Giant and complicated variants of cystic bile duct hamartomas of the liver: MRI findings and pathological correlations

✍ Scribed by Diego R. Martin; Bobby Kalb; Juan M. Sarmiento; Thomas G. Heffron; Ipek Coban; N. Volkan Adsay

• Publisher: John Wiley and Sons
• Year: 2010
• Tongue: English
• Weight: 530 KB
• Volume: 31
• Category: Article
• ISSN: 1053-1807
• DOI: 10.1002/jmri.22113

✦ Synopsis

Abstract

Purpose:

To describe a new category of liver cyst we propose calling “giant bile duct hamartoma (giant‐BDH)” and to provide a more complete record of the magnetic resonance imaging (MRI) features of BDHs with potential for clinical impact.

Materials and Methods:

This study was Institutional Review Board (IRB)‐approved and Health Insurance Portability and Accountability Act (HIPPA)‐compliant. Fifteen patients were identified with surgical liver pathology in keeping with complicated BDH and MRI findings of giant cysts.

Results:

In all, 14/15 patients presented with pain that resolved in 14/14 with surgery. Imaging features common to pretreatment cysts included sharply defined, lobulated margins with thin, smooth rim‐enhancement. Treated symptomatic cysts measured 9.8 cm on average and 21.6 cm maximum. The 14/15 patients had coexistent <2.0 cm BDH. Elevated T1 signal corresponded with hemorrhagic cyst content (10/15 patients); cyst‐wall rim‐enhancement corresponded with histological findings of inflammation (15/15), fibrocystic changes (12/15), and smaller BDH in the adjacent liver (13/15). Histology of giant‐BDH cyst walls corresponded with complicated BDH in 15/15. The incidence of symptomatic‐treated BDH at our institution was 0.4%.

Conclusion:

BDH is a benign hepatic cystic lesion that may undergo cystic enlargement, internal hemorrhage, and clinically present with abdominal pain treatable by minimally invasive laparoscopic fenestration. Complicated giant‐BDH coexists with smaller BDH and the MRI features of giant‐BDH are characteristic. J. Magn. Reson. Imaging 2010;31:903–911. ©2010 Wiley‐Liss, Inc.