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Objective: To identify important MRI features to differentiate hepatic mucinous cystic neoplasms (MCN) from septated hepatic cysts (HC) using random forest and compared with logistic regression algorithm. Methods: Pathologically diagnosed hepatic cysts and hepatic MCNs with pre-operative contrast-enhanced MRI in our hospital from 2010 to 2023 were collected and only septated lesions on enhanced MRI were enrolled. A total of 21 septated HC and 18 MCNs were included in this study. Eighteen MRI features were analyzed and top important features were identified based on random forest (RF) algorithm. The results were evaluated by the prediction performance of a RF model combining the important features and compared with the performance of the logistic regression (LR) algorithm. Finally, for each identified feature, diagnostic probability, sensitivity, and specificity were calculated and compared. Results: Four variables, i.e., the septation arising from wall without indentation, multiseptate, intracapsular cyst sign, and solitary lesion were extracted as top important features with significance for MCNs by the random forest algorithm. The RF model using these variables had an AUC of 0.982 (0.95CI, 0.950–1.000), compared with the LR model based on two identified features with AUC of 0.931 (0.95CI, 0.846–1.000), p = 0.202. Among the four important features, multiseptate had the highest specificity (95.2%) and good sensitivity (72.2%, lower than the septation from wall without indentation, 94.4%) to diagnose MCNs. Conclusion: Four out of 18 MRI features were extracted as reliably important factors to differ hepatic MCNs from septated HC. The combination of these four features in a RF model could achieve satisfactory diagnostic efficacy. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to compare the efficacy of incomplete alcohol sclerotherapy with complete treatment for hepatic cysts. Methods: From 2005 to 2021, a total of 80 patients (19 males, 61 females; median age 65 years; age range, 42–86 years) who underwent alcohol sclerotherapy for symptomatic benign hepatic cysts were enrolled and retrospectively reviewed. Complete treatment was defined as injecting 25–33% of the aspirated cyst volume with alcohol in 2–3 cycles, with a maximum of 100 mL per cycle. The overall volume reduction rate was compared between the complete and incomplete treatment groups. The response, based on cystic volume reduction, was classified as a complete regression (CR), near-complete regression (NCR), partial regression (PR), or no response (NR). CR and NCR were considered objective responses. Among 80 patients with 85 hepatic cysts, 26 patients with 29 hepatic cysts received incomplete treatment. Results: The overall volume reduction rate was not significantly different between the complete and incomplete treatment groups (94.39% vs. 95.47%, respectively, p = 0.623). The CR and NCR groups showed a significantly higher rate of symptom improvement than the PR and NR groups (p = 0.043). Conclusions: In conclusion, the efficacy of incomplete alcohol sclerotherapy was not inferior to that of complete treatment. [ABSTRACT FROM AUTHOR]

Background: Cystic echinococcosis (CE) is a parasitic zoonosis caused by the tapeworm Echinococcus granulosus. Over the past few years, a lot of research has been done on liver illnesses using metabolomics techniques to identify biomarkers which could identify the diseases in its early stages. The present study was done to explore biomarkers in serum, urine, and cystic fluid which would help in differentiating, staging, and assessing fertility of intra-abdominal hydatid cyst by using proton nuclear magnetic resonance (1H NMR) metabolomics. Materials and methods: In the study, 28 subjects (16 cases and 12 controls) were enrolled. Staging of hydatid cysts was performed using ultrasonography. In patients complying with case and control definition, blood, urine, and cystic fluid were collected for complete blood count, urine culture, Echinococcus IgG enzyme-linked immunosorbent assay (ELISA), and metabolomic analysis. The 17, 15, and 11 metabolites in serum, urine, and cystic fluid samples were quantified, respectively, to differentiate between case and control group. Results: In this study, we observed that there was a significant downregulation of succinate metabolite in urine samples of cases, down-regulation of five metabolites (isoleucine, valine, histidine, tyrosine and formate) and upregulation of alanine in cystic fluid of cases. Conclusion: Current study demonstrates that metabolomics can be used non-invasively for rapid diagnosis of CE. This is one of the very few studies, which used 1H NMR spectroscopy, to analyze the profile of metabolites in serum, urine, and cystic fluid in cases of CE and controls. [ABSTRACT FROM AUTHOR]

Maturity onset diabetes in young (MODY) is the most common form of monogenic diabetes, which characteristically presents in adolescents and young adults. Till date, pathogenic variations involving 14 different genes have been causally implicated with the development of MODY. Maturity onset diabetes in young type 4 (MODY-4) is a very rare form of MODY. We present here case of 28-year-old nonobese male patient with distinct family history of diabetes spanning two generations, incidentally, detected to have a rare form of diabetes on genetic analysis when he presented with recurrent thromboembolic manifestations: deep vein thrombosis and pulmonary thromboembolism. Our case highlights a previously unknown disease association of a rare genetic disorder. Increasing awareness about this genetic disorder and early identification of such cases will enhance our understanding of hitherto unknown disease associations and the pathophysiological role of genetic mutations. This may contribute to the improved treatment and prevention of debilitating diseases such as diabetes. [ABSTRACT FROM AUTHOR]

