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Hepatic Mucinous Cystic Neoplasm: A Step Forward Towards a Meaningful Classification System

Published:January 29, 2022DOI:https://doi.org/10.1016/j.acra.2021.12.030
      Hepatic cysts are one of the most common incidental findings in imaging, seen in approximately 18% of the population (
      • Carrim ZI
      • Murchison JT.
      The prevalence of simple renal and hepatic cysts detected by spiral computed tomography.
      ). Fortunately, they are overwhelmingly benign, requiring no further work up. The 2017 ACR white paper states lesions can be classified as benign hepatic cysts (BHC) if they demonstrate attenuation less than 20 HU, clearly marginated, homogeneous, and without enhancement, nodularity, or septations (
      • Gore RM
      • Pickhardt PJ
      • Mortele KJ
      • et al.
      Management of incidental liver lesions on CT: a white paper of the ACR incidental findings committee.
      ). The caveat was added that these criteria may not apply to high-risk patients, such as those with a history of primary malignancy such as ovarian, gastrointestinal stromal, etc., since cystic hepatic metastatic disease can have a similar appearance. A rarer cystic neoplasm to consider is hepatic mucinous cystic neoplasm (MCN), which accounts for less than 5% of cysts (
      • Soares KC
      • Arnaoutakis DJ
      • Kamel I
      • et al.
      Cystic neoplasms of the liver: biliary cystadenoma and cystadenocarcinoma.
      ). Given the paucity of published literature on its imaging characteristics and changes in nomenclature, this important clinical entity may receive less consideration in the diagnosis of cystic hepatic neoplasm.
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