A CASE OF MULTIPLE CALICULI IN HEPATIC CYSTADENOMA

A 71-year-old man was admitted to the hospital because of hypochondlarigia and hepatic dysfunction. On ultrasonography of the liver, a cyst-like mass 5 cm in diameter having internal mobile strong echos was found in the lateral segment. CT revealed irregular thichening of the cystic wall, and ERC showed pooling of the contrast medium in the peripheral area of S2 intraheptic bile ducts. In addition, angiography disclosed an avascular area agreeing with the site of the mass. A diagnosis of hepatic cystadenoma or cystadenocarcinoma was obtained, and a lateral segmental hepatectomy was performed. A unilocular cyst having a smooth wall and containing infected serous bile and four bilirubin calculi were found in the resected specimen. Histopathological examination revealed papillary proliferation of atypical epithelium showing intestinal metaplasia including goblet cells, leading to a diagnosis of hepatic cystadenoma. There is no previous report of the presence of internal caliculi in this condition. Communication with the bile duct is also rare, with only 17 cases including the present case having been reported in the literature. These case are also discussed in this paper.