Medical Care
No medical treatment has been found to be effective for the 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:
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Oncologist
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Hepatobiliary surgeon
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Interventional radiologist
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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.
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. [10] Note the following:
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A complete lobectomy is sometimes necessary for larger lesions or in the presence of adenocarcinoma.
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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. [11] According to the 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. [12]
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]
