case_images: PMC9259372_01
case_images: (a) Enhanced computed tomography and (b) T2-weighted magnetic resonance imaging show cystic lesions with septations arising from macrolobulations in the medial segment of the liver (red arrows). Uptake of fluorodeoxyglucose in the cystic lesions was not observed on positron emission tomography (c).
case_images: CRIS2022-4829153.001.jpg
case_images: PMC9259372_01_CRIS2022-4829153.001.jpg
case_images: fig1
case_images: Enhanced computed tomography (CT) and magnetic resonance imaging (MRI) revealed cystic lesions with septations arising from macrolobulations in the left medial segment of the liver (Figures 1(a) and 1(b)). Positron emission tomography revealed no fluorodeoxyglucose accumulation in the cystic lesions of the liver (Figure 1(c)).
case_images: Intraoperative view before deroofing (a). A unilocular white cystic tumor was observed in the medial segment of the liver. Intraoperative view after deroofing (b). The lumen of cystic lesions was like velvet. Histopathological findings (hematoxylin and eosin staining, x200 magnification) (c). The cyst wall was lined by mucin-producing atypical epithelium, which was surrounded by ovarian-like stroma. These findings indicated MCN-L.
case_images: CRIS2022-4829153.002.jpg
case_images: PMC9259372_01_CRIS2022-4829153.002.jpg
case_images: fig2
case_images: On the basis of these findings, the patient was diagnosed with SHCs and underwent laparoscopic deroofing of the cystic lesions (Figure 2(a)). By contrast, the lumen of the cystic lesions was velvety, atypical of the characteristics of SHCs (Figure 2(b)). Histopathological examination revealed that the cystic wall was lined by an atypical mucin-producing epithelium surrounded by ovarian-like stroma; hence, the cystic lesions were diagnosed as MCN-L (Figure 2(c)).
case_images: (a) Enhanced computed tomography and (b) T2-weighted magnetic resonance imaging at regrowth 6 months after deroofing showed cystic lesions with septations arising from the cyst wall without indentation (red arrows).
case_images: CRIS2022-4829153.003.jpg
case_images: PMC9259372_01_CRIS2022-4829153.003.jpg
case_images: fig3
case_images: However, enhanced CT and MRI 6 months after the laparoscopic deroofing revealed regrowth of the cystic lesions, with septations arising from the cyst wall without indentation (Figures 3(a)-3(b)).
case_images: Surgical method is shown. A regrowth tumor was observed in the medial segment of the liver (a). Aspiration of cystic fluid was performed to secure a field of view (b). The left hepatic artery (white arrow) was diverged from the left gastric artery and clipped (c). The left portal vein was identified and divided after clipping (d). The transection line was set using intraoperative ultrasonography (e). Pringle's maneuver was performed prior to hepatic parenchyma transection (f). The (g) left hepatic duct and the (h) left hepatic vein were divided by a linear stapler.
case_images: CRIS2022-4829153.004.jpg
case_images: PMC9259372_01_CRIS2022-4829153.004.jpg
case_images: fig4
case_images: IV (Figure 4(a)), and no peritoneal dissemination was observed. Initially, we aspirated the cystic fluid to secure a good surgical field with careful attention to avoid fluid dissemination (Figure 4(b)). We identified the left hepatic artery diverging from the left gastric artery and left portal vein in the porta hepatis and clipped and divided them individually (Figures 4(c) and 4(d)). We then confirmed the demarcation line and the locations of the MCN-L, identified the middle hepatic vein using intraoperative ultrasonography, and set a transection line (Figure 4(e)). We transected the hepatic parenchyma using the intermittent Pringle maneuver (Figure 4(f)). The left hepatic duct and vein were divided using a linear stapler (Figures 4(g) and 4(h)).