title: Mucinous cystic neoplasm or non-parasitic liver cyst? - A challenging diagnosis.
abstract: OBJECTIVE
  Mucinous cystic neoplasms (MCN) are rare liver lesions. Radiological features include internal septa or septal thickening. Imaging often fails in the differential diagnosis to non-parasitic liver cysts (NPLC), resulting in inadequate surgery. The aim of the study was to evaluate if both lesions could be differentiated pre-operatively.
  
  
  METHODS
  Retrospective study with literature review.
  
  
  RESULTS
  Twenty-six patients (22 female, 68±12 years) underwent laparoscopic deroofing for NPLC. Histo-pathological specimens showed 2 MCN (both female) with recurrence rates of 4% (NPLC) and 100% (MCN), and a time-to-recurrence of 3 months. In both cases no radiological features of MCN were seen pre-operatively. Follow-up time was 7 and 12 years with emergence of radiological features of MCN in one case. PubMed search showed 137 hits for “MCN” and 540 hits for “mucinous cystadenoma” and “liver”; 207 studies were reviewed: one prospective, 13 non-systematic reviews, 57 retrospective, 120 case reports and 16 expert opinions. The largest MCN-series included 44 subjects.
  
  
  CONCLUSIONS
  If MCN shows no characteristic radiological features, thus mimicking NPLC, pre-operative radiological differentiation is impossible. During long time course characteristic radiological morphology of MCN could appear. Early recurrence of a supposed NPLC is suspicious for MCN. Due to the literature review pre-operative imaging is inaccurate for the differential diagnosis and complete surgical excision of MCN is crucial.
authors.affiliation: Department of General, Visceral and Cancer Surgery, Transplant Center Cologne, Germany. roger.wahba@uk-koeln.de
authors.forename: Roger
authors.initials: R
authors.lastname: Wahba
authors.forename: Robert
authors.initials: R
authors.lastname: Kleinert
authors.forename: Georg
authors.initials: G
authors.lastname: Dieplinger
authors.forename: Christopher
authors.initials: C
authors.lastname: Bangard
authors.forename: Uta
authors.initials: U
authors.lastname: Drebber
authors.forename: Arnulf H
authors.initials: AH
authors.lastname: Hölscher
authors.forename: Dirk L
authors.initials: DL
authors.lastname: Stippel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D018291:Cystadenoma, Mucinous / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D003560:Cysts / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome