Hepatic cystadenoma presenting as an ovarian new growth in a 65 year old female

A case intraoperative diagnostic dilemma

Abstract

Biliary cystadenoma and cystadenocarcinoma  are rare hepatic neoplasms accounting less than 5% of all cystic liver diseases (Brittingham and Tuma 2019) and accounts for only 0.41% of malignant hepatic epithelial tumors (M. Pitchaimuthu et al., 2015)  with only less than 200 cases reported worldwide (Pillai  et al., 2012). It commonly arises from the intrahepatic ducts and rarely from extrahepatic areas as in our case. We present a case of a 65- year old female who consulted in a tertiary hospital with a 4-year history of gradual abdominal distension diagnosed as ovarian new growth on transvaginal ultrasound. However, intraoperatively referred for a hepatic mass measuring 34x30x20 cm involving the gallbladder. Intraoperative ultrasound noted multiloculated mass with no intra hepatic infiltration. Thus an excision of the mass and cholecystectomy with intraoperative cholangiogram was done. The mass was confirmed on final biopsy as mucinous cystadenocarcinoma and the patient was discharged four days after the surgery. Surgical resection remains to be the treatment of choice for hepatic lesions such as cystadenocarcinoma (Silva Neto et al., 2019). However, these lesions are often misdiagnosed preoperatively. Hence, in cases of intraoperative dilemma, an intraoperative ultrasound and a cholangiogram can aid in intraoperative planning and execution of safe surgery