Pathology cases- hepatic cyst

The decedent was a 70 year old man with obesity, diabetes mellitus type II, history of  heavy tobacco use who complained of shortness of breath.  He went to a local clinic and was reported to have a positive covid-19 result.  The next day he suffered a witnessed collapse and died.  At autopsy, he had severe multivessel atherosclerotic disease of his coronary arteries and cerebrovascular system as well as severe aortic arteriosclerosis.  Examination of the lungs revealed moderate pulmonary fibrosis, chronic bronchitis, and acute pulmonary edema with hemorrhage.  An interstitial pneumonitis was not present, nor was there acute pneumonia.  I concluded that the decedent’s death was primarily due to his cardiovascular disease.  His rapid covid test may or may not have been a false positive, but if it was positive, it represented a stressor and cardiac trigger.

As an incidental finding, there was a 15 cm thick walled cyst adherent to the liver, containing necrotic debris:

On histology, the wall consisted of a thick fibrous paucicellular wall with focal acute intramural hemorrhage.  There was no discernible epithelial lining (though these usually have low cuboidal epithelium).  Subjacent to the cyst at the point of attachment, there were thick-walled arteries and veins with prominent nervous tissue.  The obligatory chronic inflammation was also present.

The hepatic/perihepatic cysts are usually old pancreatic pseudocysts.  This decedent had no history of pancreatisis, and the sections I took looked fine (as far as postmortem autolyzed pancreases go).  You can sometimes get them with biliary obstruction, though those are usually deeper, from my reading.  They usually contain clear fluid, not the necrotic debris seen here.  When I reviewed the decedent’s medical history following the autopsy (I usually don’t get records until a day or so after the postmortem examination), it turned out that this had been incidentally discovered some years ago on CT scan for another issue.  His docs wanted to drain it, but he was not enthusiastic.


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