Biliary Cystadenoma and Cystadenocarcinoma of the Liver Jae Hoon Lee, M.D., Dong Ho Choi, M.D. 1, Kyeong Geun Lee, M.D., Hwon Kyum Park M.D. and Kwang Soo Lee, M.D. Department of Surgery, College of Medicine, Hanyang University, 1 Soonchunhyang University, Seoul, Korea Purpose: Cystic neoplasms in the liver are rarely seen tumors. Biliary cystadenoma and cystadenocarcinoma constitute less than 5% of intrahepatic cysts originating from the bile duct. The clinicopathologic and radiologic findings are important to arrive at the proper diagnosis and treatment of intrahepatic biliary cystadenoma and cystadenocarcinoma. The aims of this study were to characterize the clinical and pathologic aspects of these lesions, and also to discuss the treatment and prognosis of biliary cystadenoma and cystadenocarcinoma. Methods: We reviewed the clinical records of six patients who had intrahepatic biliary cystadenoma and cystadenocarcinoma and who had undergone operations from January, 1986 to June, 2002 at Hanyang University Hospital. Results: Primary biliary cystadenoma and cystadenocarcinoma of the intrahepatic biliary systems are rarely seen tumors. Biliary cystadenoma mainly affected women, and this was a different gender preponderance than was seen for biliary cystadenocarcinoma. We found no signs or symptoms that were specific for either of these tumors, and the diagnoses were usually made by abdominal CT and abdominal ultrasonography. These tumors were usually large, multilocular and cystic in appearance. The pathologic findings revealed multiple cystic masses lined with cuboidal to columnar epithelium. The nature of the cystic fluid was usually the mucous type. Of the 6 patients in whom the lesions were completely excised, 4 of the patients are alive. The other 2 patients died of old age and distant metastasis, respectively. Conclusion: Surgical resection of the tumor, including a margin of surrounding normal liver parenchyma, was the onlycurative method. If the tumor is confined in the liver, com- plete surgical excision yields an excellent prognosis. Complete resection of a biliary cystadenoma and radical resection of a biliary cystadenocarcinoma seem to offer these patients a chance for long-term survival. (Korean J HBP Surg 2005; 9:49-54) Key Words: Biliary Cystadenoma Cystadenocarcinoma :,
이재훈 외 간의 담관 낭선종 및 낭선암 51 ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ b a a b 5. 조직병리 소견 낭종 내용물은 6예 중 낭선종의 1예만 장액성이었고 나 머지는 점액성이었다. 세포 유형은 낭선종의 1예, 낭선암의 2예에서 입방 및 원주세포의 혼합형이었고, 그 외에선 원주 세포만 보였다. 낭종 내 내벽은 모든 예에서 보였다(Fig. 2, 3). 낭선종에서 보이지 않았던 nodular thickening은 낭선암 에선 모두 관찰되었다(Table 4). Fig. 2. Cut surface (a) and microscopic finding (b) of biliary cystadenoma. Cut section of multilocular cystic mass shows irregular thick septum and focally multiple, small cysts containing mucoid materials. Microsection shows multilobulated cysts lined by one layered low columnar epithelium containing mucin. Fig. 3. Cut surface (a) and microscopic finding (b) of biliary cystadenocarcinoma. Cut surface shows multilocular cyst, separated by fibrous septa. The cyst had thick fibrous capsule. Microsection shows multiple locules, lined by a single layer of cuboidal to columnar cells resting on basement membrane. a 예, 낭선암을 후복막농양으로 진단한 경우가 1예 있었다. Fig. 1. (a) Biliary cystadenoma, (b) biliary cystadenocarcinoma. CT finding shows multiseptated large cystic lesion. The thin-walled cystic lesion is contained with uniformed thickened septum and demonstrates well-defined mutiloculated, hypoattenuating lesion. 6. 수술 선택된 술식은 해부학적인 술식이 4예로 간우엽절제술 이 1예, 간좌엽절제술이 1예, 확대간좌엽절제술이 1예, 그 리고 4구역 절제술이 1예였다. 비해부학적 술식이 2예로 낭 선종에서 낭종절제술만 시행한 경우가 1예, 낭선암에서 후 구역절제술을 시행한 경우가 1예였다.