Atypic large hepatic cyst with persistent elevated CA19.9 serum value: utility of intracystic CA72.4 dosage for a mini-i
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CASE REPORT
Atypic large hepatic cyst with persistent elevated CA19.9 serum value: utility of intracystic CA72.4 dosage for a mini‑invasive management Letizia Zurli1,3 · Jeanne Dembinski1,3 · Brice Robert2 · Jean‑Marc Regimbeau1,3 Received: 16 July 2020 / Accepted: 30 October 2020 © Japanese Society of Gastroenterology 2020
Abstract Simple hepatic cysts are very common, but may be difficult to differentiate from a biliary cystadenoma or cystadenocarcinoma. Because the surgical treatment if needed, such as a hepatic fenestration or resection, depends on the diagnosis, the assay of intracystic tumor markers is useful. We report the case of a 67-year-old woman with a large hepatic cyst responsible of pain and inflammation. The combination of imaging findings, serum, and intracystic fluid tumor markers [CA72.4 (carbohydrate hydrogen)] permitted to diagnose a simple hepatic cyst despite an unusual persistent elevated serum CA19.9 level. A laparoscopic cyst fenestration was proposed with an uneventful postoperative course. The pathological findings showed a simple hepatic cyst. In case of hepatic cysts, radiological findings can discriminate between benign and (pre)malignant lesions, but in case of doubtful diagnosis, the serum and intracystic tumor markers can be helpful. The use of serum or intracystic tumor marker allows to choose the correct therapeutic strategy and to use mini-invasive approach when feasible. Keywords Simple hepatic cyst · Hepatic cystadenoma · Hepatic cystadenocarcinoma · CA19.9 · CA72.4
Introduction The simple hepatic cysts are the most common hepatic cystic lesion as their incidence is up to 2.5% in the population [1]. They are most often asymptomatic and, therefore, incidentally diagnosed on an abdominal imaging. Occasionally, they may be symptomatic due to compression of the adjacent organs or to complications as intracystic bleeding or infection and therefore require a special care. The high incidence and benign nature of the simple hepatic cysts should not lead to a lack of awareness of the other diagnoses of cystic hepatic lesions which can be premalignant, as biliary cystadenomas, or even malignant, as biliary cystadenocarcinomas, * Jean‑Marc Regimbeau regimbeau.jean‑marc@chu‑amiens.fr 1
Department of Digestive Surgery, CHU Amiens and University of Picardie, 1 rue du Professeur Christian Cabrol, 80054 Amiens cedex, France
2
Department of Radiology, Amiens University Hospital, Amiens, France
3
SSPC UR UPJV 7518 Simplification of Surgical Patients Care, University of Picardie Jules Verne, Amiens, France
and which management is completely different: in the case of a symptomatic simple hepatic cyst, the surgical procedure of choice is a laparoscopic fenestration while in case of premalignant or malignant lesions a major hepatic resection is required. The clinician has to establish the diagnosis based on the patient’s and the imaging’s characteristics. Sometimes some doubt may persist, especially in the case of cystic remodeling due to bleeding or infection that may make the
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