Liver Cysts: Cystic Neoplasms Flashcards
How common are cystic neoplasms?
True cystic neoplasms of the liver are rare and account for <5% of liver cysts.
What are the most common types of cystic neoplasms?
Most common subtype are cystadenomas (non-invasive mucinous cystic neoplasms). These are premalignant lesions, developing as a result of abnormal proliferation of biliary epithelium and can undergo malignant transformation into cystadenocarcinomas in around 10% of cases.
What are the clinical features of cystic neoplasms?
As with other hepatic cysts, patients are commonly asymptomatic. Cystic neoplasms grow slowly, typically 1-2mm per year and if symptoms do develop, they may do so insidiously.
For symptomatic individuals, common symptoms include abdominal pain and anorexia, as well as more vague symptoms of nausea, fullness, and bloating.
What investigations should be ordered for cystic neoplasms?
LFTs are often normal, although ALP, CEA, and CA19-9 can all become mildly elevated. Ultrasound scanning will often be able to differentiate between simple cysts and more complicated cystic lesions.
CT imaging with contrast should be performed on all patients in whom a cystic neoplasm is suspected for further delineation +/- evidence of metastasis.
Aspiration or biopsy should be avoided if a cystic neoplasm is suspected as this can result in potential peritoneal seeding of the malignancy.
What features on liver cysts that can suggest a sinister pathology?
- Suspicious for malignancy: (1) septations (2) wall enhancement (3) nodularity
- Suspicious for abscess: (1) debris within the lesion (2) Loculation (may also suggest malignancy)
- Suspicious for hydatid cyst: (1) Calcification (2) “Daughter cysts” around the main lesion
Briefly describe the management of cystic neoplasms
Liver lobe resection is the treatment of choice for both cystadenomas and cystadenocarcinomas, with the samples only then sent for histopathology to confirm the diagnosis.
