Investigations:
Laboratory data at the time of presentation to our institution showed
almost no abnormalities, with an alkaline phosphatase concentration of
321 IU/L, gamma-glutamyl transpeptidase concentration of 48 IU/L,
alanine aminotransferase concentration of 69 IU/L, and aspartate
aminotransferase concentration of 35 IU/L. The bilirubin concentration
was 0.7 IU/L, and she was negative for hepatitis serology. Ultrasound
revealed a well-defined septated cystic mass in the left liver lobe with
a maximum diameter of 45 mm (Fig. 1a–c). Subsequent abdominal computed
tomography (CT), contrast-enhanced CT, and drip infusion
cholecystocholangiography CT showed no contrast effect of the cyst, no
calcification or enhanced nodules, and no bile duct traffic (Fig.
1d–f). Magnetic resonance imaging of the liver with
cholangiopancreatography confirmed the presence of a multifocal cyst in
liver section III (Fig. 1 g, h). There was no traffic between the cyst
and the bile duct. Bile cytology was negative.
Differential diagnosis:
A simple cyst was thought to be unlikely, and a provisional
diagnosis of a complex cyst, mucinous cystic neoplasm, or hepatic
peribiliary cysts was made. Given the patient’s age and
symptomology, the growing size of the cyst, biliary compression, and
risk of malignant transformation, we decided to perform surgical
resection rather than to continue observation.