We congratulate Mazza and colleagues for a comprehensive article on their 17-year experience treating nonparasitic hepatic cysts (NPHC). Although some mention was made of malignant cystic neoplasms in their reference to the use of tumor markers in the diagnostic workup, as well as the radio-logic appearance of irregular, thickened cystic walls, we feel that this important component of cystic hepatic lesions was not sufficiently emphasized. After all, the title of the article is "Management of NPHC," and the consequence of missing a malignant lesion can be catastrophic. Intrahepatic biliary cys-tadenoma (IBCA) is one of the most common premalignant cystic hepatic lesions, accounting for approximately 5% of all symptomatic cystic lesions. The typical ultrasonographic feature of an IBCA is that of a solitary, multiloculated cyst; whereas the computed tomography scan appearance reveals thin, internal septae. Magnetic resonance imaging shows gadolinium enhancement of the septae. Elevated levels of CA 19-9 in the cystic fluid has also been shown to differentiate between benign and malignant lesions. It would therefore be quite interesting to know the radiologic features of the 7 patients diagnosed with cystic neoplasms by Dr Mazza and his team and what specific measures they would recommend to exclude malignancy prior to embarking on definitive management.
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