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Inicio Cirugía Española (English Edition) Diagnosis and treatment of hepatic cysts. Usefulness of intracystic tumor marker...
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Vol. 102. Issue 1.
Pages 19-24 (January 2024)
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Vol. 102. Issue 1.
Pages 19-24 (January 2024)
Original article
Diagnosis and treatment of hepatic cysts. Usefulness of intracystic tumor markers (CEA and CA 19.9.)
Diagnóstico y tratamiento de los quistes hepáticos. Utilidad de los marcadores tumorales intraquísticos (CEA y CA 19.9.)
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Daniela Polettea,
Corresponding author
dpolette@bellvitgehospital.cat

Corresponding author.
, Kristel Milsa, Fina López-Domíngueza, Oriana Barriosa, David Leivab, Isabel Puigb, Emilio Ramosa, Laura Lladóa
a Unidad de Cirugía Hepatobiliopancreática del Servicio de Cirugía General, Hospital Universitario de Bellvitge, Barcelona, Spain
b Unidad de Radiología Hepatobiliopancreática, Hospital Universitario de Bellvitge, Barcelona, Spain
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Abstract
Introduction

To decide treatment of hepatic cysts diagnosis between simple hepatic cyst (SHC) and cystic mucinous neoplasm (CMN). Radiological features are not patognomonic. Some studies have suggested the utility of intracystic tumor markers.

Methods

Retrospective analysis of our prospective database including patients treated due to symptomatic SHC from 2003 to 2021. The aim of the study was to evaluate the results of treatment of symptomatic SHC and the usefulness of the determination of intracystic “carcinoembryonic antigen” (CEA) and “carbohydrate antigen” CA 19.9.

Results

50 patients diagnosed and treated for symptomatic SHC were included. In 15 patients the first treatment was percutaneous drainage. In 35 patients the first treatment was laparoscopic fenestration. Four patients were diagnosed of premalignant or malignant liver cystic lesions (MCN, IPMN, lymphoma B); three of them required surgery after initial fenestration and pathological diagnosis.

Median CEA and CA 19−9 were 196 μg/L and 227.321 U/mL respectively. Patients with malignant or premalignant pathology did not have higher levels of intracystic tumor markers. Positive predictive value was 0% for both markers, and negative predictive value was 89% and 91% respectively.

Conclusion

Values of intracystic tumor markers CEA and CA 19−9 do not allow distinguishing simple cysts from cystic liver neoplasms. The most effective treatment for symptomatic simple liver cysts is surgical fenestration. The pathological analysis of the wall of the cysts enables the correct diagnosis, allowing to indicate a surgical reintervention in cases of hepatic cyst neoplasia.

Keywords:
Hepatic cyst
Simple cyst
Tumour markers
Mucinous cystic neoplasms of the liver
Treatment
Resumen
Introducción

El tratamiento de los quistes hepáticos requiere del diagnóstico diferencial de quiste simple hepático (QSH) de la neoplasia mucinosa quística (NMQ) hepática. Las características radiológicas no son patognomónicas. Algunos estudios han sugerido la utilidad de los marcadores tumorales (MKT) intraquísticos.

Métodos

Análisis retrospectivo de base de datos prospectiva incluyendo pacientes diagnosticados de QSH sintomático desde el 2003 hasta el 2021. El objetivo del estudio es evaluar los resultados del tratamiento de los QSH sintomáticos y analizar la utilidad de la determinación de “carcinoembryonic antigen” (CEA) y “carbohydrate antigen” CA 19.9 intraquísticos.

Resultados

Se incluyeron 50 pacientes tratados por quiste sintomático. En 15 pacientes el primer tratamiento fue el drenaje percutáneo. En 35 pacientes se realizó fenestración laparoscópica. Cuatro pacientes se diagnosticaron de lesiones premalignas/malignas (NMQ, NPIB, linfoma B); tres de ellos requirieron una segunda cirugía tras la fenestración y el diagnóstico anatomopatólogo.

La mediana de los valores de CEA y CA- 19.9 fue de 196 μg/L y 227.321U/mL respectivamente. Los pacientes con lesiones premalignas no tuvieron valores elevados de MKT. El valor predictivo positivo fue del 0% en ambos MKT, y el valor predictivo negativo fue de 89% y 91% respectivamente.

Conclusiones

Los valores de CEA y CA 19.9 intraquísticos no permiten distinguir los QSH de las NMH. El tratamiento más resolutivo de los QSH sintomáticos es la fenestración quirúrgica. El análisis anatomopatológico de la pared del quiste posibilita su correcto diagnóstico, permitiendo indicar una reintervención quirúrgica en los casos de NMQ.

Palabras clave:
Quiste hepático
Quiste simple
Marcadores tumorales
Neoplasia mucinosa hepática
Tratamiento

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