2017-02-16 02:22:08 UTC

A Subhepatic Calcified Cyst

Feb. 15, 2017

Gastro image challenge features a patient with a cystic mass with tissue and calcified rim components.

Question: In a February 2017 Gastroenterology image challenge, a 68-year-old woman, asymptomatic, with no medical history, underwent an abdominal CT scan in a traumatic context. An enhanced series (Figure A) revealed a 4 cm cystic mass with tissue and calcified rim components located under the left liver (Figure A, arrow) inside the ligamentum teres. The lesion was supplied by a left hepatic artery branch. The frontal view showed the mass drainage into the left external iliac vein through a long pedicle (the umbilicus vein connected to the left inferior epigastric vein) (v). A laparoscopic resection of this mass was performed because of the risk of spontaneous hemorrhage linked to the dense tumoral vasculature and the lack of formal histologic diagnosis.

During the procedure, the surgeon observed a cystic mass attached to ligamentum teres between the liver and the umbilicus. At pathologic examination, a well-circumscribed largely cystic mass, with a fibrous and calcified shell and hemorrhagic modifications was observed. Histologically, the fibrous wall contained many large vessels and a small cellular area. This area consisted of small nests of moderate-sized monotonous clear cells with normochromatic ovoid nuclei. There was no nuclear atypia and no mitosis. The tumor exhibited an elaborate network of small capillaries. Tumor cells expressed the melanocytic marker HMB45 and smooth muscular actin.

What is your diagnosis? Read the full description and diagnosis on Gastroenterology. Additionally, be sure to check out this and other Gastro image challenges in the Clinical Image Challenge App, which is part of AGA App Central and available for download on the Apple App Store or Google Play.