Solitary intrahepatic biliary cyst (SIBC) is a rare disease, and due to the lack of adequate understanding of it, SIBC is often misdiagnosed as simple liver cyst (SLC), which in turn affects the therapeutic effect. In order to arouse more attention to SIBC, combined with clinical experience in our center, this study specifically screened 3 representative cases of SIBC, and conducted a comprehensive retrospective analysis of their clinical characteristics, diagnosis and treatment process. Combined with the relevant literature, the diagnosis and treatment process of SIBC is widely discussed. [ABSTRACT FROM AUTHOR]

Symptomatic hepatic cysts are infrequent and their presentation with rupture leading to an hemoperitonium is even more uncommon. This case report illustrates the challenges associated with the diagnosis and management of a ruptured simple hepatic cyst. We report the case of 72-year-old female, a known case of liver cirrhosis, hypertension, diabetes mellitus, and cholelithiasis who presented to our center with features of acute abdomen and was diagnosed with the ruptured simple hepatic cyst. Deroofing and marsupialization of the cyst was performed. This case report emphasizes the significance of early recognition and a multidisciplinary approach in managing ruptured simple hepatic cysts. Heightened clinical awareness, coupled with advanced imaging techniques, is crucial for accurate diagnosis and timely intervention.

Background: The purpose of this study was to compare the efficacy of incomplete alcohol sclerotherapy with complete treatment for hepatic cysts. Methods: From 2005 to 2021, a total of 80 patients (19 males, 61 females; median age 65 years; age range, 42–86 years) who underwent alcohol sclerotherapy for symptomatic benign hepatic cysts were enrolled and retrospectively reviewed. Complete treatment was defined as injecting 25–33% of the aspirated cyst volume with alcohol in 2–3 cycles, with a maximum of 100 mL per cycle. The overall volume reduction rate was compared between the complete and incomplete treatment groups. The response, based on cystic volume reduction, was classified as a complete regression (CR), near-complete regression (NCR), partial regression (PR), or no response (NR). CR and NCR were considered objective responses. Among 80 patients with 85 hepatic cysts, 26 patients with 29 hepatic cysts received incomplete treatment. Results: The overall volume reduction rate was not significantly different between the complete and incomplete treatment groups (94.39% vs. 95.47%, respectively, p = 0.623). The CR and NCR groups showed a significantly higher rate of symptom improvement than the PR and NR groups (p = 0.043). Conclusions: In conclusion, the efficacy of incomplete alcohol sclerotherapy was not inferior to that of complete treatment.

Introduction: Pseudoprune-belly syndrome is a rare anomaly, an incomplete form of Prune-belly syndrome. The etiology is not clear, and though this syndrome may present associated with other malformations, the association with a liver cyst is extremely rare. Case presentation: We report the case of a male newborn who was referred to our hospital with an antenatal ultrasound that suggested a gastric duplication. Clinical examination revealed lax abdominal wall, unilateral undescended testis and a palpable mass on the right upper quadrant with fuzzy boundaries. On laparotomy we found a giant hepatic cyst displacing the bowel to the left. The baby underwent a partial ressection and marsupialization of the cyst as total resection was infeasible. The patient's recovery was uneventful. Conclusion: Although rarely, the Pseudoprune-belly syndrome can present with a liver cyst. Large liver cysts should be partially or totally ressected as soon as possible.

Biliary cystadenoma (also called mucinous cystic neoplasm with low-grade intraepithelial neoplasia) is a rare cystic tumor that arises from the biliary epithelium. The cause of biliary cystadenoma is still unclear. Jaundice is a rare presentation of intrahepatic biliary cystadenoma, which can lead to a diagnostic dilemma. Herein, we present a case of intrahepatic biliary cystadenoma that primarily exhibited as jaundice. A 56-year-old woman has suffered from yellow staining of her skin and sclera for more than 1 month. She had a poor appetite and mild epigastric pain. Laboratory examination showed elevated levels of total bilirubin and elevated carbohydrate antigen 19-9 (CA19-9). A contrast-enhanced computed tomography of the abdomen showed a 7.4 * 5.3-cm, oval, low-density lesion in the left liver parenchyma with a clear boundary and visible septa. The common bile duct was obviously dilated with wall thickening. Onmagnetic resonance imaging, the lesion in the liver showed a multilocular cystic, unenhanced long T2 signal. There was local thickening of the common bile duct wall with short T2-like filling defects and high signal intensity on diffusion-weighted imaging (DWI). The patient had no history of other malignant tumors and adjuvant therapy such as radiotherapy and chemotherapy. She was clinically suspected of having either biliary cystadenoma or a malignancy; hence, resection was performed. Macroscopically, the excised tissue specimen showed a polypoidmass in the common bile duct, which extended along the bile duct to the intrahepatic bile duct. There was a cystic and solid mass in the left liver with yellow turbid fluid, which was associated with the polypoidmass in the common bile duct. Histopathology suggests mucinous cystadenoma of the liver and hilar bile duct. The differential diagnosis of biliary cystadenoma and treatment selection have been discussed. [ABSTRACT FROM AUTHOR]

Aim: Minocycline hydrochloride (MINO) aspiration sclerotherapy (AS) has been widely used for treating hepatic cysts (HC). However, cyst recurrence remains problematic. Information on monoethanolamine oleate (EO) AS, another effective HC treatment, is currently limited. We investigated the efficacy of EO on ineffective MINO treatments, and the relationship between MINO AS and cyst fluid pH. Methods: A total of 22 cases with symptomatic HC underwent AS with 500 mg of MINO from January 2016 to June 2021. Cyst fluid pH was measured before and after MINO injection. Cyst volume ratio (CVR, %) after 2 weeks was calculated as follows:cyst volume 2 weeks after MINO injection / pre‐treatment cyst volume × 100. Treatment was completed if CVR after 2 weeks was ≤35% (MINO‐group). For patients with CVR >35%, 2 g of EO was added (MINO/EO‐group). Cyst volume ratio was measured every 12 months thereafter. Results: There were no recurrence symptoms in any of the patients during follow‐up. Of the 22 cases, 21 had CVR ≤20% after 12 months. The MINO/EO‐group (n = 8) tended to have smaller CVRs after 12 months than the MINO‐group (n = 14). Cyst volume ratio after 2 weeks was correlated to pH change (p = 0.012) and was larger in patients whose pH decreased by <1.5 (p = 0.015). All adverse events were mild, including in elderly patients. Conclusion: Adding EO is an effective and safe treatment for symptomatic HC when MINO AS alone is insufficient. Patients with pH decreases of <1.5 should be considered for additional EO treatment. [ABSTRACT FROM AUTHOR]

Background: Simple hepatic cysts are commonly detected in the general population, both solitary and associated with Adult Dominant Polycystic Kidney Disease (ADPKD). Laparoscopic fenestration is a surgical option adopted as first-line treatment and to treat complications. The techniques reported in the literature are associated with cyst recurrence in up to 41% of cases. Methods: From 2012 to May 2021, 19 symptomatic patients diagnosed with simple HCs underwent an innovative technique for laparoscopic fenestration, which includes simultaneous ethanol injection into the residual cavity. The median follow up was 57 (range 4-116) months. We retrospectively analysed symptomatic relief obtained in the short and long term as primary outcome. We also evaluated the postoperative outcome, recurrence and re-intervention rates. Results: 11 patients (of 19) were female (58 %), with a median age of 58 (range 31-78) years. Most patients (17 of 19) experienced relief of symptoms after intervention (89,5 %). Radiological recurrence occurred in 21% of patients; nevertheless, only one patient, affected by ADPKD, experienced clinical relapse with abdominal discomfort. No patient needed reintervention. There was no major morbidity (Clavien-Dindo III-IV) nor 90-day mortality. The technique allowed early removal of abdominal drainage (median 2.5 days). Conclusions: Laparoscopic fenestration of a simple hepatic cyst, with simultaneous ethanol injection, combines the advantages of the laparoscopic approach with those of injecting sclerosing agent. The described technique is associated with symptomatic relief and a favourable outcome in the postoperative period, as well as with good long term results.

This case report will discuss a 6-month-old female, born at 37 weeks gestation, who underwent a diagnostic laparoscopy for an intra-abdominal cystic mass that was diagnosed in utero at 22 weeks’ gestation. She underwent an abdominal U/S on her second day of life. This redemonstrated the intra-abdominal cystic lesion, measuring 2.8 × 2.3 × 2.9 cm with differential diagnosis including a mesenteric cyst, enteric duplication cyst, and lymphatic malformation. The patient was taken to the operating room for surgical intervention. She was found to have a hepatic lesion, which appeared to be a simple hepatic cyst. Pathology reported this to be a benign congenital biliary-type cyst. We describe a laparoscopic approach to this benign appearing hepatic/biliary mass.

A 14-year-old spayed female Shih-Tzu was referred to the Veterinary Medical Teaching Hospital of Konkuk University for evaluation of an abdominal mass. In diagnostic imaging, two large cystic masses were identified. The affected liver lobes were surgically resected, and the specimens were submitted for histopathological evaluation and immunohistochemical staining. The two cystic lesions were diagnosed as biliary cystadenocarcinoma (BCAC). Recurrence and regional invasion were identified on ultrasonography 36 days postoperatively. The patient died on postoperative day 271. To the best of our knowledge, previously reported case studies of BCAC in dogs presented limited clinical information. In this report, we present a detailed picture comprising a range of clinical information and histopathological examination of BCAC in a dog. [ABSTRACT FROM AUTHOR]

