series. The management of typical SCA may require resection or observation. Survival after pancreatic resection seems better for cystadenocarcinomas (MCACs) than for ductal adenocarcinomas of the pancreas. METHODS: Three hundred ninety-eight cases of cystadenomas of the pancreas were collected between 1984 and 1996 in 73 institutions of the French Surgical Association. Clinical presentation, radiologic evaluation, and surgical procedures were analyzed for 144 operated SCAs, 150 mucinous cystadenomas (MCAs), and 78 MCACs. The outcome of 372 operated patients and 26 nonoperated patients with SCA was analyzed. RESULTS: Cystadenomas represented 76% of all primary pancreatic cystic tumors (398/522). An asymptomatic tumor was discovered in 32% of patients with SCA, 26% of those with MCA, and 13% of those with MCAC. The tumor was located in the head or uncinate process of the pancreas in 38% of those with SCA, 27% of those with MCA, and 49% of those with MCAC. A communication between the cyst and pancreatic duct was discovered in 0.6% of those with SCA, 6% of those with MCA, and 10% of those with MCAC. The main investigations were ultrasonography and computed tomography (94% for SCA, MCA, and MCAC), endosonography (34%, 28%, and 22% for SCA, MCA, and MCAC respectively), endoscopic retrograde cholangiopancreatography (16%, 14%, 22%), and cyst fluid analysis (22%, 31%, 35%). An accurate preoperative diagnosis of tumor type was proposed for 20% of those with SCA (144 cases), 30% of those with MCA, and 29% of those with MCAC. An atypical unilocular macrocyst was observed in 10% of SCA cases. The most common misdiagnosis for mucinous cystic tumors was pseudocyst (9% of MCAs, 15% of MCACs). Intraoperative frozen sections (126 cases) allowed a diagnosis according to definitive histologic examination in 50% of those with SCA and MCA and 62% of those with MCAC. For management, 93% of patients underwent surgery. Nonoperated patients (7%) had exclusively typical SCA. A complete cyst excision was performed in 94% of benign cystadenomas, with an operative mortality rate of 2% for SCA and 1.4% for MCA. Resection was possible in 74% of cases of MCAC. Mean follow-up of 26 patients with nonresected SCAs was 38 months, and no patients required surgery. For resected MCACs, the actuarial 5-year survival rate was 63%. CONCLUSIONS: Spiral computed tomography is the examination of choice for a correct prediction of tumor type. Endosonography may be useful to detect the morphologic criteria of small tumors. Diagnostic aspiration of the cyst allows differentiation of the macrocystic form of SCA (10% of cases) and the unilocular type of mucinous cystic neoplasm from a pseudocyst. Surgical resection should be performed for symptomatic SCAs, all mucinous cystic neoplasms, and cystic tumors that are not clearly defined. Conservative management is wholly justified for a well-documented SCA with no symptoms. An extensive resection is warranted for MCAC because the 5-year survival rate may exceed 60%.

Adolescent↗
PubMed2004

Incidental cystadenoma after laparoscopic treatment of hepatic cysts: which strategy?

Biliary cystadenoma is a very rare hepatic neoplasm, accounting for fewer than 5% of cystic neoplasms of the liver; regardless of the various diagnostic modalities, such a lesion may be difficult to distinguish preoperatively from a cystadenocarcinoma. Although a diagnosis of cystadenoma during open hepatic surgery demands a complete surgical resection, there are few reports describing the correct approach to such lesions after a laparoscopic approach. This article presents the first case series of incidental cystadenoma after laparoscopic surgery for hepatic cystic lesions. One patient with a polycystic liver disease treated with a laparoscopic enucleation of the larger cyst declined the reintervention after the diagnosis of cystadenoma; she had no recurrence at follow-up. One patient with a large simple hepatic cyst laparoscopically enucleated had no recurrence at the 18-month follow-up. In one patient, there was a high suspicion of recurrence of cystadenoma after the laparoscopic fenestration of a large cyst, but a histopathological specimen obtained after the open surgical resection could not confirm any signs of cystadenoma. The incidental finding of biliary cystadenoma after laparoscopic fenestration of a cystic hepatic lesion requires an open hepatic resection. When a complete laparoscopic enucleation of the cyst may be assured, a strict clinical, biochemical, and radiologic follow-up could be considered as the definitive treatment, demanding the surgical intervention only in case of recurrence or high suspicion for malignancy.

