Biliary cystadenoma and other complicated cystic lesions of the liver: diagnostic and therapeutic challenges.
BACKGROUND
Biliary cystadenomas are complicated cystic lesions of the liver. They are rare and pose considerable diagnostic and therapeutic challenges.


METHODS
We present our experience managing these lesions by performing a retrospective review of all patients with a preoperative diagnosis of or histologically proven biliary cystadenoma who underwent surgery between January 1995 and January 2005 at our institution. Altogether, 20 patients (16 women, 4 men) with a mean age of 58 years underwent a total of 22 operations. The diagnosis of biliary cystadenoma was based on exclusion of other pathologic entities and the presence of radiologic characteristics of biliary cystadenoma. Abdominal ultrasonography (US), computed tomography, or both were performed in all patients. US-guided fine-needle aspiration cytology was performed in seven patients and all of them were negative for malignancy. A preoperative diagnosis of biliary cystadenoma was made in 16 patients based on clinical and radiologic features and was correct in 6 of them. Diagnosis of biliary cystadenoma was not suspected in four patients.


RESULTS
The overall diagnostic accuracy was 30%. Enucleation was the most common surgical procedure and was performed in 10 patients. The mean follow-up period was 5.5+/-2.8 years. No recurrence was detected in patients with confirmed biliary cystadenoma after adequate excision.


CONCLUSIONS
The findings of this study highlight the difficulty with preoperative diagnosis of biliary cystadenoma, which has seldom been discussed in the literature. Preoperative differentiation by means of radiologic imaging is inaccurate (30%). Any therapy short of complete excision leads to local recurrence and risk of malignant transformation. Complete excision of any suspicious lesion remains the best method of diagnosis and treatment.
Teoh
Anthony Y B
AY
Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
Ng
Simon S M
SS
Lee
K F
KF
Lai
Paul B S
PB
D000231:Adenocarcinoma, Papillary / Q000175:diagnosis / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000175:diagnosis / Q000601:surgery; D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary / Q000601:surgery; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000601:surgery; D003536:Cystadenocarcinoma / Q000175:diagnosis / Q000601:surgery; D003537:Cystadenoma / Q000175:diagnosis* / Q000601:surgery; D003560:Cysts / Q000175:diagnosis / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008100:Liver Abscess / Q000175:diagnosis / Q000601:surgery; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D014386:Tuberculosis, Hepatic / Q000175:diagnosis / Q000601:surgery