The management of hepatobiliary cystadenomas: lessons learned

Abstract

Background: Mucinous cystic neoplasms of the liver (hepatobiliary cystadenomas) are rare neoplastic lesions. Such cysts are often incorrectly diagnosed and managed, and carry a risk of malignancy. The objective of this study was to review the surgical experience with these lesions over 15 years.

Methods: A retrospective chart review identified consecutive patients undergoing surgery for liver cystadenomas from 1997-2011. Clinical data were collected and summarized.

Results: Thirteen patients (mean age 51 years, 12/13 females) with cysts 4.6-18.1 cm were identified. Most cysts were located in the left lobe/centrally (11/12) and had septations (8/13). Mural nodularity was infrequent (3/13). Nine patients had liver resection/enucleation, whereas four had unroofing. Frozen section analysis had a high false-negative rate (4/6). All patients had cystadenomas, of which two had foci of invasive carcinoma (cystadenocarcinoma) within mural nodules. There was no 90-day mortality. All but one patient (myocardial infarction) were alive at a median follow-up of 23.1 months. No patient with unroofing has developed malignancy to date.

Conclusions: Non-invasive hepatobiliary cystadenomas present as large central/left-sided cysts in young or middle-aged women. Associated malignancy was relatively uncommon and found within mural nodules. Intra-operative frozen section analysis was ineffective at ruling out cystadenomas. Complete excision is recommended, but close follow-up might be considered in patients with a prohibitive technical or medical risk, in the absence of nodularity on high-quality imaging.

Figure 1

(a) T2-weighted magnetic resonance imaging (MRI) demonstrating a 14 × 15 cm centrally-located liver cystadenoma with mural nodularity and inferior vena cava compression in a 63-year-old female. (b) Computed tomography (CT) scan demonstrating an 11 × 8 cm centrally-located multi-sepatated liver cystadenoma arising above the portal bifurcation in a 56-year-old female

Figure 2

(a) Mucinous cystadenoma (10×, haematoxylin and eosin stain). There is a large cyst lined by a simple biliary-type columnar epithelium. (b) The ovarian-like mesenchymal stroma is seen underneath the simple epithelium (100×, haematoxylin and eosin stain).