title: Inferior vena cava obstruction and collateral circulation as unusual manifestations of hepatobiliary cystadenocarcinoma.
abstract: BACKGROUND
  Hepatobiliary cystadenocarcinoma represents a rare epithelial malignant tumor derived from the intrahepatic bile duct.
  
  
  METHODS
  A 71-year-old woman, who had undergone laparoscopic drainage of a cystic lesion of the right hepatic lobe, was misdiagnosed as having hepatic echinococcal disease, and received intracystic infusion of 95% ethanol four years ago. She was admitted to our hospital for further treatment.
  
  
  RESULTS
  Physical examination revealed dilated superficial veins across the right abdominal wall. After mapping the direction of blood flow in these vessels, we assumed that this was a sign of inferior vena cava obstruction. Abdominal ultrasound, computed tomography, magnetic resonance imaging combined with magnetic resonance angiography showed a large cystic mass in the right upper quadrant and epigastrium, displacing the adjacent structures, adherent to the inferior vena cava, which was not patent, resulting in dilation of superficial epigastric veins. The patient underwent an exploratory laparotomy. Total excision of the huge mass measuring 16X15 cm was possible under selective vascular exclusion of the liver. Removal of the tumor resulted in immediate restoration of flow in the inferior vena cava. On the basis of the pathology and findings of immunohistochemical analysis, a hepatobiliary cystadenocarcinoma was diagnosed.
  
  
  CONCLUSIONS
  In the present case, hepatobiliary cystadenocarcinoma was accompanied by dilated superficial venous collaterals due to inferior vena cava obstruction. Selective vascular exclusion of the liver allowed a safe oncological resection of the tumor.
authors.affiliation: 2nd Department of Surgery, Aretaieion Hospital, University of Athens, Athens Greece. annyiallo@yahoo.gr
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Arkadopoulos
authors.forename: Anneza I
authors.initials: AI
authors.lastname: Yiallourou
authors.forename: Constantinos
authors.initials: C
authors.lastname: Palialexis
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Stamatakis
authors.forename: Evi
authors.initials: E
authors.lastname: Kairi-Vassilatou
authors.forename: Vassilis
authors.initials: V
authors.lastname: Smyrniotis
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000473:pathology / Q000601:surgery; D001706:Biopsy; D003097:Collateral Circulation; D003251:Constriction, Pathologic; D003536:Cystadenocarcinoma / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D003951:Diagnostic Errors; D004444:Echinococcosis, Hepatic / Q000175:diagnosis / Q000628:therapy; D000431:Ethanol / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008102:Liver Circulation; D018810:Magnetic Resonance Angiography; D010690:Phlebography / Q000379:methods; D011237:Predictive Value of Tests; D020127:Recovery of Function; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D014682:Vena Cava, Inferior / Q000473:pathology / Q000503:physiopathology*
chemical_list: D000431:Ethanol