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ABDOMEN / Hepatobiliary   / ,  Liver mass
2017-11-01
About Author
Authors Shin Yong Moon
Institution Asan Medical Center
E-mail cjimage@amc.seoul.kr
About Case
Chief complaint
or Title
Liver mass
Subspecialty ABDOMEN / Hepatobiliary
Classification Neoplasm, benign / cyst
Age Sex
Difficulty For student, For resident
Modality US, CT, MR
Case Figures
Click above Figure for more images.
Questions
What case is NOT MCN of liver
Answer
Diagnosis 4 Case D
Comments

Á¤´ä  1, 2, 3 ¹øÀº ¸ðµÎ Mucinous cyst adenoma

  4 ¹øÀº benign biliary cyst with hemorrhage.

 

 

 

 

 




³¶¼º°£º´º¯Àº ¾ç¼º¿¡¼­ºÎÅÍ ¾Ç¼ºº´º¯±îÁö ´Ù¾çÇϸç À§ table°ú °°Àº
Ư¡Àû ÀÓ»ó¼Ò°ß°ú
CT/MR ¼Ò°ßÀ» º¸ÀδÙ.




1.°£³¶Á¾ (Hepatic or
Bile duct cyst)




Àα¸ÀÇ ¾à 2.5~4.5%¿¡¼­ ¹ß»ýÇÏ¸ç º¸Åë single, unilocular cyst·Î cuboidal bile duct
epithelium
ÀÇ single layer·Î ±¸¼ºµÇ¾î ÀÖ´Ù. Simple cystÀÇ ÃÊÀ½ÆÄ ¼Ò°ßÀº anechoic content,
smooth border, lateral shadowing, posterior acoustic enhancement, no detectable
wall, no septation, and no mural calcification
ÀÌ Æ¯Â¡ÀÌ´Ù.   ´ëºÎºÐÀÌ ´Ü¹æ¼ºÀ̳ª °Ý¸·ÀÌ ÀÖ¾î ´Ù¹æ¼ºÀ¸·Î º¸ÀÌ´Â °æ¿ì¿¡ Á¡¾×³¶¼ºÁ¾¾ç mucionous cystic neoplasm µî°ú °°Àº ³¶¼º Á¾¾ç°ú °¨º°Çϱ⠾î·Á¿ï ¼ö ÀÖ´Ù.




 Complicated
cyst
´Â °¨¿°À̳ª ÃâÇ÷À» µ¿¹ÝÇϸç simple cyst¿Í ¹Ý´ë·Î internal echo, septation, thickened wall, solid component¸¦ Æ÷ÇÔÇÒ
¼ö ÀÖ´Ù
. °¨º°ÁúȯÀ¸·Î mucinous cystic neoplasm,
IPNB, necrotic/cystic metastasis
°¡ ÀÖ´Ù. ³¶Á¾ ³»¿¡ ÃâÇ÷ÀÌ »ý±â¸é
Á¾±«´Â
T1°­Á¶¿µ»ó¿¡¼­ °í½ÅÈ£°­µµ¸¦ º¸À̰ųª, T2°­Á¶¿µ»ó¿¡¼­
Àú½ÅÈ£°­µµ¸¦ º¸ÀÌ´Â ºÎÀ§°¡ »ý±ä´Ù
.




 




 2. Á¡¾×ºÐºñ¼º
³¶¼ºÁ¾¾ç
(Mucinous cystic neoplasm and Cyst forming IPNB)




 °£¿¡´Â
Á¡¾×À» »ý¼ºÇÏ´Â µÎ °¡Áö ³¶¼ºÁ¾¾çÀÌ ÀÖÀ¸¸ç
2010³â WHO
classification
¿¡ µû¸£¸émucinous cystic neoplasm°ú IPNB (Intraductal Papillary Neoplasm of the Bile duct)·Î ºÐ·ùÇÑ´Ù.