Aim: Simple hepatic cysts are typically benign; however, when they are large and symptomatic, therapeutic intervention is required. We previously reported our initial experience with ultrasound (US)‐guided polidocanol foam sclerotherapy in three patients with symptomatic giant hepatic cysts. In the present study, we examined the efficacy and safety of polidocanol foam sclerotherapy in a larger number of patients with long‐term follow‐up. Methods: Between May 2016 and April 2021, 15 patients with symptomatic giant hepatic cysts were referred to our hospital. All patients were prospectively included in the study and underwent US‐guided polidocanol foam sclerotherapy. Results: The mean maximum diameter and estimated cyst volume were 128.4 mm (77–223 mm) and 922.3 ml (123.2–2797 ml), respectively. Polidocanol foam was successfully administered through an 8.5‐Fr pigtail catheter in all patients. The percentages of cyst diameter/volume after 1–3 months, 3–6 months, 6 months–1 year, 1–2 years, and 2–4 years of sclerotherapy were 66.8%/36.5%, 48.1%/14.8%, 34.1%/6.9%, 28.2%/3.7%, and 26.2%/3.1%, respectively. During the follow‐up period, there were no cases of symptom recurrence or need for additional treatment due to cyst re‐growth. Six patients (40%) had fever, one had nausea, and one had right‐sided chest pain, but none of these adverse events required prolonged hospitalization or readmission. Conclusions: US‐guided polidocanol foam sclerotherapy may be an effective and safe method for the treatment of symptomatic giant hepatic cysts. [ABSTRACT FROM AUTHOR]

Simple hepatic cysts, common benign liver conditions, are increasingly detected incidentally due to advancements in imaging technologies. While typically asymptomatic, complications such as compression of neighboring structures can arise, presenting unique diagnostic and management challenges. We present a doubly complicated case of a massive non-parasitic liver cyst in a 61-year-old female patient, manifesting with dyspnea and compression of the inferior vena cava. A 61-year-old female with a history of treated hypertension presented with worsening dyspnea over six months. Physical examination revealed a large, painless abdominal mass, and imaging confirmed a 20 cm cystic liver mass compressing the inferior vena cava and exerting a mass effect on the diaphragm. Surgical exploration and deroofing of the cyst led to successful resolution. The presentation of dyspnea in non-parasitic liver cysts is rare but notable, highlighting the importance of considering hepatic etiologies in respiratory symptoms. Imaging modalities such as ultrasound and CT play crucial roles in diagnosis, while MRI aids in ruling out biliary-cystic fistulas. Surgical management, particularly subcostal laparotomy, remains a viable option for complex cases. This case underscores the need for heightened awareness of atypical presentations of non-parasitic liver cysts and the significance of imaging in diagnosis. Subcostal laparotomy, though associated with limitations, remains valuable in select cases. Further research comparing surgical approaches is warranted to optimize management strategies for symptomatic non-parasitic liver cysts. • This presentation details a rare case of a massive non-parasitic liver cyst, complicated by dyspnea and compression of the inferior vena cava. • Imaging modalities including CT scans and biliary MRI were crucial in diagnosis, revealing compression not only of adjacent structures such as the inferior vena cava and the ipsilateral kidney but also demonstrating displacement of the liver against the diaphragmatic dome. • Successful resolution achieved through cyst deroofing, emphasizing the doubly complicated nature of the case. • This case highlights the atypical presentation and complications associated with hepatic cysts, emphasizing the importance of considering hepatic etiologies in such cases and the crucial role of imaging in guiding management strategies. [ABSTRACT FROM AUTHOR]

Cysticercus fasciolaris (C. fasciolaris) is the larval stage of a cestode parasite named Taenia taeniaeformis (T. taeniaeformis). C. fasiolaris is found in small rodents, especially rats. Rattus species are listed as intermediate hosts of this parasite, and cats are the main definitive host of C. fasiolaris. The objective of this study was to study the pathological, microscopic, and molecular aspects of C. fasciolaris in rodents residing in human residence areas. One hundred and two rodents were trapped in human settlements and dissected for larva-containing cyst examinations in the body cavity. The larvae of C. fasciolaris were investigated using histopathological examination, microscopic observations under a stereomicroscope and scanning electron microscope, and molecular detection using polymerase chain reaction. The prevalence of hepatic cysts containing larvae was 8.91% (95% CI = 4.16–16.24). In addition, the older larvae also had longer micropapillae. Histopathological investigation revealed normal hepatic tissue containing larvae and a scanty fluid cyst. The cyst capsule contains mostly mononuclear cells and spindle cells in all infected rats. The molecular detection using two primer sets revealed the amplicons were similar to the clade of C. fasciolaris. In the future, more investigation is necessary to fully understand the parasite's molecular pathogenesis and virulent molecules, which are less obvious. • The prevalence of Cysticercus cysts in the livers of captured rats was 8.91%. • Cysticercus fasciolaris larvae were coiled in fluid space, surrounded by a fibrous cyst wall embedded in the liver parenchyma. • The infected liver tissues presented the filtration of mononuclear cells with no liver parenchyma change. • The rostellum, hook, and micropapillae structures of C. fasciolaris can be used to determine larval development. • The partial sequences of 28 S rRNA and COI genes that were obtained in this study matched T. taeniaeformis. [ABSTRACT FROM AUTHOR]

