[Mucinous cystic liver tumors: diagnosis and surgical treatment].
OBJECTIVE
To optimize diagnostics and treatment of cystic liver tumors.


METHODS
The analysis included outcomes of 46 patients with liver cystic tumors.


CONCLUSIONS
The use of abdominal Doppler-sonography (37 patients), abdominal contrast-enhanced CT (44 patients) and MRI of abdominal cavity with MR-cholangiography (24 patients) defined radiological semiotics of cystic liver diseases. The most important features of cystic tumors are intraluminal septums with blood flow (82% of patients), solid component (6.8%), daughterly cysts (11.3%), as well as biliary hypertension (39.2% of patients). Research of oncomarkers (CEA, SA 19-9, AFP) in 40 patients showed increased level of SA 19-9 only in case of cystadenocarcinoma and intraductal papillary mucinous neoplasm of biliary type. Benign and malignant cystic tumors had increased contents of oncomarkers in all cases. Surgical treatment was used in 42 patients. Extended liver resections were performed in 10 (23.8%) patients, atypical and anatomical resections (removal of less than 3 segments) - in 31 (73.8%) patients. In one case we applied cryoablation of CA in segment I of the liver in view of invasion into the wall of inferior vena cava and hepatoduodenal ligament. In 2 cases surgery was carried out laparoscopically. Also robot-assisted technique was used in 3 patients. Immunohistochemical study was performed in 22 (44.8%) patients. The diagnosis of CAC and biliary type of IPMN was confirmed in case of high expression of CK7, SK19, MUC1, S100p, SDH2, p53 antibodies. Cystadenomas were associated with moderate expression of ER, PR and p53 antibodies by stroma and CK7, SK19, CDX2, MUC1, S100p antibodies by epithelium.


CONCLUSIONS
There are considerable difficulties of differential diagnosis of liver cystic tumors. Therefore, the use of single algorithm of diagnostics and treatment is necessary to confirm accurately the diagnosis at the perioperative stage. Cystic tumor is more likely to be assumed in women with solitary cyst in segment IV of liver. If the diagnosis is suspected or confirmed anatomical liver resection with complete tumor removal is necessary to prevent the recurrence.
Vishnevsky Institute of Surgery, Health Ministry of the Russian Federation, Moscow, Russia.
P V
PV
Usyaky
Vishnevsky Institute of Surgery, Health Ministry of the Russian Federation, Moscow, Russia.
V A
VA
Kubyshkin
Vishnevsky Institute of Surgery, Health Ministry of the Russian Federation, Moscow, Russia.
V A
VA
Vishnevsky
Vishnevsky Institute of Surgery, Health Ministry of the Russian Federation, Moscow, Russia.
Yu A
YA
Kovalenko
Vishnevsky Institute of Surgery, Health Ministry of the Russian Federation, Moscow, Russia.
N A
NA
Karel'skaya
Vishnevsky Institute of Surgery, Health Ministry of the Russian Federation, Moscow, Russia.
D V
DV
Kalinin
Vishnevsky Institute of Surgery, Health Ministry of the Russian Federation, Moscow, Russia.
V S
VS
Demidova
Vishnevsky Institute of Surgery, Health Ministry of the Russian Federation, Moscow, Russia.
A V
AV
Varlamov
D000328:Adult; D014408:Biomarkers, Tumor / Q000097:blood; D018282:Cystadenocarcinoma, Mucinous / Q000097:blood / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D018291:Cystadenoma, Mucinous / Q000097:blood / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008113:Liver Neoplasms / Q000097:blood / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009367:Neoplasm Staging; D010043:Outcome and Process Assessment, Health Care; D014057:Tomography, X-Ray Computed / Q000379:methods; D018608:Ultrasonography, Doppler / Q000379:methods
D014408:Biomarkers, Tumor