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So the following patient

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is a 30-year-old female who presents

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with right upper quadrant pain.

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An MRI was obtained to further evaluate

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the etiology of these findings.

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I'm going to start off by showing a

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T2-weighted, fat-saturated image, and

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we'll focus on the right hepatic lobe.

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And what do we see there?

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Well, there's a mass in the right hepatic lobe.

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It looks multi-septated, right?

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Lots of internal septations within it.

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Internally, it looks pretty T2 hyperintense,

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right, the contents look quite bright.

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But there are certain portions of the

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mass, for example over here, that look like

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they have more intermediate signal within

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them, and overall looks quite complex,

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that there's sort of a cystic lesion with

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internal septations; outer borders are a

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little bit lobulated in its appearance.

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On the T1 axial fat-sat pre-contrast image,

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can see that no real T1 hyperintense

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components associated with this lesion.

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Everything looks fairly dark.

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Maybe a portion of it over here

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looks like it may have some intermediate

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signal, but for the most part looks pretty T1

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hypointense and we give intravenous contrast.

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We can see that there's not a whole lot

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of enhancement associated with these.

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Some of the internal septation is enhanced,

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but the lesion itself doesn't have a

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discrete, solid component that enhances.

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So in and of itself, this is

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quite a nonspecific finding.

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You essentially have a complex cystic mass that

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is sort of situated in the right hepatic lobe.

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And this was removed, and this came back

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as a hepatic mucinous cystic neoplasm.

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And so I wanted to take this opportunity

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to talk a little bit about this entity.

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And this is something that has also still

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to certain degrees been called a biliary cyst

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adenoma, but the updated terminology is

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hepatic mucinous cystic neoplasm.

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And it's very uncommon.

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We just don't see a lot of cases of this.

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And when they take these out, they see a

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cystic hepatic neoplasm with internally

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ovarian-type stroma and mucinous epithelium.

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And in fact, it does not

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communicate with the bile ducts.

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And when we do see it, it's often

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seen in middle- to older-aged women.

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This happened to be a 30-year-old woman, but

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when we do see it, we see it in women

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who are maybe 70 or 80 years old in general.

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And on imaging, there are a variety of

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appearances that have been described.

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It can certainly be a unilocular cyst

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or a multilocular cystic mass, as we

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see in this instance.

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One of the things is that it's

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often isolated and rather large.

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And so I suppose something that was sort

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of unusual about this is that this person

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happens to have a few other cysts in

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the liver over here and a few other scattered cysts over here.

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Typically, when they see these

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hepatic mucinous cystic neoplasms,

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you don't quite see other cysts.

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You only see that lesion.

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It tends to be a little bit larger than this.

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You know, I wanted to show this case because

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things can come in different

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flavors and look a little bit differently.

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Certainly, this has some of the imaging features

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that can be seen with that entity in that it

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is a multiloculated cyst that has septations.

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And, you know, differentiation of this entity

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from its malignant counterpart is challenging.

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However, the presence of enhancing soft tissue

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nodules within this suggests that it's more

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malignant as opposed to something benign.

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And so when you see this, that's why

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the post-contrast imaging sequences

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become very important, because what I'm

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looking for is areas of nodular

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enhancement associated with this, which

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were not readily seen in this instance.

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So I thought this was an interesting case

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of something that's a very uncommon entity.

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And something which also, you know, within

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that space of being uncommon also has

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perhaps a slightly more atypical appearance

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in that it's not completely isolated and

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that internally it looks much more complex

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than perhaps some of the cases that are

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typically described in the literature.

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But nevertheless, this turned out to be

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a hepatic mucinous cystic neoplasm in this patient

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represented with right upper quadrant pain.