Background: Biliary cystadenomas are very rare benign tumors which can transform into cystadenocarcinomas. The largest case series reported on 221 cases over 30 years from 10 HPB centers, i.e., about 7 cases per center per decade. The recommended treatment is liver resection. Enucleation of biliary cystadenomas has been done rarely. The purpose of the study was to determine the outcome of enucleation of these cysts, particularly the mortality rate and the recurrence rate. Methods: A keyword search was done using OVID followed by a search of the bibliography of papers describing the enucleation of biliary cystadenomas. Of 45 articles obtained, 25 were retained. The main reasons for exclusion were non-English language and review articles. Results: One hundred three patients in the 25 studies were treated with enucleation. Thirteen studies described prior treatments that had failed with resulting recurrence requiring re-treatment. The main indication for enucleation was large central cysts for which liver resection would be high risk. There were no postoperative deaths in patients treated by enucleation. Thirteen studies provided long-term follow-up in 40 patients, a substantial number given the rarity of the tumor. There were no recurrences or transformations to malignancy. Conclusions: Enucleation seems to represent a reasonable treatment technique for BCA, especially when a large cystic lesion is located centrally and/or would require a large liver resection with significant loss of parenchyma. [ABSTRACT FROM AUTHOR]

Introduction: Congenital hepatic cyst is a rare hepatobiliary malformation that can present as an asymptomatic, unilocular, upper abdominal cystic mass in the fetus. Cases: We report two cases of congenital hepatic cyst in which the diagnosis was made by prenatal ultrasound at 25 and 33 weeks' gestation. The diagnosis was confirmed postnatally by abdominal ultrasound and radiologic imaging studies. Although the infants remained asymptomatic, laparoscopic excision was performed due to the increasing size of the cyst in both cases. Pathological examination of the resected specimens confirmed a simple cyst in one case and an epidermoid cyst in the other. Conclusions: Our cases and those described in the literature demonstrate the usefulness of incidental prenatal detection of congenital hepatic cyst, especially during late pregnancy. Such a diagnosis can allow for proper perinatal surveillance, selection of the route of delivery, and timely postnatal surgical intervention if required. [ABSTRACT FROM AUTHOR]

Introduction: Intracystic haemorrhage is a rare complication of hepatic cysts, and is often mistaken for a malignant lesion. Case Report: A 55-year-old female with a history of polycystic kidney and liver disease presented with a six-month history of abdominal distension, abdominal pain, early satiety, shortness of breath and 5 kg of weight loss. Imaging revealed a 20 cm mixed solid-cystic hepatic lesion containing peripheral avascular mobile echogenic material with a flame-like morphology. After experiencing symptomatic relief from ultrasound-guided aspiration, the patient underwent cyst fenestration for more definitive treatment. Discussion: Haemorrhagic hepatic cysts are uncommon and may present on imaging as having lace-like retractile clot, internal layering or shading of separating blood products or avascular mobile flame-like excrescences. The presence of avascular mobile flame-like excrescences appears to be a unique feature of haemorrhagic hepatic cysts. Conclusion: While haemorrhagic hepatic cysts are rare and commonly mistaken for biliary cystadenomas or adenocarcinomas, the identification of particular features on high-resolution magnetic resonance imaging and contrast-enhanced ultrasound can lead to the correct diagnosis. [ABSTRACT FROM AUTHOR]

Background The ventriculoperitoneal shunt (VPS) procedure is still the most used technique for management of hydrocephalus. This article reports a case of hepatic cerebrospinal fluid (CSF) pseudocyst as a rare, but important, complication of the VPS insertion. Case Description An 18-year-old male presented to the hospital complaining of temporal headache and visual turbidity for approximately 3 months with a history of VPS insertion for treatment of hydrocephalus and revision of the valve in adolescence. The diagnosis was based on abdominal imaging, demonstrating an extra-axial hepatic CSF pseudocyst free from infection. Following the diagnosis, the management of the case consisted in the removal and repositioning of the catheter on the opposite site of the peritoneum. Conclusion The hepatic CSF pseudocyst is an infrequent complication of VPS procedure, but it needs to be considered when performing the first evaluation of the patient. Several techniques are considered efficient for the management of this condition, the choice must be made based on the variables of each individual case.

Introduction: Abdominal cystic lesions can be localized either in parenchymal or non-parenchymal organs and can be acquired or congenital. Knowing the characteristic imaging features as well as demographic data and the prevalence of cystic lesions can help radiologists in establishing the correct diagnosis. In this article, we conducted a statistical study of congenital and acquired cystic lesions of the abdomen, diagnosed by CT scan in patients hospitalized in Emergency Clinical County Hospital of Constanţa in years 2019 - 2020. Material and methods: The retrospective study included 285 patients admitted to the hospital. In the case of each patient, we recorded the following variables: Age, Sex, Localization of the lesion, Types of cysts for each localization. Results: The average age of the patients is 61.53 years. Most of the cystic lesions were localized in the liver (182 cases) and they were represented by: hydatid cysts, simple hepatic cysts, hepatic abscess, hepato-renal polycystic disease and hepatic adenocarcinoma. Cystic lesions of the kidney (56 cases) were represented by: autosomal dominant polycystic kidney disease, renal carcinoma, simple renal cysts, acquired polycystic renal disease, tuberous sclerosis, clear cell renal carcinoma and von Hippel Lindau syndrome. Cystic lesions of pancreas (47 cases) were represented by: pancreatic cysts, pancreatic pseudocysts and pancreatic adenocarcinoma. Conclusions: CT examination is extremely useful in establishing the location, type, imaging characteristics of cystic lesions, echo over surrounding organs, possibility of malignant transformation. The prevalence of certain types of localizations and morphologies depending on the age and organ involved always helps to obtain a correct and rapid diagnosis. [ABSTRACT FROM AUTHOR]

