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JAMA Surgery Clinical Challenge
March 2014

Complex Cystic Lesions in the Liver Causing Abdominal Pain

Author Affiliations
  • 1Department of Surgery, Thomas Jefferson University, Jefferson Pancreas, Biliary, and Related Cancer Center, Philadelphia, Pennsylvania
JAMA Surg. 2014;149(3):303-304. doi:10.1001/2013.jamasurg.351

A 74-year-old woman was seen by her primary care physician for dull epigastric and right upper quadrant abdominal pain of 1-year duration. Routine laboratory values were within normal limits. The patient underwent ultrasonography of the abdomen, and 2 cystic lesions were discovered in the liver. Magnetic resonance imaging of the abdomen revealed 2 multiloculated cystic lesions in segments IV and V of the liver (Figure, A). Additional laboratory values included normal carcinoembryonic antigen and cancer antigen 19-9 levels. Percutaneous aspiration with a biopsy of one of the cystic lesions was performed that revealed atypical cells suspicious for malignancy. The patient was then referred for management to our institution, where she underwent an exploratory laparotomy and enucleation of these 2 complex multiloculated cystic lesions (Figure, B).

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