Interactive Transcript
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So this is a 30-year-old female who presents
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with right upper quadrant pain, and a CT
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scan was obtained to further evaluate this.
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So we scroll down.
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The CT scan was performed with
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or without intravenous contrast.
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I'm showing you the post-contrast phase only.
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We can see that there's an abnormality
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in the right hepatic lobe, and there's
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essentially quite a large mass that's
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replacing much of the right hepatic lobe.
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Internally, it looks like it has low density,
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so it's probably going to be a cystic mass.
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But its borders are quite irregular.
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If you look at this border here,
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it's a little bit lobulated and maybe
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a little bit thickened over here.
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As you go down here, posteriorly,
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there's thin septation associated with this.
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As you go over here, there's another thin
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septation associated with this.
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And so whatever it is, it's
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not completely simple looking.
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You also note that if you look at the remainder
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of the liver parenchyma, this is an isolated
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finding in that you're not really seeing
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other masses or other cysts in the liver.
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The only real abnormality we're
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seeing is this large mass
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in the right hepatic lobe.
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Look at the coronals.
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It'll give you a sense of sort
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of how large this lesion is.
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From cranial to caudal dimension, you get
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a sense of some of the borders that are
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a little bit thicker, like over here is much
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thicker than, say, this border over here.
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And then this, particularly inferiorly and
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posteriorly, you can see that there's multiple
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septations within portions of this mass.
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And so, again, this finding in and of itself is
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nonspecific, but if you sort of look at it, one
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of the things you may want to consider is this
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entity of hepatic mucinous cystic neoplasm.
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And it has a lot of things that
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are going for this instance in
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that it's a large cystic mass.
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It's isolated.
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It has minimal complexity to it, and it has
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little septations, little thickened walls.
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It's in the right gender, which
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is female in this patient.
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Typically, we see them in patients
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who are a little bit older than this
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30-year-old female, but we can see
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them in a wide variety of age groups.
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And so, it's certainly something that may
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be suggested as part of the differential
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diagnosis in this patient, and this
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turned out to be a hepatic mucinous
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cystic neoplasm when it was resected.
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Remember that this was formerly sort of known
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as a biliary cystadenoma, but the nomenclature
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has changed over time.
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Yep, and so this was just something to think
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about when you see these isolated, large cystic
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lesions that have minimal areas of complexity,
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and certainly to differentiate it from its
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malignant counterpart, we're looking for
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discrete soft tissue nodules with enhancement,
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which we don't see in this instance.
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