|LETTER TO EDITOR
|Year : 2012 | Volume
| Issue : 1 | Page : 115
Simple hepatic cyst
KVS Hari Kumar1, S Priya2, D Mukherjee3
1 Department of Endocrinology, Command Hospital, Lucknow, Uttar Pradesh, India
2 Department of Gastroenterology, Command Hospital, Lucknow, Uttar Pradesh, India
3 Department of Nephrology, Command Hospital, Lucknow, Uttar Pradesh, India
|Date of Web Publication||20-Mar-2012|
KVS Hari Kumar
Department of Endocrinology, Command Hospital, Lucknow- 226 002, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kumar KH, Priya S, Mukherjee D. Simple hepatic cyst. Niger J Clin Pract 2012;15:115
A 33-year-old man was referred to our hospital for evaluation of a cystic lesion in his abdomen. The patient underwent a routine master health check-up, and ultrasonography revealed a cystic lesion in the liver with a doubtful lesion in the left kidney. He gave no history of pain in the abdomen, chronic diarrhea, weight loss or jaundice. His appetite was normal and he denied any systemic symptoms. Clinical examination revealed a normotensive individual with a palpable, nontender liver, up to 2 cm below the right costal margin. There was no evidence of jaundice, ascites or any palpable mass. A computed tomography (CT) scan of the abdomen showed a large cyst of about 8 x 7 cm, with no septations or lobulations [[Figure 1], Long arrow]. The cyst compressed the right kidney and there was a small heterogenous cystic lesion seen on the superior pole of the left kidney (encircled). The rest of the abdominal organs and the biochemical profile of the patient were normal. His liver function tests revealed serum bilirubin of 12.7 μmol / L, alanine aminotransferase -24 U / L, aspartate aminotransferase - 32 U / L, alkaline phosphatase - 68 U / L, serum proteins - 66 g / L, albumin - 42 g / L, and globulin - 24 g / L.
|Figure 1 : CT scan of the abdomen showing a giant hepatic cyst and a small cystic lesion in left kidney|
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Our patient was unique in having two intra-abdominal cystic lesions involving the liver and kidney. He did not have the characteristic features of any single disease. He denied prior history of fever, weight loss or echinococcal infection, ruling out the possibility of multiple abscesses or echinococcal cysts. His tumor marker (CA-125, HCG, AFP, and CA 19-9) levels were normal and the hemagglutination test for hydatid disease was negative. He presented asymptomatically and the solitary cyst in the liver was big in comparison with the kidney cyst. Other intra-abdominal organs had no evidence of any cystic lesions precluding the diagnosis of autosomal dominant polycystic kidney disease (ADPKD). The patient did not fulfil the ultrasonographic criteria for diagnosing ADPKD and there was no similar history in the family members.  Genetic testing for ADPKD was not considered necessary. The profile of the patient (asymptomatic detection, young age, normal liver function tests, no hypertension or polycythemia, absent echinococcal antibody) suggested that the diagnosis was a simple hepatic cyst. However, the unusual feature in our case was the associated unilateral renal cyst.
Giant hepatic cysts are uncommon in clinical practice and are rarely detected on routine screening.  Hepatic cysts occur with a population prevalence of 0.5% increasing up to 2.5%, based on abdominal ultrasonography. Hepatic cysts may be congenital, neoplastic, traumatic or inflammatory in origin.  Simple hepatic cysts may be solitary or multiple, and usually arise from the abnormal development of intrahepatic bile ducts. Hepatic cysts are usually detected as an incidental finding, as seen in our case, and the fluid within the cyst mimics plasma, in composition. The epithelial lining of the cyst secretes fluid continuously, negating the therapeutic role of needle aspiration.≠  Simple cysts when enlarged in size may produce dull right upper quadrant pain, and this is complicated by a rupture of the cyst and torsion. The patients generally present with an acute abdomen or with a hepatic abscess after torsion or a rupture, respectively. Therapy is not indicated in asymptomatic patients, as in our patient. ,, Symptomatic patients are subjected to surgical therapy, by unroofing the cyst after excision of a portion of the wall of the cyst.
| References|| |
|1.||Pei Y, Obaji J, Dupuis A, Paterson AD, Magistroni R, Dicks E, et al. Unified criteria for ultrasonographic diagnosis of ADPKD. J Am Soc Nephrol 2009;20:205-12. |
|2.||Haap M, Seeger A, Haas CS. Giant solitary hepatic cyst. Liver Int 2008;28:840. |
|3.||Gaines PA, Sampson MA. The prevalence and characterization of simple hepatic cysts by ultrasound examination. Br J Radiol 1989;62:335-7. |
|4.||Tocchi A, Mazzoni G, Costa G, Cassini D, Bettelli E, Agostini N, et al. Symptomatic nonparasitic hepatic cysts: options for and results of surgical management. Arch Surg 2002;137:154-8. |