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Late Complication of a Large Simple Cyst of the Liver Mimicking Cystadenocarcinoma After Sclerotherapy

Kenichi Takayasu1, Yasunori Mizuguchi1, Yukio Muramatsu1, Susumu Yamasaki2, Teiichi Sugiura2, Chise Sato1 and Michiie Sakamoto3

1 Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045 Japan.
2 Department of Hepatobiliary Surgery, National Cancer Center Hospital, Tokyo 104-0045, Japan.
3 Pathology Division, National Cancer Center Research Institute, Tokyo 104-0045, Japan.



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  		Fig. 1A. —72-year-old woman complaining of abdominal fullness and having unilocular 21 x 19 cm hepatic cyst. Subcostal sonogram reveals echogenic mass (straight arrow) measuring 2 x 2 cm emerging in residual cyst measuring 5 x 2.5 cm. Strong echo (arrowheads), suggesting calcification of cyst wall, and middle hepatic vein (curved arrow) are seen.

 


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  		Fig. 1B. —72-year-old woman complaining of abdominal fullness and having unilocular 21 x 19 cm hepatic cyst. Dynamic axial CT scan obtained during arterial phase shows two stellar-shaped enhancements in medial component (arrow). Calcifications of cyst wall laterally and associated cyst (arrowhead) are seen.

 


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  		Fig. 1C. —72-year-old woman complaining of abdominal fullness and having unilocular 21 x 19 cm hepatic cyst. Axial T1-weighted fast spin-echo MR image (TR/TE, 600/12) reveals hypointense area (arrow) in medial portion of lesion and crescent-shaped hyperintense region in lateral portion.

 


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  		Fig. 1D. —72-year-old woman complaining of abdominal fullness and having unilocular 21 x 19 cm hepatic cyst. Axial T2-weighted fast spin-echo MR image (3000/120) shows hypointense area with central hyperintensity (arrow) in medial and crescent-shaped lateral portions.

 


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  		Fig. 1E. —72-year-old woman complaining of abdominal fullness and having unilocular 21 x 19 cm hepatic cyst. Gadolinium-enhanced T1-weighted image (143/5; 60° flip angle) reveals two nodular areas of enhancement (arrows) surrounded by hypointense area in medial portion of lesion.

 


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  		Fig. 1F. —72-year-old woman complaining of abdominal fullness and having unilocular 21 x 19 cm hepatic cyst. Photomicrograph of histologic specimen shows multiple bizarrely shaped vessels (arrows) with RBCs covered by endothelial cell lining in hematoma. (H and E, x 40)

 

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