Mucinous cystic neoplasmÀº ÀÌÀü ºÐ·ù¹ý¿¡¼­ biliary cystadenoma/cystadenocarcinoma·Î ¸í¸íµÇ¾ú´ø º´º¯À¸·Î ovarian-type subepithelial stromaÀ» µ¿¹ÝÇÑ
cyst-forming epithelial neoplasm
À¸·Î Á¤ÀÇÇÏ°í º¸Åë ´ã°ü°úÀÇ ±³ÅëÀÌ ¾ø´Ù.
ÀÌ¿Í´Â ´Þ¸® IPNB´Â ÀÌÀü biliary
papilloma, biliary papillomatosis, and biliarycholangiocarcinoma
À» Æ÷ÇÔÇÑ »õ·Î¿î
ºÐ·ù·Î
mucinÀ» °ú»ý¼ºÇÏ¸ç º¸Åë ´ã°ü°úÀÇ ±³ÅëÀÌ ÀÖ°í ÃéÀå¿¡¼­ ¹ß»ýÇÑ IPMN°ú ´ëÀÀ°ü°è·Î °£ÁÖÇÑ´Ù. ÀÌÁß tubular or fusiform shapeÀÇ IPNB¸¦ Á¦¿ÜÇÑ cyst forming IPNB¿Í mucinous cystic neoplasmÀº
À¯»çÇÑ ¿µ»ó¼Ò°ßÀ» º¸ÀÌ¸ç ¼ö¼úÀû Ä¡·á°¡ ÇÊ¿äÇϹǷÎ
simple hepatic cyst¿ÍÀÇ °¨º°ÀÌ Áß¿äÇÏ´Ù.




¿µ»ó°Ë»ç¿¡¼­ Mucinous cystic neoplasmÀº ´Ü¹æ¼ºÀ̳ª, °Ý¸·ÀÌ ÀÖ´Â ´Ù¹æ¼ºÀÇ ³¶¼º Á¾±«·Î º¸À̸ç, ³¶Á¾º®À̳ª, °Ý¸·¿¡ °íÇü¼º °áÀýÀÌ µ¿¹ÝµÉ ¼ö Àִµ¥, ÀÌ·± ¼Ò°ßÀÌ º¸ÀÌ¸é ¾Ç¼ºÀÏ
°¡´É¼ºÀÌ ¤¤Æ÷´Ù°í Çϳª ¾ç¼ºÀÎ °æ¿ì¿¡µµ ÈçÈ÷ º¼¼ö ÀÖ´Â ¼Ò°ßÀÌ´Ù
. ³¶Á¾º®À̳ª °Ý¸·¿¡ calcificationÀÌ º¸ÀÏ ¼ö ÀÖ´Ù. Á¶¿µÁõ°­ ÈÄ CT ³ª MRI¿¡¼­ ³¶Á¾º®, °Ý¸·, °íÇü¼º °áÀý µîÀº Á¶¿µÁõ°­ µÈ´Ù. MRI¿¡¼­´Â Á¾±«³»ÀÇ ´Ü¹éÁú ÇÔ·®ÀÇ
º¯È­¿¡ µû¶ó ¾×üÀÇ ½ÅÈ£°­µµ°¡ ´Ù¾çÇÏ°Ô ³ªÅ¸³¯ ¼ö ÀÖ´Ù
.




 




 ÃÖ±Ù
¹®Çå¿¡ ÀÇÇϸé
central septa, mural nodules, upstream, and downstream
bile duct dilatation
ÀÇ ¼Ò°ßÀ¸·Î »ó±â µÎ ÁúȯÀ» ´Ü¼ø °£³¶Á¾°ú °¨º°Çϴµ¥ µµ¿òÀ» ÁÙ ¼ö ÀÖ´Ù°í ÇÑ´Ù. ±×·¯³ª °¨¿°À̳ª ÃâÇ÷À» µ¿¹ÝÇÑ °£³¶Á¾ÀÇ °æ¿ì °¨º°Áø´ÜÀÌ ¾î·Á¿ï ¼ö ÀÖ¾î
MRI
µîÀÇ Ãß°¡Àû °Ë»ç°¡ ÇÊ¿äÇÏ´Ù.




 

References
Keywords Liver, MRI, Cystadenoma, MCN
Attachment File -

Number of Applicants : 44
Correct Answer 17
Magnum Diagnostics Paresh Desai
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