0:01

So this is a 30-year-old female who presents

0:03

with right upper quadrant pain, and a CT

0:05

scan was obtained to further evaluate this.

0:08

So we scroll down.

0:09

The CT scan was performed with

0:10

or without intravenous contrast.

0:11

I'm showing you the post-contrast phase only.

0:14

We can see that there's an abnormality

0:15

in the right hepatic lobe, and there's

0:18

essentially quite a large mass that's

0:20

replacing much of the right hepatic lobe.

0:23

Internally, it looks like it has low density,

0:26

so it's probably going to be a cystic mass.

0:28

But its borders are quite irregular.

0:30

If you look at this border here,

0:31

it's a little bit lobulated and maybe

0:33

a little bit thickened over here.

0:35

As you go down here, posteriorly,

0:37

there's thin septation associated with this.

0:41

As you go over here, there's another thin

0:42

septation associated with this.

0:44

And so whatever it is, it's

0:46

not completely simple looking.

0:49

You also note that if you look at the remainder

0:50

of the liver parenchyma, this is an isolated

0:52

finding in that you're not really seeing

0:54

other masses or other cysts in the liver.

0:56

The only real abnormality we're

0:57

seeing is this large mass

1:00

in the right hepatic lobe.

1:03

Look at the coronals.

1:04

It'll give you a sense of sort

1:05

of how large this lesion is.

1:07

From cranial to caudal dimension, you get

1:09

a sense of some of the borders that are

1:11

a little bit thicker, like over here is much

1:13

thicker than, say, this border over here.

1:16

And then this, particularly inferiorly and

1:18

posteriorly, you can see that there's multiple

1:19

septations within portions of this mass.

1:23

And so, again, this finding in and of itself is

1:25

nonspecific, but if you sort of look at it, one

1:29

of the things you may want to consider is this

1:31

entity of hepatic mucinous cystic neoplasm.

1:35

And it has a lot of things that

1:37

are going for this instance in

1:38

that it's a large cystic mass.

1:41

It's isolated.

1:42

It has minimal complexity to it, and it has

1:44

little septations, little thickened walls.

1:47

It's in the right gender, which

1:48

is female in this patient.

1:50

Typically, we see them in patients

1:51

who are a little bit older than this

1:53

30-year-old female, but we can see

1:55

them in a wide variety of age groups.

1:58

And so, it's certainly something that may

2:01

be suggested as part of the differential

2:03

diagnosis in this patient, and this

2:04

turned out to be a hepatic mucinous

2:07

cystic neoplasm when it was resected.

2:10

Remember that this was formerly sort of known

2:13

as a biliary cystadenoma, but the nomenclature

2:16

has changed over time.

2:21

Yep, and so this was just something to think

2:23

about when you see these isolated, large cystic

2:25

lesions that have minimal areas of complexity,

2:28

and certainly to differentiate it from its

2:30

malignant counterpart, we're looking for

2:32

discrete soft tissue nodules with enhancement,

2:36

which we don't see in this instance.