San Antonio Uniformed Services Health Education Consortium Fort Sam Houston, TX, United States
Howard D. Lee, MD1, Ashleigh M. Tomkovich, MD1, Geoff A. Bader, MD2 1San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, TX; 2San Antonio Uniformed Services Health Education Consortium, San Antonio, TX
Introduction: Simple hepatic cysts are the result of benign congenital exclusions of hyperplastic bile ducts. These are common benign focal liver lesions, occurring in up to 15% of the general population. While the majority of these lesions are small, asymptomatic, and discovered incidentally, they can result in complications requiring intervention. We present a unique case of a symptomatic exophytic hepatic cyst discovered via upper endoscopy demonstrating extra-luminal compression.
Case Description/Methods: A 67-year-old female with history of well-controlled GERD presented reporting a one-year history of progressive dull epigastric pain with early satiety. A physical exam was not performed due to the encounter being virtual, and no recent laboratory results were available. Diagnostic upper endoscopy demonstrated a prominent bulge along the greater curvature of her stomach with overlying normal mucosa, suspicious for extra-luminal compression. Computed tomography with intravenous contrast revealed a large benign-appearing exophytic hepatic cyst with septation measuring 7.4 x 5.5 x 7.2 cm compressing on the stomach posteriorly. Given the atypical features and presumed association with symptoms, patient underwent robot-assisted laparoscopic cyst fenestration and partial hepatectomy. Intraoperatively, a large septated cyst was visualized on the periphery of segment II with adhesions to the omentum and diaphragm; the lesion was successfully dissected from surrounding structures and excised. Histologic evaluation of the surgical specimen demonstrated fragments of thin-walled cyst lined with cuboidal epithelium, compatible with simple hepatic cyst. On follow-up two weeks after her surgery, she reported complete resolution of her presenting clinical symptoms.
Discussion: Cystic hepatic lesions are routinely encountered in clinical practice, with indications for evaluation and treatment dictated by the clinical history and radiographic features of the cyst. Our case highlights a few notable atypical clinical and radiological features, including the cyst’s exophytic morphology, large size, and the presence of septation. While mass effect symptoms from large cysts are well defined, to our knowledge this is only the fourth case of gastric compression by exophytic benign hepatic cysts described in the literature. The optimal approach for cystic hepatic lesions that need intervention remains elusive, but typically involves surgical excision or aspiration and sclerotherapy for non-surgical candidates.
Figure: Panels A and B: CT demonstrating a large exophytic hepatic cyst with septation compressing on the stomach posteriorly. Panel C: EGD demonstrating prominent extramural compression over the greater curvature. Panel D: Histology demonstrating thin-walled cyst lined with cuboidal epithelium.
Disclosures: Howard Lee indicated no relevant financial relationships. Ashleigh Tomkovich indicated no relevant financial relationships. Geoff Bader indicated no relevant financial relationships.
Howard D. Lee, MD1, Ashleigh M. Tomkovich, MD1, Geoff A. Bader, MD2. P1860 - A Not so Simple Cyst: A Case of a Large Benign Exophytic Hepatic Cyst Causing Symptomatic Gastric Compression, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