Adrenal myelolipomas are nonfunctional tumors that are usually asymptomatic; however, they have been known to coexist with other endocrine disorders, such as Cushing's syndrome, congenital adrenal hyperplasia (CAH), Conn's syndrome, and pheochromocytoma. We report a case of a 49-year-old man with hypertension and diabetes mellitus who complained of chronic abdominal pain, vomiting, and early satiety. Preoperative contrast-enhanced computerized tomography (CECT) was performed, and adrenal myelolipoma was considered, lab investigations revealed a nonfunctional tumor. CECT also revealed bilateral renal cortical cyst, right renal calculi, and hepatic cyst. A left open cortical sparing adrenalectomy was performed, pathological examination confirmed the diagnosis, and a radiological surveillance was planned for the right tumor. Four years following this, the patient came back with a similar presentation. Right adrenalectomy was performed after preoperative workup, and subsequently steroid replacement therapy was initiated. We suggest adequate follow-up of a patient presenting with adrenal myelolipoma and to explore the possibility of establishing a syndromic diagnosis such as autosomal dominant polycystic kidney disease (ADPKD).

Background: Hemorrhagic rupture of a hepatic cyst is rare. To date, very few cases have been reported in the literature. Case Report: A patient with a history of a suspected liver hydatid cyst presented to the emergency department with abdominal pain and fever. She was admitted with the presumptive diagnosis of acute cholecystitis. During hospitalization, the patient presented with hemodynamic instability and abrupt worsening of the abdominal pain. The abdominal angio-chemotherapy scan showed an abundant free peritoneal effusion and an apparent effacement of the anterior wall of a hepatic cyst of 16 cm. The patient underwent an exploratory laparotomy, deroofing of the cyst, and peritoneal lavage. The anatomopathological results showed a simple hepatic cyst. Discussion: Hemorrhagic rupture of simple hepatic cysts is a life-threatening complication and, although rare, should be included in the differential diagnosis of sudden abdominal pain in patients with a history of simple hepatic cysts.

Background: Some hydatid cysts of cystic echinococcosis type 1 (CE1) lack well-defined cyst walls or distinctive endocysts, making them difficult to differentiate from simple hepatic cysts., Aim: To investigate the diagnostic methods for atypical hepatic CE1 and the clinical efficacy of laparoscopic surgeries., Methods: The clinical data of 93 patients who had a history of visiting endemic areas of CE and were diagnosed with cystic liver lesions for the first time at the People's Hospital of Xinjiang Uygur Autonomous Region (China) from January 2018 to September 2023 were retrospectively analyzed. Clinical diagnoses were made based on findings from serum immunoglobulin tests for echinococcosis, routine abdominal ultrasound, high-frequency ultrasound, abdominal computed tomography (CT) scan, and laparoscopy. Subsequent to the treatments, these patients underwent reexaminations at the outpatient clinic until October 2023. The evaluations included the diagnostic precision of diverse examinations, the efficacy of surgical approaches, and the incidence of CE recurrence., Results: All 93 patients were diagnosed with simple hepatic cysts by conventional abdominal ultrasound and abdominal CT scan. Among them, 16 patients were preoperatively diagnosed with atypical CE1, and 77 were diagnosed with simple hepatic cysts by high-frequency ultrasound. All the 16 patients preoperatively diagnosed with atypical CE1 underwent laparoscopy, of whom 14 patients were intraoperatively confirmed to have CE1, which was consistent with the postoperative pathological diagnosis, one patient was diagnosed with a mesothelial cyst of the liver, and the other was diagnosed with a hepatic cyst combined with local infection. Among the 77 patients who were preoperatively diagnosed with simple hepatic cysts, 4 received aspiration sclerotherapy of hepatic cysts, and 19 received laparoscopic fenestration. These patients were intraoperatively diagnosed with simple hepatic cysts. During the follow-up period, none of the 14 patients with CE1 experienced recurrence or implantation of hydatid scolices. One of the 77 patients was finally confirmed to have CE complicated with implantation to the right intercostal space., Conclusion: Abdominal high-frequency ultrasound can detect CE1 hydatid cysts. The laparoscopic technique serves as a more effective diagnostic and therapeutic tool for CE., Competing Interests: Conflict-of-interest statement: The authors declare that there is no conflict of interest., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: Cystic echinococcosis (CE) is a parasitic zoonosis caused by the tapeworm Echinococcus granulosus. Over the past few years, a lot of research has been done on liver illnesses using metabolomics techniques to identify biomarkers which could identify the diseases in its early stages. The present study was done to explore biomarkers in serum, urine, and cystic fluid which would help in differentiating, staging, and assessing fertility of intra-abdominal hydatid cyst by using proton nuclear magnetic resonance ( 1 H NMR) metabolomics., Materials and Methods: In the study, 28 subjects (16 cases and 12 controls) were enrolled. Staging of hydatid cysts was performed using ultrasonography. In patients complying with case and control definition, blood, urine, and cystic fluid were collected for complete blood count, urine culture, Echinococcus IgG enzyme-linked immunosorbent assay (ELISA), and metabolomic analysis. The 17, 15, and 11 metabolites in serum, urine, and cystic fluid samples were quantified, respectively, to differentiate between case and control group., Results: In this study, we observed that there was a significant downregulation of succinate metabolite in urine samples of cases, down-regulation of five metabolites (isoleucine, valine, histidine, tyrosine and formate) and upregulation of alanine in cystic fluid of cases., Conclusion: Current study demonstrates that metabolomics can be used non-invasively for rapid diagnosis of CE. This is one of the very few studies, which used 1 H NMR spectroscopy, to analyze the profile of metabolites in serum, urine, and cystic fluid in cases of CE and controls., How to Cite This Article: Raj N, Pandey A, Roy R, et al . Proton Nuclear Magnetic Resonance (1H NMR) Metabolomics Study in Serum, Urine, and Cystic Fluid for Differentiating Fertility and Staging of Intra-abdominal Hydatid Cyst in Adults. Euroasian J Hepato-Gastroenterol 2024;14(1):30-34., Competing Interests: Source of support: Nil Conflict of interest: None, (Copyright © 2024; The Author(s).)

