History
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 the compression of a neighboring organ may be noted. Presenting symptoms depend on the size and the location of the lesion. [2] The final diagnosis is made after surgical resection. Note the following:
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Roughly 15% of patients present with small intrahepatic lesions, which are usually asymptomatic and discovered incidentally after screening ultrasonography.
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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.
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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:
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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.
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Jaundice suggests obstruction of the biliary system. Rare extension of the lesion in a pedunculated fashion inside the biliary system has been described.
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Obstruction of the inferior vena cava may cause marked lower-extremity edema.
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In the rare occurrence of intraperitoneal rupture of the lesion, the patient may have signs typical of acute peritonitis.
