Effective Treatment of Biliary Cystadenoma

Abstract

Biliary cystadenoma must be recognized and treated differently than most hepatic cysts. There remains a need for education about the imaging findings for biliary cystadenoma to reduce the demonstrated delay in appropriate treatment. Traditional treatment of simple cysts such as aspiration, drainage, and marsupialization results in near universal recurrence and occasional malignant degeneration. This experience demonstrates effective options include total ablation by standard hepatic resection and cyst enucleation.

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

“…However, core biopsy is unlikely to yield sufficient tissue in case of simple cyst or cystadenoma; it also is not suitable for the diagnostics of focal malignancy and rarely can lead to peritoneal carcinomatosis [13]. Therefore radiological diagnostics, especially computed tomography, is essential [117]. Grossly, biliary cystadenocarcinoma is multicystic.…”

“…Vascularity of septa is characteristic for cystic biliary tumours [14] and is considered by some specialists to be more reliable in distinguishing biliary cystadenoma from cyst than the simple presence of septations [117]. Biliary cystadenoma is characterised by smooth and thin internal septa, but presence of enhanced mural nodules in the outer wall or septa is the most important sign of malignancy.…”

“…The other manifestations and complications include jaundice, cholangitis, tumour rupture [114], haemorrhage [115], compression of the portal or caval veins with possible subsequent ascites [113], hemobilia [12] and mucobilia [116]. Notably, the tumour can progress slowly [117] with the clinical history of biliary cystadenocarcinoma as long as 10-15 years [112,118]. The long course is is in accordance with the low grade of malignancy and gradual development of tumour through stages of increased epithelial proliferation, dysplasia, in situ cancer and, finally, invasive cancer.…”

Laparoscopic fenestration of multiple giant biliary mucinous cystadenomas of the liver

“…Frozen sections are used to direct the surgical treatment but they can miss the diagnosis of hepatobiliary cystadenoma during a fenestration as was the case in our patient [7] . Thomas et al [8] reported that tumor recurrence occurs in two thirds of the patients, who have only local or pericystic excision. In contrast, only 10% of the patients, who have hepatic lobectomy, hemihepatectomy or radical excision of cystadenoma with a rim of normal tissue with a diameter of 2 cm, require further surgery for recurrence.…”

“…In contrast, only 10% of the patients, who have hepatic lobectomy, hemihepatectomy or radical excision of cystadenoma with a rim of normal tissue with a diameter of 2 cm, require further surgery for recurrence. Therefore, the detection of hepatobiliary cystadenoma after a laparoscopic surgical approach implies many challenging therapeutic dilemmas [8,9] .…”