Introduction: To decide treatment of hepatic cysts diagnosis between simple hepatic cyst (SHC) and cystic mucinous neoplasm (CMN). Radiological features are not patognomonic. Some studies have suggested the utility of intracystic tumor markers., Methods: Retrospective analysis of our prospective database including patients treated due to symptomatic SHC from 2003 to 2021. The aim of the study was to evaluate the results of treatment of symptomatic SHC and the usefulness of the determination of intracystic "carcinoembryonic antigen" (CEA) and "carbohydrate antigen" CA 19.9., Results: 50 patients diagnosed and treated for symptomatic SHC were included. In 15 patients the first treatment was percutaneous drainage. In 35 patients the first treatment was laparoscopic fenestration. Four patients were diagnosed of premalignant or malignant liver cystic lesions (MCN, IPMN, lymphoma B); three of them required surgery after initial fenestration and pathological diagnosis. Median CEA and CA 19-9 were 196 μg/L and 227.321 U/mL respectively. Patients with malignant or premalignant pathology did not have higher levels of intracystic tumor markers. Positive predictive value was 0% for both markers, and negative predictive value was 89% and 91% respectively., Conclusion: Values of intracystic tumor markers CEA and CA 19-9 do not allow distinguishing simple cysts from cystic liver neoplasms. The most effective treatment for symptomatic simple liver cysts is surgical fenestration. The pathological analysis of the wall of the cysts enables the correct diagnosis, allowing to indicate a surgical reintervention in cases of hepatic cyst neoplasia., (Copyright © 2023. Published by Elsevier España, S.L.U.)

A hepatic cyst is usually asymptomatic but, in some cases, can be associated with various complications. Here we report a rare case with rapid enlargement of a hepatic hilar cyst that induced bile duct obstruction after an acute exacerbation of chronic hepatitis B. The case is a 60-year old female who discontinued entecavir by herself. Hyperbilirubinemia was prolonged along with bile duct obstruction due to an enlarged cyst. After the administration of entecavir and steroid pulse therapy, biliary drainage and punctuation of the cyst were performed. There was no evidence of malignancy in the cyst. The therapies were not effective enough, probably due to the prior liver damage, and she died of acute on chronic liver failure. This case suggests that a hepatic hilar cyst in a patient with acute hepatitis or an acute exacerbation of chronic hepatitis can become enlarged and may affect the clinical course of hepatitis. In such a case, the size of the cyst should be monitored frequently and bile duct obstruction should be treated early if it occurs. [ABSTRACT FROM AUTHOR]

Abstract Backgroud Hepatic cysts are the most frequent, innocuous, space-occupying lesions of the liver. The majority of solitary liver cysts are nonsymptomatic. When liver cysts reach a large size, there are some complications, including infection, rupture, spontaneous hemorrhage, obstructive jaundice, and neoplastic degeneration. Percutaneous aspiration, fenestration, hepatic resection, and liver transplantation have been proposed for symptomatic patients. Case presentation In this case report, we describe a 41-year-old woman who presented with persistent liver dysfunction, indolent xanthochromia, and skin itching for 3 months. After a series of tests, she has a 5.0 × 5.3 cm hepatic cyst with many separations in the left medial liver lobe. The obstructive jaundice was caused by a large pedunculated lump protruding into the common bile duct from the left hepatic duct. She was treated with laparotomy and this lump was completely removed from the root by choledochoscopic needle-knife electrotomy with a good clinical response. Postoperative pathology of the lump suggested a hepatic cyst wall without heterocysts or tumor cells. Conclusion Hepatic cyst wall protruding into the common bile duct can form capsular lump and result in indolent jaundice. Choledochoscopic high-frequency needle-knife electrotomy could be considered as a simple, safe and effective complementary approach for benign mass on the bile duct wall.

