The management of hepatobiliary cystadenomas: lessons learned. Issue 8 (6th December 2012) - Martel, Guillaume
Abstract: Background: Mucinous cystic neoplasms of the liver (hepatobiliary cystadenomas) are rare neoplastic lesions. Such cysts are often incorrectly diagnosed and managed, and carry a risk of malignancy. The objective of this study was to review the surgical experience with these lesions over 15 years. Methods: A retrospective chart review identified consecutive patients undergoing surgery for liver cystadenomas from 1997–2011. Clinical data were collected and summarized. Results: Thirteen patients (mean age 51 years, 12/13 females) with cysts 4.6–18.1 cm were identified. Most cysts were located in the left lobe/centrally (11/12) and had septations (8/13). Mural nodularity was infrequent (3/13). Nine patients had liver resection/enucleation, whereas four had unroofing. Frozen section analysis had a high false‐negative rate (4/6). All patients had cystadenomas, of which two had foci of invasive carcinoma (cystadenocarcinoma) within mural nodules. There was no 90‐day mortality. All but one patient (myocardial infarction) were alive at a median follow‐up of 23.1 months. No patient with unroofing has developed malignancy to date. Conclusions: Non‐invasive hepatobiliary cystadenomas present as large central/left‐sided cysts in young or middle‐aged women. Associated malignancy was relatively uncommon and found within mural nodules. Intra‐operative frozen section analysis was ineffective at ruling out cystadenomas. Complete excision is recommended, but close follow‐up might be considered in patients with a prohibitive technical or medical risk, in the absence of nodularity on high‐quality imaging.