Answer for BIR CoW 11 Dec 2022
BILIARY IPMN
Findings
ULTRASOUND Well defined heteroechoic lesion with solid and cystic components noted involving segment IV of liver . The solid component of the lesion shows internal vascularity. The solid component is also noted infiltrating the portal hilum with narrowing of bileduct confluence causing retrograde assymetrical IHBR dilatation CROSS SECTIONAL IMAGING Large well defined solitary cystic lesion with multiple internal septations and papillary excresences noted arising from the confluence of right hepatic duct and left hepatic duct It appears to be communicating inferiorly with normal appearing common hepatic duct The lesion causes mass effect over the hilum and assymetric dilatation of intrahepatic biliary radicles ( left> right ) , right , left common hepatic duct and proximal common bile duct On contrast , enhancement of peripheral solid paiilary excresences and internal septations noted with non enhacement of cystic components Lesion shows multiple metabolically active enhancing solid mural papillary projections noted in PET CT
Discussion
Biliary cystic tumors (BCTs), specifically biliary cystadenoma (BCA) and cystadenocarcinoma (Biliary cystic tumors, such as BCA and BCAC, constitute <5% of all liver cysts Although BCA occurs predominantly in females (90%), BCAC is more evenly distributed between males and females. Majority of BCTs arise from the intrahepatic biliary system. Biliary cystic tumors are typically slow-growing lesions with a reported size that can range in diameter from 1.5 to 35 cm Biliary cystadenocarcinoma is thought to originate either de novo from formed biliary ducts induced by ischemia and carcinogens, or from malignant transformation of a pre-existing BCA Biliary IPMN is a recently recognized entity characterized by mucin production and prominent intraductal papillary proliferation. Biliary IPMN occurs equally in both sexes, with a mean age of 58 years. Some authors now advocate classifying BCTs with biliary tree communication and no ovarian stroma as biliary IPMNs BCA can be differentiated from biliary IPMN based on 3 main imaging characteristics. First, BCAs typically have a smooth tumor wall with septa inside the tumor, resulting in a “cysts-in-cyst” appearance. Second, papillary projections are typical in IPMN and less so in BCA. Third, demonstration of cystic tumor and intrahepatic bile duct communication along with the presence of distal mucin is more characteristic of biliary IPMN
Findings
ULTRASOUND Well defined heteroechoic lesion with solid and cystic components noted involving segment IV of liver . The solid component of the lesion shows internal vascularity. The solid component is also noted infiltrating the portal hilum with narrowing of bileduct confluence causing retrograde assymetrical IHBR dilatation CROSS SECTIONAL IMAGING Large well defined solitary cystic lesion with multiple internal septations and papillary excresences noted arising from the confluence of right hepatic duct and left hepatic duct It appears to be communicating inferiorly with normal appearing common hepatic duct The lesion causes mass effect over the hilum and assymetric dilatation of intrahepatic biliary radicles ( left> right ) , right , left common hepatic duct and proximal common bile duct On contrast , enhancement of peripheral solid paiilary excresences and internal septations noted with non enhacement of cystic components Lesion shows multiple metabolically active enhancing solid mural papillary projections noted in PET CT
Discussion
Biliary cystic tumors (BCTs), specifically biliary cystadenoma (BCA) and cystadenocarcinoma (Biliary cystic tumors, such as BCA and BCAC, constitute <5% of all liver cysts Although BCA occurs predominantly in females (90%), BCAC is more evenly distributed between males and females. Majority of BCTs arise from the intrahepatic biliary system. Biliary cystic tumors are typically slow-growing lesions with a reported size that can range in diameter from 1.5 to 35 cm Biliary cystadenocarcinoma is thought to originate either de novo from formed biliary ducts induced by ischemia and carcinogens, or from malignant transformation of a pre-existing BCA Biliary IPMN is a recently recognized entity characterized by mucin production and prominent intraductal papillary proliferation. Biliary IPMN occurs equally in both sexes, with a mean age of 58 years. Some authors now advocate classifying BCTs with biliary tree communication and no ovarian stroma as biliary IPMNs BCA can be differentiated from biliary IPMN based on 3 main imaging characteristics. First, BCAs typically have a smooth tumor wall with septa inside the tumor, resulting in a “cysts-in-cyst” appearance. Second, papillary projections are typical in IPMN and less so in BCA. Third, demonstration of cystic tumor and intrahepatic bile duct communication along with the presence of distal mucin is more characteristic of biliary IPMN
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
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Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!