Overview of liver cystic adenocarcinoma
Hepatic cystadenocarcinoma is a rare primary cystic malignant tumor of the liver, which is prevalent in middle-aged women, with a male-to-female ratio of about 1:4, and its etiology is unknown. The cause of the disease is unknown. The disease is mostly treated by surgery, and the prognosis is generally good.
Etiology
The cause of the disease is unknown. It may be a malignant transformation from a cystadenoma of the intrahepatic bile ducts, and environmental factors may also play a role.
Symptoms
1. Symptoms
The main manifestations are epigastric mass, epigastric discomfort, abdominal pain, abdominal distension, malaise, lack of appetite, weight loss, occasionally jaundice may occur due to the compression of bile ducts by the tumor, and some patients may be accompanied by nausea, vomiting, fever and other symptoms.
2. Physical signs
Physical examination may show hepatomegaly and palpable liver mass with smooth surface, cystic feeling, moving up and down with respiration, mostly without ascites formation.
Examination
1. Ultrasonography
It can show the size, shape and location of the tumor, and whether there is any thrombus in the hepatic vein or portal vein, and is a non-invasive examination with comparative diagnostic value.
2. CT examination
The tumor often forms a huge mass in the liver parenchyma, which can be more than 20cm. Scanning shows low-density cystic lesions, which are often multicompartmental or single-compartmental. The cystic wall and septum can be calcified, and some parts of the cystic wall are thicker, with papillary protrusions and enhancement effect.
3. Hepatic arteriography
Clusters of abnormal blood vessels can be seen distributed at the edge of the tumor, and the cyst wall and septum may have contrast accumulation.
4. Laboratory examination
Early liver function is mostly normal. Serum CA19-9 may be increased, and the concentration of CA19-9 in the cystic fluid may be several times higher than that of simple hepatic cysts.
Diagnosis
Middle-aged or above patients with multicompartmental cystic space-occupying lesions in the hepatic region, with papillary protrusions within the cyst wall, uneven thickness of the cyst wall, and lesion
The possibility of hepatic cystic adenocarcinoma should be considered if there are abnormal vascular images at the periphery and intracystic septum.
Differential diagnosis
This disease should be differentiated from hepatic cystadenoma, hepatic cyst and hepatic cysticercosis.
1. Hepatic cystadenoma is mostly seen in middle-aged women, due to the similarity between its imaging changes and hepatic cystadenocarcinoma, so it is difficult to differentiate clinically, and most of them need to rely on histopathological diagnosis.
2. Hepatic cysts are single or multiple cystic changes with sharp edges, without cystic segregation.
3. CT examination of hepatic cysticercosis is multiple or single round or ovoid cystic hypodense foci, with beaded nodules on the cyst wall and accompanied by calcification; ultrasonography can see the cysts on the wall of the inner cysts, etc. It is not difficult to be diagnosed by combining with the medical history.
Treatment
Surgical resection of hepatic cystadenocarcinoma is more effective, so once suspected as hepatic cystadenoma or cystadenocarcinoma, surgical treatment should be preferred. For those who cannot be resected, radiotherapy is feasible, or repeated puncture and extraction of intracapsular fluid in the tumor under ultrasound guidance, and injection of chemotherapeutic drugs or anhydrous ethanol can control the tumor development to a certain extent.