Cystadenoma↗
PubMed1988

[Cystadenoma and cystadenocarcinoma of the pancreas].

In the past 28 years 298 pancreatic tumors have been observed, out of which 2% (6 cases) were cystadenomas and 1.3% (4 cases) were cystadenocarcinomas. Cystadenomas appear around the 6th decade of life, what constitutes an argument against its congenital origin. They are more frequent in woman (2 to 1). The histopathologic differentiation of the mucinous cystic neoplasma often forming papillae of the serous cystadenoma is useful because those are likely to become malignant. Association of pancreatic cystadenomas with different pathologies (biliary lithiasis, cancer of a different location, cysts in other organs, diabetes) has been observed, but these would be mere coincidences. Cystadenomas are frequently operative findings (3 cases) in patients who had been operated on for different reasons, but they may have different symptoms, mainly pain and a abdominal mass. Visual method of diagnosis are useful in preoperative diagnosis. In cystic formations of the pancreas with surgical possibilities, operative biopsy a must be preferred to that one obtained by means of pre-operating needle puncture. Surgical resection is the method to be chosen, either enucleation (1 case) or pancreatectomy (3 cases), being more important in mucinous cystadenoma because they may become malignant. Cystadenocarcinomas are not so frequent and seem to originate in benign cystadenomas. Palpable tumors, compression signs and pain are the late clinical manifestations. The resection is the treatment to be chosen although the most cases are unresectable. An external drainage is not a satisfactory operation but it sometimes helps to lessen the symptoms, and sometimes its posterior resection was possible.

Adult↗
PubMed1981

[Cystadenoma of the pancreas, a potentially malignant tumor (author's transl)].

Cystadenomas occur rather rarely among the cystic lesions of the pancreas, but they nevertheless require special attention. These cystadenomas do have a tendency for malignant degeneration, especially their mucinous form with papillary proliferation of the epithelium; insofar cystadenomas have to distinguished from retention nor pseudocysts, resulting from pancreatitis or from traumatic lesions of the pancreas. Differentiation of cystadenomas and other cysts can neither be achieved by preoperative diagnostic procedures nor by macroscopic findings during surgery. Diagnosis however can be established after biopsy during surgery. A cystadenoma has to be suspected especially in women of middle age, who do not have any history of pancreatitis, abdominal trauma or alcoholism, if the lesion is localized in the corpus or tail are of the pancreas. Cystadenoma have to be treated as potentially malignant tumors. The therapy of choice is excision far out in normal tissue; this is the only way to prevent relapses and to avoid transition of the lesion into a carcinoma. Thus, it has to be postulated for all patients who are being operated upon because of cysts of the pancreas that multiple biopsies should be done from various parts of the cystic wall during surgery and that drainage of the cyst should be performed only if a cystadenoma can be excluded.

Adult↗
PubMed2001

Serous cystadenoma of the pancreas with papillary features: a diagnostic pitfall on fine-needle aspiration biopsy.

Serous cystadenoma of the pancreas is an uncommon neoplasm that occasionally exhibits papillary differentiation. The cytomorphologic structure of pancreatic serous cystadenoma has been rarely described, and, to our knowledge, such papillary morphologic structure has never been reported on fine-needle aspiration cytologic examination. We present a case of serous cystadenoma of the pancreas in a 77-year-old woman. Endoscopic ultrasonography showed a well-demarcated solid/cystic mass in the midbody of the pancreas, suggestive of solid pseudopapillary tumor. Aspiration cytologic examination, performed under endoscopic ultrasound guidance, showed a predominantly papillary epithelial neoplasm consistent with the radiologic impression. Gross and histologic examination of the excised specimen revealed a pancreatic serous cystadenoma with multifocal papillae. This case illustrates the cytomorphologic structure of serous cystadenoma that presents with prominent papillary differentiation on aspiration cytologic examination. The unusual cytologic appearance of this tumor introduces significant diagnostic challenges to the pathologist. Serous cystadenoma must be included in the differential diagnosis of pancreatic neoplasms with papillary morphologic structure as evaluated by fine-needle aspiration cytologic examination.