A female patient, 59-year-old, was complaining of abdominal pain in the right hypochondrium and mesogastrium for 6 months. Ultrasonography and abdominal computed tomography were performed, both confirming a large hepatic cyst (10.6 cm × 7.6 cm × 7.3 cm) on the left lobe. A hybrid minilaparoscopic resection was proposed. We opted for unroofing the cyst, and the procedure was uneventfully performed, with a total surgical time of 60 min. In the post-operative the patient did well, with minimal abdominal pain, being discharged on the 5th post-operative day, after drain removal due to the use of intravenous antibiotic therapy.

Campylobacter upsaliensis is an enteropathogenic bacterium in animals, and is also rarely isolated from humans, where it can cause enteritis and bacteremia. This report describes the first case of isolation of C. upsaliensis from an infected giant hepatic cyst. This bacterium could not be cultured from abscess punctuate in a usual Campylobacter -selection medium (charcoal cefoperazone deoxycholate agar medium), because of high concentration of cefoperazone as a selection agent. It could not identified by matrix-assisted laser desorption ionization-time of flight mass spectrum. Rather, it was identified as C. upsaliensis by whole genome sequencing, including by multilocus sequence typing. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical features, pathological features, differential diagnosis, and prognosis of Caroli’s disease (CD). Methods A retrospective analysis was performed for the clinicopathological data of 5 parents with CD who were treated in Beijing Tsinghua Chang Gung Hospital from January 2014 to May 2019, and a literature review was also performed. Results There were 3 male and 2 female patients, with a mean age of 20 years. All of them attended the hospital due to the presence of intermittent upper abdominal pain, and among these patients, 4 had pyrexia, 2 had splenomegaly and portal hypertension, 1 had gallstones, 4 had bilateral renal cysts, and 4 had abnormal hepatic function. Imaging examination showed varying degrees of cystic dilatation of the intrahepatic bile ducts which communicated with the biliary tree, and fibrous bands were observed in these cysts. Pathological examination showed intrahepatic bile duct dilatation with fibrous tissue proliferation and chronic inflammatory cell infiltration on the bile duct wall, and fibrovascular bundles were observed in the bile duct cavity. In addition, fibrosis and proliferation of the portal area and abnormal small bile ducts were observed in type II CD. Conclusion CD is often seen in children and adolescents, and its clinical manifestations lack specificity. A confirmed diagnosis of CD relies on imaging and pathological examinations. Histopathological features of this disease include cystic dilatation of the intrahepatic bile ducts communicating with the biliary tree and the bands consisting of fibrous tissue and vessels in these cysts. [ABSTRACT FROM AUTHOR]

Context: Cysts arising from the hepatobiliary tree are a group of heterogeneous lesions with regard to pathogenesis, clinical presentation, and radiological finding. They can be intrahepatic or extrahepatic, developmental, secondary to infective/inflammatory etiologies, as well as neoplastic. This study was conducted to determine the spectrum of hepatobiliary cysts in surgically intervened cases, with regard to their prevalence, histological spectrum, and clinicoradiological correlation, wherever possible. Methods: In this retrospective observational study, hematoxylin and eosin stained slides of all cases of hepatobiliary cystic lesions, operated between 2009 and 2016 were reviewed. Special stains as reticulin, Masson's trichrome, and periodic acid Schiff were done wherever necessary. Overall prevalence, age-sex distribution, clinical presentation and histopathological patterns were studied. Relevant imaging findings were correlated wherever possible. Results: A total of 312 cases of hepatobiliary cysts were identified, the majority in females. Choledochal cysts (CCs) were the most common type (n = 198,63.5%), followed by hydatid cysts (n = 73,23.3%), simple hepatic cysts (n = 10,3.2%), congenital hepatic fibrosis (n = 10,3.2%), biliary cystadenomas (n = 4,1.2%) hepatic mesenchymal hamartomas (n = 7,2.2%), and cavernous hemangiomas (n = 3,0.9%). Fibropolycystic liver disease (n = 2,0.6%), Caroli's disease (n = 1, 0.3%), liver abscess (n = 2, 0.6%), infantile hemangioendothelioma (n = 1,0.3%), and biliary cystadenocarcinomas (n = 1,0.3%) were rare. Lesions noted mostly in 1st decade of life were: CCs, fibrocystic liver disease, Caroli's syndrome, cystic mesenchymal hamartoma, and infantile hemangioendotheliomas. Conclusion: In our cohort of surgically intervened cases of hepatobiliary cystic lesions from a tertiary care hospital in North India, the CCs, followed by hydatid cyst were the most common lesions. Histology can play vital role in characterization, as often clinical findings and radiology can overlap.