Surgical Management of a Cystic Liver Lesion — A Case Study by Dr. Manoj Dongare
How a Complex 18 cm Liver Tumour Was Successfully Treated Without a Full Liver Removal
When a 36-year-old man walked into the clinic with persistent pain in his right upper abdomen, nobody expected what the scans would reveal — an 18 cm cystic lesion occupying almost the entire right lobe of the liver. This is the story of how careful diagnosis, expert surgical planning, and multidisciplinary teamwork led to a successful outcome.
The Patient and the Problem
A young, otherwise healthy gentleman presented with discomfort in the right side of his abdomen. CT and MRI scans told a concerning story:
An 18 cm cystic lesion in the right lobe of the liver
The lesion was extending into the left lateral segment
It was splaying the left hepatic veins
Both right and left hepatic veins were not clearly visible on imaging
Given the size and location of the lesion, the patient was referred to Dr. Manoj Dongare, a leading HPB Surgeon and best liver specialist practising at Cloverleaf Speciality Clinic, Pune-PCMC, for further evaluation and possible liver resection surgery.
Thorough Investigation Before Surgery
Rather than rushing into the operation theatre, Dr. Manoj Dongare followed a systematic, evidence-based approach to fully understand the nature of the lesion.
Investigations performed included:
PET Scan — Showed no evidence of disease anywhere else in the body
Tumour Markers — AFP, CEA, and CA 19.9 were all within normal limits
Provisional Diagnosis — Cystadenoma or Cystadenocarcinoma of the liver
This comprehensive pre-operative workup is what distinguishes expert HPB surgery from routine care. Knowing the lesion was localised gave the surgical team the confidence to proceed with curative intent.
The Surgery — Extended Right Hepatectomy with Precision
Dr. Manoj Dongare performed what is technically described as an almost extended right hepatectomy — one of the most complex liver surgeries in HPB surgical practice.
What made this surgery especially challenging:
The lesion was massive — 18 cm in size
It had encroached upon the left lateral segment
The hepatic veins were compressed and poorly visualised
Preserving enough healthy liver tissue was critical for patient survival
What the surgical team achieved:
Complete removal of the cystic lesion along with the right lobe
Preservation of the branches of the left hepatic vein — ensuring adequate blood drainage from the remaining liver
Clear surgical margins — meaning no tumour cells were left behind
This level of precision is what patients can expect when consulting a best liver specialist with dedicated HPB expertise.
The Surprise Finding — A Neuroendocrine Tumour
Post-operative histopathology (HPR) revealed something unexpected — the lesion was not a cystadenoma or carcinoma as initially suspected.
Final Diagnosis: Grade 2 Neuroendocrine Tumour (NET) of the liver
Neuroendocrine tumours presenting as large cystic lesions in the liver are rare. They can closely mimic other cystic liver lesions on imaging, which is why histopathology remains the gold standard for final diagnosis.
Post-operative steps taken by Dr. Manoj Dongare:
A DOTA scan was performed after surgery
Results confirmed no evidence of disease anywhere else in the body
Surgical margins were confirmed as free of tumour
This meant the patient had achieved a complete surgical cure — a remarkable outcome for such a complex case.
Key Takeaways from This Case
This case managed by Dr. Manoj Dongare at Cloverleaf Speciality Clinic offers several important lessons for patients and medical professionals alike:
Large liver lesions require expert evaluation — not all cystic liver masses are simple cysts
Pre-operative imaging and tumour markers are essential but may not always give a final diagnosis
PET and DOTA scans play a vital role in staging and post-operative surveillance
Liver-sparing surgery, when technically feasible, significantly improves recovery and quality of life
Multidisciplinary management — involving radiology, pathology, oncology, and surgery — is non-negotiable in complex liver cases
Regular follow-up is essential, especially for neuroendocrine tumours, which can recur
Why Consult Dr. Manoj Dongare for Liver Conditions?
Dr. Manoj Dongare is a highly experienced HPB Surgeon based in Pune-PCMC, specialising in complex liver, pancreas, and biliary surgeries. As the best liver specialist at Cloverleaf Speciality Clinic, he combines advanced surgical techniques with a patient-first approach.
Whether you are dealing with a liver cyst, liver tumour, or any complex hepatobiliary condition, early consultation with a dedicated specialist can make all the difference.
If you or a loved one has been diagnosed with a liver lesion, do not delay. Reach out to Dr. Manoj Dongare for a thorough evaluation and expert surgical opinion.
📞 Call Us: +91 9881379573 🗓️ Book An Appointment →
