Cystadenoma

Section: Hepatobiliary Sub-section: Liver Curriculum: Curriculum, page 85

Definition

• Rare cystic tumour within liver parenchyma or bile ducts

Epidemiology

• Mostly women
• 4th decade

Risk factors

• No association with OCP

Aetiology

• Unclear

Pathology

• Histologically
  • Lined by biliary-type mucus-secreting cuboidal or columnar epithelium, supported by fibrous stroma (representing ovarian tissue)
  • Some do not have ovarian-like stroma

Clinical

• Cystadenomas are often found incidentally.
• Larger cysts can be symptomatic and present with abdominal pain, abdominal fullness, early satiety and weight loss. Laboratory values are usually normal.

Investigations

• USS
  • Hypoechoic with thickened, irregular wall, occasional internal echoes representing debris and wall nodularity – all features of complicated cyst.
• CT and MRI can be organised to further diagnosis
• Can be difficult to differentiate cystadenoma from cystadenocarcinoma
  • Presence of calcifications along with mixed solid and cystic components on imaging is associated with cystadenocarcinoma. 
  • Mural or septal nodule and a nodule diameter > 10 mm on conventional ultrasound are suggestive of cystadenocarcinoma.

Management

• Thought to be precursor to Bilary cystadenocarcinoma
  • Cystadenocarcinoma are found to be more equally distributed in men and women
    • More aggressive in men
• Aspiration or biopsy is not recommended as it has limited sensitivity and there is a risk of disseminating malignancy if there is an underlying cystadenocarcinoma. 
• Treatment: Resection
  • Obtain histological diagnosis
  • Prevent malignant transformation