MUCINOUS CYSTIC NEOPLASM OF LIVER - PEELING SIGN MITIGATES A DIAGNOSTIC CONUNDRUM

Background: Mucinous cystic neoplasms (MCN) are rare primary cystic neoplasms of the liver. It is commonly misdiagnosed for other cystic SOLs of liver. Clinical management of MCN is challenging due to scant literature on pre-operative and per-operative indices to distinguish MCN from other cystic SOLs of liver. Imprecise diagnosis leading to suboptimal surgical management results in recurrence and progression to malignancy. Methods: A retrospective analysis of cystic SOLs from July 2019 to July 2023 was analyzed in our centre. Data collection included demographics, clinical presentations, imaging characteristics, surgical techniques, intra-operative observations, complications, histopathology, post-operative follow-up, morbidity, and mortality. Results:Between July 2019 and July 2023, six patients were diagnosed and treated for MCN at our centre. Female patients were predominant (5 out of 6) with average age of 45.5yrs (Range 26-53). Abdominal discomfort was the commonest symptom (50%). All patients underwent abdominal ultrasounds and CT scans, while MRI was done in one patient. Two were misdiagnosed with non-neoplastic liver cysts and one had an ambiguous diagnosis. Four patients underwent liver resection and two had enucleation. All were MCN by HPE. In 3 patients, with ambiguous pre-op diagnosis, our recommended pre-operative and per-operative strategy including THE PEELING SIGN was helpful in diagnosing MCN. No recurrences were observed at 43 months of follow up. Conclusions:Liver MCNs are infrequent and often mistaken for other hepatic cystic conditions. By applying our pre-operative and per-operative indices, patients with MCN of liver can be diagnosed with precision and offered radical surgery.