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Hepatic Cystadenomas Clinical Presentation

  • Author: Krishan Ariyarathna, MD; Chief Editor: BS Anand, MD  more...
Updated: Jun 16, 2016


Hepatic cystadenomas are often discovered incidentally at a routine physical examination or on imaging studies, such as ultrasound (US) or CT scan. Less frequently, nonspecific symptoms related to compression of a neighboring organ may be noted. Presenting symptoms depend on the size and the location of the lesion. The final diagnosis is made after surgical resection. Note the following:

  • Roughly 15% of patients present with small intrahepatic lesions, which are usually asymptomatic and discovered incidentally after screening ultrasonography.
  • For larger lesions, the typical presentation is that of an expanding mass in the right upper quadrant accompanied by pain, nausea, vomiting, and, in selected cases, cholangitis and sepsis.
  • Unusual presentations include obstructive jaundice, ascites secondary to portal vein compression, and intracystic hemorrhage. Acute abdomen is a rare presentation and may be caused by the rupture of the cystic wall, intra-peritoneal hemorrhage, or cyst torsion.

Physical Examination

Physical examination findings from patients with hepatic cystadenomas are usually unremarkable unless the tumor has reached a significant size and causes compressive symptoms. Physical examination may reveal a palpable and tender mass in the right upper quadrant or epigastrium and, less commonly, hepatomegaly. Lower-extremity edema and/or signs of portal hypertension may occur in patients with lesions large enough to compress the portal vein or vena cava. Note the following:

  • Splenomegaly may be an indication of a compressive effect on the portal circulation, with the development of portal hypertension. These patients also may develop ascites.
  • Jaundice suggests obstruction of the biliary system. Rare extension of the lesion in a pedunculated fashion inside the biliary system has been described.
  • Obstruction of the inferior vena cava may cause marked lower-extremity edema.
  • In the rare occurrence of intraperitoneal rupture of the lesion, the patient may have signs typical of acute peritonitis.
Contributor Information and Disclosures

Krishan Ariyarathna, MD Staff Physician, Department of Internal Medicine, Creighton University Medical Center

Krishan Ariyarathna, MD is a member of the following medical societies: American College of Physicians, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

John Gunn Lee, MD Director of Pancreaticobiliary Service, Associate Professor, Department of Internal Medicine, Division of Gastroenterology, University of California at Irvine School of Medicine

John Gunn Lee, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.


Sandeep Mukherjee, MB, BCh, MPH, FRCPC Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center

Sandeep Mukherjee, MB, BCh, MPH, FRCPC is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Merck Honoraria Speaking and teaching; Ikaria Pharmaceuticals Honoraria Board membership

The authors and editors of Medscape Reference gratefully acknowledge the contributions of the previous author and coauthors, Andrea Duchini, MD, John Goss, MD, Murat Kilic, MD, Philip Seu, MD, and Paul J Pockros, MD, to the development and writing of this article.

  1. Ratti F, Ferla F, Paganelli M, Cipriani F, Aldrighetti L, Ferla G. Biliary cystadenoma: short- and long-term outcome after radical hepatic resection. Updates Surg. 2012 Mar. 64(1):13-8. [Medline].

  2. Fukunaga N, Ishikawa M, Ishikura H, et al. Hepatobiliary cystadenoma exhibiting morphologic changes from simple hepatic cyst shown by 11-year follow up imagings. World J Surg Oncol. 2008 Dec 11. 6:129. [Medline]. [Full Text].

  3. Choi HK, Lee JK, Lee KH, et al. Differential diagnosis for intrahepatic biliary cystadenoma and hepatic simple cyst: significance of cystic fluid analysis and radiologic findings. J Clin Gastroenterol. 2010 Apr. 44(4):289-93. [Medline].

  4. Zhang YL, Yuan L, Shen F, Wang Y. Hemorrhagic hepatic cysts mimicking biliary cystadenoma. World J Gastroenterol. 2009 Sep 28. 15(36):4601-3. [Medline]. [Full Text].

  5. Fuks D, Voitot H, Paradis V, et al. Intracystic concentrations of tumour markers for the diagnosis of cystic liver lesions. Br J Surg. 2014 Mar. 101(4):408-16. [Medline].

  6. Xu HX, Lu MD, Liu LN, et al. Imaging features of intrahepatic biliary cystadenoma and cystadenocarcinoma on B-mode and contrast-enhanced ultrasound. Ultraschall Med. 2012 Dec. 33(7):E241-9. [Medline].

  7. Gamblin TC, Holloway SE, Heckman JT, Geller DA. Laparoscopic resection of benign hepatic cysts: a new standard. J Am Coll Surg. 2008 Nov. 207(5):731-6. [Medline].

  8. Abu Hilal M, Di Fabio F, Teng MJ, Godfrey DA, Primrose JN, Pearce NW. Surgical management of benign and indeterminate hepatic lesions in the era of laparoscopic liver surgery. Dig Surg. 2011. 28(3):232-6. [Medline].