Aged↗
PubMed1994

[Mucinous cystadenomas and cystadenocarcinomas of the pancreas--the pancreaticoscopy as a new device for endoscopic and histological diagnosis].

Recent advances in diagnostic imaging procedures offer the opportunity for detection of rare cystic neoplasms of the pancreas. Cystadenomas of the pancreas have been reported to represent 10% of cystic pancreatic lesions. Serous microcystic cystadenoma, megacystic mucinous and duct-ectatic mucinous cystadenoma were distinguished. While the serous cystadenoma is benign, in general the megacystic and the duct-ectatic mucinous cystadenoma have a significant malignant potential. With pancreatoscopy, a rather new endoscopic technique, five cases of mucinous megacystic cystadenoma were diagnosed preoperatively by macroscopic and microscopic means. In one case, development of malignant neoplasm was diagnosed, one patient did not undergo surgery because of her age. Three patients were operated (total pancreatectomy in one case, duodeno-hemipancreatectomy in two cases) and are without any further signs of recurrence and free of symptoms in a one year to four year clinical follow-up.

Adult↗
PubMed1977

Biliary cystadenoma and cystadenocarcinoma: report of 14 cases and review of the literature.

The clinical and pathologic features and long-term follow-up of eight patients with biliary cystadenoma and six patients with biliary cystadenocarcinoma are reported and the previous literature is reviewed. All the cystadenomas were in middle-aged women, but the six cystadenocarcinomas occurred in both male (4) and female (2) patients. The majority of the patients with cystadenoma and half of those with cystadenocarcinoma presented with an abdominal mass. Four of the patients whose cystadenoma was excised are alive and well for periods of time ranging from 2 1/2 to 13 years. Two of the patients with cystadenocarcinoma have survived for three years and for three years and eight months, respectively, after subtotal hepatic lobectomy. Morphologically the cystadenocarcinomas differ from the cystadenomas in that the former have cellular pleomorphism and anaplasia and infiltration of the underlying fribrous stroma; they can invade adjacent viscera and may occasionally metastasize to distant sites. The presence of benign epithelium in most cystadenocarcinomas supports their origin from cystadenoma.

Adult↗
PubMed2002

Mucinous cystadenoma of the pancreas resected 11 years after cystgastrostomy.

There have been numerous reports that mucinous cystadenoma of the pancreas can transform to mucinous cystadenocarcinoma after cystenterostomy, but few authors have reported morphological changes long after cystenterostomy for mucinous cystadenoma. A 41-year-old Japanese woman had undergone cystgastrostomy at a nearby hospital 11 years before undergoing the treatment reported here. The preoperative diagnosis at the time of cystgastrostomy was a pancreatic cyst. At laparotomy a cyst, measuring 10cm in diameter, was found in the body and tail of the pancreas. The histopathological diagnosis of the cyst wall was mucinous cystadenoma of mild dysplasia. Computed tomography 10 years after the cystgastrostomy showed that the cyst had decreased in diameter from 10 cm to 5cm. Gastroscopy showed a scar at the cystgastrostomy site in the stomach. A complete resection of the mucinous cystadenoma was done, 11 years after the cystgastrostomy, because of the malignant potential. The resected specimen showed mucinous cystadenoma of mild dysplasia with structural and cellular atypia similar to that in the previous specimen. There was no malignant change. The patient was discharged after an uneventful postoperative course and no recurrence has been evident for 6 months to date. This case showed imaging and histopathological evidence of the slow-growing nature of mucinous cystadenoma of the pancreas.

Adult↗
PubMed1993

Cyst fluid analysis in the differential diagnosis of pancreatic cysts. A comparison of pseudocysts, serous cystadenomas, mucinous cystic neoplasms, and mucinous cystadenocarcinoma.

