Biliary Cystadenomas: A Case for Complete Resection

Abstract

Introduction and Objective. Biliary cystadenoma is a rare benign neoplasm of the liver with less than 200 cases being reported allover the world. We report a series of 13 cases highlighting the radiological findings and problems related to its management. Materials and Methods. Records of thirteen patients who underwent surgery for biliary cystadenomas, between March 2006 and October 2011, were reviewed retrospectively. Results. Majority of the patients were females (11 out of 13), with a median age of 46 (23–65) years. The most frequent symptom was abdominal pain (92%). Seven patients had presented with history of previous surgery for liver lesions. Five patients had presented with recurrence after partial resection for a suspected hydatid cyst and two after surgery for presumed simple liver cyst. Ten of the 13 patients had complete resection of the cyst with enucleation in 3 patients, 2 of whom in addition required T-tube drainage of the bile duct. There has been no recurrence during the follow-up period ranging from 3 months to 5 years. Conclusion. Biliary cystadenoma must be differentiated from other benign cysts. Hepatic resection or cyst enucleation is the recommended treatment option.

Cystic Neoplasms of the Liver: Biliary Cystadenoma and Cystadenocarcinoma

“…Many patients with BCT will be asymptomatic; other patients with BCT can present with non-specific symptoms, most commonly abdominal pain and distention (55-90%). (3, 7, 11, 17, 18, 23) While laboratory values are normal in most patients, approximately 20% of patients present with elevated liver function tests such as an abnormal bilirubin level. (19, 24) Obstructive jaundice and cholangitis are rare and do not correlate with malignant disease and typically occur with extrahepatic BCT.…”

“…(34, 36) Some authors now advocate classifying BCT with biliary tree communication and no ovarian stroma as biliary IPMNs. (23, 35-37) In one study, Zen et al (35) identified 9 cases of BCT noting 5 tumors with direct communication to the biliary tree. None of these 5 cases contained ovarian-like stroma and all had different clinicopathologic characteristics than BCT.…”

“…Mural nodule, and irregular cyst wall thickness on CT may suggest a higher likelihood of malignancy, but these features are not pathognomonic for BCAC. (17, 23, 43, 52, 63) Wang and colleagues (9) proposed a novel scoring system using age, gender, duration of symptoms, and lesion location to differentiate BCA and BCAC. The authors validated this scoring system using two separate patient cohorts and demonstrated over a 90% sensitivity and specificity.…”

“…(7, 8, 56) Because of this risk, along with the low likelihood of identifying malignant cells, routine FNA and core needle biopsy of suspected BCT should generally be avoided. (23, 65, 66)…”

Increased survivin expression and its association with clinical parameters of congenital choledochal cysts

“…A possible explanation for these observations may be that the apoptotic rate of epithelial cells has been shown to be positively correlated with the degree of duct damage, highlighting the essential role of cell apoptosis and relevant markers thereof in the progression of this disease. Cystic-shaped CCCs are characterized by relatively large sizes and thick cyst walls, with moderate to large numbers of elastic and reticular fibers (Ahanatha Pillai et al, 2012). In contrast, fusiform-shaped CCCs are relatively smaller and have thinner walls without elastic or reticular fibers (De and Basu, 2007).…”