Cytologic diagnosis of hepatobiliary cystadenoma with mesenchymal stroma during intraoperative consultation: a case report.
BACKGROUND
Hepatobiliary cystadenoma with mesenchymal stroma (HCMS) is a rare cystic tumor characterized by a layer of mucinous cuboidal to columnar epithelium situated on top of a basement membrane resting on an ovarian-like stroma. Cytologic features of this entity have not been extensively studied. We present a case of HCMS with emphasis on cytologic material obtained at the time of intraoperative consultation (IOC).


METHODS
A 51-year-old woman had partial resection of a liver cyst. Seven months later she sought further medical attention and presented for surgical reevaluation and reexcision of the same lesion. Initial computed tomography revealed a multiloculated liver cyst. Five months after reexcision the lesion recurred and was again excised. During IOC, scrape cytology revealed both biliary epithelial and mesenchymal stromal cells in a cystic background. Permanent sections showed histologic features of HCMS. To the best of our knowledge, this is the first cytologic description of such a neoplasm to include both epithelial and mesenchymal stromal elements.


CONCLUSIONS
The use of scrape cytology during IOC can be a fast and effective way of identifying both the epithelium and mesenchymal stroma when HCMS is in the differential diagnosis of a cystic liver lesion.
Department of Pathology, George Washington University Hospital, 2300 Eye Street NW, Room 502, Ross Hall, Washington, DC 20037, USA. lvoltaggio@mfa.gwu.edu
Lysandra
L
Voltaggio
Oliver J
OJ
Szeto
Sana O
SO
Tabbara
D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000473:pathology; D001652:Bile Ducts / Q000473:pathology; D003537:Cystadenoma / Q000175:diagnosis* / Q000473:pathology*; D003560:Cysts / Q000473:pathology; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008648:Mesoderm / Q000473:pathology*; D008875:Middle Aged; D012017:Referral and Consultation; D017154:Stromal Cells / Q000473:pathology