Pancreatic cystic lesions include inflammatory pseudocysts, benign serous tumors, and mucinous neoplasms, some of which are malignant. Clinical and radiologic indices are often inadequate to discriminate reliably among these possibilities. In an attempt to develop new preoperative diagnostic criteria to assist in decisions regarding therapy, the authors have performed cyst fluid analysis for tumor markers (carcinoembryonic antigen: CEA, CA 125, and CA 19.9), amylase content, amylase isoenzymes, relative viscosity, and cytology on 26 pancreatic cysts. The cases included nine pseudocysts, five serous cystadenomas, 4 mucinous cystic neoplasms, 7 mucinous cystadenocarcinomas, and one mucinous ductal adenocarcinoma with cystic degeneration. Carcinoembryonic antigen levels were high (> 367) in all benign and malignant mucinous cysts, but were low (< 23) in the pseudocysts and benign serous cystadenomas, an indication that CEA discriminates between mucinous and nonmucinous cysts (p < 0.0001). Values for CA 125 were high in all malignant cysts, low in pseudocysts, and variable in mucinous cystic neoplasms and serous cystadenomas. Levels of Ca 19.9 were nondiscriminatory. Cyst fluid amylase and lipase content were variable but were generally high in pseudocysts and low in cystic tumors. Amylase isoenzyme analysis was useful to differentiate pseudocysts from cystic tumors. Measurement of the relative viscosity in cyst fluid showed high (> serum viscosity) values in 89% of mucinous tumors and low values (< serum) in all pseudocysts and serous cystadenomas (p < 0.01). Cytologic analysis of cyst fluids was of limited value in differentiating pseudocysts from serous cystadenoma, but in seven of eight mucinous tumors provided useful diagnostic information and correctly classified three of five malignant tumors. The authors conclude that cyst fluid analysis can provide a preoperative classification of these diagnostically difficult lesions. The combination of viscosity, CEA, CA 125, and cytology can reliably distinguish malignant cystic tumors and potentially premalignant mucinous cystic neoplasms from pseudocysts and serous cystadenomas. Amylase content with isoenzyme analysis is useful to identify pseudocysts.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1982

Cystadenoma of the liver.

We report a patient with cystadenoma of the liver who presented with jaundice and abdominal mass. Although cystadenoma of the liver is a rare neoplasm, the lesion was diagnosed preoperatively by gray scale ultrasonography, PTC and ERCP. Characteristically, cystadenoma shows a multiseptated cystic appearance. While the origin of a cystadenoma is unclear, theories of synchronous development from anomalous bile ducts, endodermal diverticula, and ectopic germ cell origins have been promoted. Approximately 85% of patients with hepatic cystadenoma are women, with an insidious onset of symptoms due to the slowly growing nature of this tumor. Common symptoms include right upper quadrant mass, abdominal distension, and dull abdominal pain. Jaundice is less common. Complications include biliary obstruction, infection, hemorrhage, and rupture. As hepatic cystadenoma tends to recur after inadequate excision, and has malignant transformation potential, hepatic lobectomy has been promoted as definitive treatment.

Adult↗
PubMed2005

Serous cystadenoma of the pancreas: tumor growth rates and recommendations for treatment.

OBJECTIVE: To define the natural history and optimal management of serous cystadenoma of the pancreas. SUMMARY BACKGROUND DATA: Serous cystadenoma of the pancreas is the most common benign pancreatic neoplasm. Diagnostic criteria, potential for growth or malignancy, and outcomes are not well defined. As a result, management for patients with serous cystadenomas varies widely in current practice. METHODS: A total of 106 patients presenting with serous cystadenoma of the pancreas from 1976-2004 were identified. Hospital records were evaluated for patient and tumor characteristics, diagnostic workup, treatment, and outcome. Twenty-four patients with serial radiographic imaging were identified, and tumor growth curves calculated. RESULTS: Mean age at presentation was 61.5 years and 75% of patients were female. The most common symptoms were abdominal pain (25%), fullness/mass (10%), and jaundice (7%); 47% were asymptomatic. Mean tumor diameter was 4.9 +/- 3.1 cm, which did not vary by location. Tumors <4 cm were less likely to be symptomatic than were tumors > or =4 cm (22% vs. 72%, P < 0.001). The median growth rate in the patients who had serial radiography was 0.60 cm/y. For tumors <4 cm at presentation (n = 15), the rate was 0.12 cm/y, whereas for tumors > or =4 cm (n = 9), the rate was 1.98 cm/y (P = 0.0002). Overall, 86 patients underwent surgery, with one perioperative death. CONCLUSIONS: Large (>4 cm) serous cystadenomas are more likely to be symptomatic. Although the median growth rate for this neoplasm is only 0.6 cm/y, it is significantly greater in large tumors. Whereas expectant management is reasonable in small asymptomatic tumors, we recommend resection for large serous cystadenomas regardless of the presence or absence of symptoms.

