Cystic tumors of the liver: A practical approach

Abstract

Biliary cyst tumors (cystadenoma and cystadenocarcinoma) are an indication for liver resection. They account for only 5% of all solitary cystic lesions of the liver, but differential diagnosis with multiloculated or complicated biliary cysts, atypical hemangiomas, hamartomas and lymphangiomas may be difficult. The most frequent challenge is to differentiate biliary cyst tumors from hemorrhagic cysts. Computerized tomography (CT) and magnetic resonance imaging (MRI) are often not diagnostic and in these cases fine needle aspiration (FNA) is used to confirm the presence of atypical biliary cells. FNA, however, lacks adequate sensitivity and specificity and should always be used in conjunction with imaging. Pre-operative differentiation o f c y s t a d e n o m a f r o m c y s t a d e n o c a r c i n o m a i s impossible and surgery must be performed if a biliary cyst tumor is suspected. When multiple cystic lesions are observed throughout the liver parenchyma, it is important to exclude liver metastasis, of which colonic cancer is the most common primary site. Multiple biliary hamartomas (von Meyenburg complex) can appear as a mixture of solid and cystic lesions and can be confused with cystic metastasis. Strong and uniform T2 hyperintensity on MRI is usually diagnostic, but occasionally a percutaneous biopsy may be required.

Calcification in biliary hamartomatosis

“…The prevalence of biliary hamartomas has been estimated at 5.6% in adults and 0.9% in children [1,2]; the rate increases with age and chronic liver disease [7]. Biliary hamartomas can be confused with metastases, microabscesses, cysts, biliary adenomas, dilated bile ducts [4], cirrhosis [8,9], granulomatous hepatitis [8] and cystadenocarcinoma [10].…”

Primary and Metastatic Tumours of the Liver: Expanding Scope of Morphological and Immunohistochemical Details in the Biopsy

“…Size, number of septations or location of the neoplasm does not help to differentiate between benign or malignant cystic biliary tumours [14]. Some authors have postulated that preoperative differentiation between biliary adenoma and cystadenocarcinoma by radiologic imaging is not possible therefore liver resection should be performed for all cystic biliary tumours [120]. This assumption is based on the experience that internal papillae with arterial enhancement may be present in both tumours so that computed tomography and magnetic resonance imaging yield overlapping data.…”

“…Extrahepatic bile ducts (13%) or the gall bladder (0.02%) has been affected by this tumour as well [14]. The size of cystic biliary tumours (1.5-30 cm) is not helpful in the differential diagnostics between simple hepatic cyst and cystic biliary tumours; it also has no correlation with malignant biological potential [120]. The metastatic spread of biliary cystadenocarcinoma can affect the liver, regional lymph nodes in the hepatoduodenal ligament, lungs, pleura or peritoneum [100].…”

Intrahepatic biliary cystadenoma—diagnosis and treatment options

“…Their preoperative diagnosis is difficult and opinions regarding surgical treatment of cystadenomas differ considerably. The aim of our study is to establish an optimal diagnostic and therapeutic approach toward liver cystadenomas (1,2).…”