title: Intrahepatic biliary mucinous cystic neoplasms: clinicoradiological characteristics and surgical results.
abstract: BACKGROUND
  Intrahepatic biliary mucinous cystic neoplasms are rare hepatic tumors and account for less than 5% of intrahepatic cystic lesions. Accurate preoperative diagnosis is difficult and the outcome differs among various treatment modalities.The aim of this study is to investigate the clinico-radiological characteristics of intrahepatic biliary mucinous cystic neoplasms and to establish eligible diagnostic and treatment suggestions.
  
  
  METHODS
  Nineteen patients with intrahepatic biliary cystadenomas and two patients with biliary cystadenocarcinomas were retrospectively reviewed. Their clinico-radiological variables and survival outcome were analyzed.
  
  
  RESULTS
  Of the 19 patients with biliary cystadenoma, 16 (84.2 %) were female. 11 (57.9 %) patients had symptoms before operation with the most common presenting symptom being abdominal pain. Among the patients with available data, serum and cystic fluid CA 19-9 levels were invariably elevated and the CA 19-9 level in the cystic fluid was significantly higher than that in the serum. Loculations (84.2 %) and septations (63.2 %) were the most common radiologic findings. For treatment, 11 (57.9 %) patients received radical resection by either enucleation or hepatic resection, while the remaining 8 (42.1 %) patients underwent only fenestration of liver cysts. Radical resection provided a significantly better clinical outcome than fenestration in terms of tumor recurrence (p = 0.018). The only two male patients with biliary cystadenocarcinoma received radical hepatic resection and achieved a disease-free survival of 16.5 months and 33 months, respectively.
  
  
  CONCLUSIONS
  Intrahepatic biliary mucinous cystic neoplasms are rare and preoperative diagnosis is difficult. Internal septations and loculations on radiologic examinations should raise some suspicion of this diagnosis. Complete tumor excision is the standard treatment that may provide patients with better long term results after the operation.
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan. alanchaoweilee@hotmail.com.|Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan. alanchaoweilee@hotmail.com.
authors.forename: Chao-Wei
authors.initials: CW
authors.lastname: Lee
authors.affiliation: Department Anesthesiology, Chang Gung Memorial Hospital, Linkou, Taiwan. tsaic@hotmail.com.
authors.forename: Hsin-I
authors.initials: HI
authors.lastname: Tsai
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan. yann.mail@msa.hinet.net.
authors.forename: Yann-Sheng
authors.initials: YS
authors.lastname: Lin
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan. wutsunghan@gmail.com.
authors.forename: Tsung-Han
authors.initials: TH
authors.lastname: Wu
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan. mingchin2000@gmail.com.|Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan. mingchin2000@gmail.com.
authors.forename: Ming-Chin
authors.initials: MC
authors.lastname: Yu
authors.affiliation: Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan. chenmf@adm.cgmh.org.tw.|Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan. chenmf@adm.cgmh.org.tw.
authors.forename: Miin-Fu
authors.initials: MF
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging / Q000601:surgery; D003536:Cystadenocarcinoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D003537:Cystadenoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D011859:Radiography; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome