Hepatic Cystadenomas Treatment & Management

  • Author: Krishan Ariyarathna, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Jan 4, 2012
 

Medical Care

  • No medical treatment has been found to be effective.
  • Discontinuing hormonal treatment until the estrogen/progesterone receptor studies are completed is prudent.
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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.
    • 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.[5] 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.
  • 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.[6]
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Consultations

Oncologist

Hepatobiliary surgeon

Interventional radiologist

Interventional gastroenterologist

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Diet

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

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Activity

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

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

Specialty Editor Board

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.

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

Disclosure: Medscape Salary Employment

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.

Alex J Mechaber, MD, FACP  Senior 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

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 & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine 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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