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Hepatic Cystadenomas Treatment & Management

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

Medical Care

No medical treatment has been found to be effective for management of hepatic cystadenomas.

Discontinuing hormonal treatment until the estrogen/progesterone receptor studies are completed is prudent.

Consultations

Consult with the following specialists for treatment recommendations and procedures in patients with hepatic cystadenomas:

  • Oncologist
  • Hepatobiliary surgeon
  • Interventional radiologist
  • Interventional gastroenterologist

Dietary and activity considerations

No specific diet is recommended. In the presence of biliary obstruction, deficiency of fat-soluble vitamins should be corrected.

Activity is usually not restricted. However, after surgical intervention, standard precautions as in other abdominal surgery should be taken.

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Surgical Care

The treatment of choice for hepatic cystadenomas is surgical resection. Complete resection of the tumor is imperative to avoid local recurrence and malignant transformation. Note the following:

  • A complete lobectomy is sometimes necessary for larger lesions or in the presence of adenocarcinoma.
  • For smaller lesions, enucleation alone can usually be accomplished with preservation of the remaining hepatic parenchyma unless the tumor is in a central location close to the hepatic hilum. Enucleation is possible because cystadenomas have a thick fibrous capsule that can be dissected bluntly without major bleeding or biliary leak.

Surgical mortality is not higher than mortality associated with a corresponding hepatic resection or lobectomy.

Liver transplantation may be necessary in the rare occurrence of extensive bilobar extension of the tumor.

In a study of 51 patients, Gamblin et al investigated the efficacy of laparoscopic resection of symptomatic hepatic cysts.[7] According to histologic examination, 90% of the lesions in the study were simple cysts, and 10% were cystadenomas. All patients who were operated on for pain experienced symptom relief. According to the authors, the study's results support a routine laparoscopic approach to the treatment of benign symptomatic cysts. They concluded that traditional surgical measures should be reserved for cases of expected malignancy or for those in which laparoscopy is contraindicated or the cyst recurs following laparoscopic treatment.

Abu Hilal et al also concluded that the laparoscopic approach represents a safe option for the management of benign and indeterminate liver lesions, even when major hepatectomy is required.[8]

Outpatient follow-up

No further outpatient care is indicated routinely after complete surgical resection. However, because local recurrence of a cystadenoma with progression to cellular atypia and, ultimately, carcinoma has been described, regular postoperative follow-up is indicated. Follow-up is conducted best by performing abdominal US or CT scan at 6-month intervals for the first postoperative year and then annually.[1]

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Contributor Information and Disclosures
Author

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.

Acknowledgements

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.

References
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