  9. Abdul-Al HM, Makhlouf HR, Goodman ZD. Expression of estrogen and progesterone receptors and inhibin-alpha in hepatobiliary cystadenoma: an immunohistochemical study. Virchows Arch. 2007 Jun. 450(6):691-7. [Medline].

  10. Baudin G, Novellas S, Buratti MS, et al. Atypical MRI features of a biliary cystadenoma revealed by jaundice. Clin Imaging. 2006 Nov-Dec. 30(6):413-5. [Medline].

  11. Catinis GE, Frey DJ, Skinner JW, Balart LA. Hepatic cystadenoma: an unusual presentation. Am J Gastroenterol. 1998 May. 93(5):827-9. [Medline].

  12. D'Errico A, Deleonardi G, Fiorentino M, Scoazec JY, Grigioni WF. Diagnostic implications of albumin messenger RNA detection and cytokeratin pattern in benign hepatic lesions and biliary cystadenocarcinoma. Diagn Mol Pathol. 1998 Dec. 7(6):289-94. [Medline].

  13. Dardik H, Glotzer P, Silver C. Congenital hepatic cyst causing jaundice: report of a case and analogies with respiratory malformation. Ann Surg. 1964 Apr. 159:585-92. [Medline].

  14. Franko J, Nussbaum ML, Morris JB. Choledochal cyst cholangiocarcinoma arising from adenoma: case report and a review of the literature. Curr Surg. 2006 Jul-Aug. 63(4):281-4. [Medline].

  15. Grayson W, Teare J, Myburgh JA, Paterson AC. Immunohistochemical demonstration of progesterone receptor in hepatobiliary cystadenoma with mesenchymal stroma. Histopathology. 1996 Nov. 29(5):461-3. [Medline].

  16. Horsmans Y, Laka A, Gigot JF, Geubel AP. Serum and cystic fluid CA 19-9 determinations as a diagnostic help in liver cysts of uncertain nature. Liver. 1996 Aug. 16(4):255-7. [Medline].

  17. Ishak KG, Willis GW, Cummins SD, Bullock AA. Biliary cystadenoma and cystadenocarcinoma: report of 14 cases and review of the literature. Cancer. 1977 Jan. 39(1):322-38. [Medline].

  18. Jenkins RL, Johnson LB, Lewis WD. Surgical approach to benign liver tumors. Semin Liver Dis. 1994 May. 14(2):178-89. [Medline].

  19. Kanamori H, Kawahara H, Oh S, et al. A case of biliary cystadenocarcinoma with recurrent jaundice. Diagnostic evaluation of computed tomography. Cancer. 1985 Jun 1. 55(11):2722-4. [Medline].

  20. Karahan OI, Kahriman G, Soyuer I, Ok E. Hepatic von Meyenburg complex simulating biliary cystadenocarcinoma. Clin Imaging. 2007 Jan-Feb. 31(1):50-3. [Medline].

  21. Koffron A, Rao S, Ferrario M, Abecassis M. Intrahepatic biliary cystadenoma: role of cyst fluid analysis and surgical management in the laparoscopic era. Surgery. 2004 Oct. 136(4):926-36. [Medline].

  22. Mills GC, Alperin JB, Trimmer KB. Studies on variant glucose-6-phosphate dehydrogenases: G6PD Fort Worth. Biochem Med. 1975 Jul. 13(3):264-75. [Medline].

  23. Ramacciato G, Nigri GR, D'Angelo F, et al. Emergency laparotomy for misdiagnosed biliary cystadenoma originating from caudate lobe. World J Surg Oncol. 2006 Nov 7. 4:76. [Medline].

  24. Sanchez H, Gagner M, Rossi RL, et al. Surgical management of nonparasitic cystic liver disease. Am J Surg. 1991 Jan. 161(1):113-8; discussion 118-9. [Medline].

  25. Shimada M, Takenaka K, Gion T, et al. Treatment strategy for patients with cystic lesions mimicking a liver tumor: a recent 10-year surgical experience in Japan. Arch Surg. 1998 Jun. 133(6):643-6. [Medline].

  26. Teoh AY, Ng SS, Lee KF, Lai PB. Biliary cystadenoma and other complicated cystic lesions of the liver: diagnostic and therapeutic challenges. World J Surg. 2006 Aug. 30(8):1560-6. [Medline].

  27. Terada T, Kitamura Y, Ohta T. Endocrine cells in hepatobiliary cystadenomas and cystadenocarcinomas. Virchows Arch. 1997 Jan. 430(1):37-40. [Medline].

  28. Wheeler DA, Edmondson HA. Cystadenoma with mesenchymal stroma (CMS) in the liver and bile ducts. A clinicopathologic study of 17 cases, 4 with malignant change. Cancer. 1985 Sep 15. 56(6):1434-45. [Medline].

  29. Woods GL. Biliary cystadenocarcinoma: Case report of hepatic malignancy originating in benign cystadenoma. Cancer. 1981 Jun 15. 47(12):2936-40. [Medline].

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