eMedicine Specialties > Gastroenterology > Liver

Hepatic Cystadenomas: Treatment & Medication

Author: Krishan Ariyarathna, MD, Staff Physician, Department of Internal Medicine, Creighton University Medical Center
Coauthor(s): 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
Contributor Information and Disclosures

Updated: Nov 11, 2009

Treatment

Medical Care

  • No medical treatment has been found to be effective.
  • Discontinuing hormonal treatment until the estrogen/progesterone receptor studies are completed is prudent.

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.
    • 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.4 According to histologic examination, 90% of the lesions in the study were simple cysts, and 10% of them 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.

Consultations

Oncologist

Hepatobiliary surgeon

Interventional radiologist

Interventional gastroenterologist

Diet

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

Activity

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

More on Hepatic Cystadenomas

Overview: Hepatic Cystadenomas
Differential Diagnoses & Workup: Hepatic Cystadenomas
Treatment & Medication: Hepatic Cystadenomas
Follow-up: Hepatic Cystadenomas
References
Further Reading
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References

  1. Fukunaga N, Ishikawa M, Ishikura H, Ichimori T, Kimura S, Sakata A, et al. Hepatobiliary cystadenoma exhibiting morphologic changes from simple hepatic cyst shown by 11-year follow up imagings. World J Surg Oncol. Dec 11 2008;6:129. [Medline].

  2. Choi HK, Lee JK, Lee KH, Lee KT, Rhee JC, Kim KH, et al. Differential Diagnosis for Intrahepatic Biliary Cystadenoma and Hepatic Simple Cyst: Significance of Cystic Fluid Analysis and Radiologic Findings. J Clin Gastroenterol. Sep 18 2009;[Medline].

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

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

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

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

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

  8. 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. Dec 1998;7(6):289-94. [Medline].

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

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

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

  12. 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. Aug 1996;16(4):255-7. [Medline].

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

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

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

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

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

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

  19. Ramacciato G, Nigri GR, D'Angelo F, Aurello P, Bellagamba R, Colarossi C, et al. Emergency laparotomy for misdiagnosed biliary cystadenoma originating from caudate lobe. World J Surg Oncol. 2006;4:76. [Medline].

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

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

  22. 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. Aug 2006;30(8):1560-6. [Medline].

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

  24. 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. Sep 15 1985;56(6):1434-45. [Medline].

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

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Further Reading

Clinical guideline

ACR Appropriateness Criteria® liver lesion characterization.
American College of Radiology - Medical Specialty Society. 1998 (revised 2006). 7 pages. NGC:005115


Clinical trial

Evaluation of Intra-operative Ultrasound Contrast Enhancement in the Evaluation of Liver Tumors


Related eMedicine topics
Biliary Cystadenoma/Cystadenocarcinoma

Cholangitis

Hepatic Cysts

Liver, Metastases

Bile Duct Tumors

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Keywords

hepatic cystadenoma, liver cyst, liver cysts, hepatic cyst, hepatic cysts, cyst on liver, cysts on liver, hepatic lesion, hepatic lesions, liver cyst symptoms, biliary cystadenoma, multilocular cystic tumor, cystic tumor, liver tumor, liver adenoma, liver cystadenoma, liver lesion, benign tumor, hepatic tumor

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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 and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

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: Nothing to disclose.

Medical Editor

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, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing 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, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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