title: The management of hepatobiliary cystadenomas: lessons learned.
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.
authors: Liver and Pancreas Unit, Division of General Surgery, Gastrointestinal Pathology Section, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
authors: Guillaume
authors: G
authors: Martel
authors: Jamal
authors: J
authors: Alsharif
authors: Jean-Michel
authors: JM
authors: Aubin
authors: Celia
authors: C
authors: Marginean
authors: Richard
authors: R
authors: Mimeault
authors: Robert J
authors: RJ
authors: Fairfull-Smith
authors: Waleed M
authors: WM
authors: Mohammad
authors: Fady K
authors: FK
authors: Balaa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018291:