Aged↗
PubMed1997

Apocrine cystadenoma, apocrine hidrocystoma, and eccrine hidrocystoma: three distinct tumors defined by expression of keratins and human milk fat globulin 1.

Eccrine hidrocystomas and apocrine cystadenomas are morphologically related cystic sweat gland tumors. To elucidate their cellular differentiation we examined by immunohistochemistry the expression of keratins and of human milk fat globulin 1 in 12 of each of these tumors, diagnosed using established conventional histological criteria. All tumors diagnosed as apocrine cystadenomas by these criteria were characterized by a keratin pattern of secretory type. In addition, they expressed human milk fat globulin 1. Tumors diagnosed as eccrine hidrocystomas expressed a keratin pattern of excretory type. A part of the tumors with an excretory keratin pattern expressed human milk fat globulin, while others did not. Some presumed eccrine hidrocystomas expressed the very same antigens as apocrine cystadenomas. Thus, our study reveals three distinct types of tumors, in contrast to the conventional distinction of only eccrine hidrocystomas and apocrine cystadenomas. Apocrine cystadenomas differentiate towards the secretory coil of apocrine sweat glands. Presumed eccrine hidrocystomas may represent cystic tumors of the eccrine sweat duct, or they may represent cystic tumors of the apocrine duct. Thus, the name hidrocystoma should be used without further specification of an eccrine or apocrine nature, unless certainty is reached by immunohistochemical characterization. Also, hidrocystomas often prove to be histologically misdiagnosed apocrine cystadenomas because of a flattened cyst wall secondary to increased intraluminal pressure.

Apocrine Glands↗
PubMedDate not supplied

Ultrasonographic evaluation of biliary cystadenomas in cats.

The purpose of this study was to describe the ultrasonographic appearance of biliary cystadenomas in cats and compare the findings to a similar rare form of liver tumor in humans. Biliary cystadenomas are uncommon, benign liver tumors of older cats that may occur as focal or multifocal cystic lesions within the liver. The records of 10 cats which had abdominal ultrasonography and histologic diagnosis of biliary cystadenoma were reviewed. The average age of affected cats was 13.3 years (range 10-16 years). Eight cats were neutered males and two were neutered females. In three cats, the tumors were not seen ultrasonographically due to their small size or from being obscured by near-field reverberation echoes. The remaining seven cats had solitary (4 cats) or multifocal (3 cats) masses corresponding to variable ultrasonographic patterns: multilocular masses containing thin-walled cysts, hyperechoic masses with cystic components, or masses of mixed echogenicity with cystic components. The masses had variable ultrasonographic patterns when multifocal disease was present. Recognizable cysts were evident somewhere within the tumors seen ultrasonographically, although sometimes the cysts appeared very small. The biliary cystadenomas were thought to be clinically silent. Although liver enlargement or a cranial abdominal mass was palpable in 4 cats, no consistent trend of clinical signs, CBC or serum biochemical abnormalities could be directly attributed to biliary cystadenoma. The treatment of choice is surgical resection of the tumor, as continued growth may compress adjacent vital structures within the liver. The differential diagnosis of biliary cystadenomas from other cystic liver lesions such as hepatic cysts, hematomas, abscesses, parasitic cysts, or other liver tumors is discussed.

Adenoma, Bile Duct↗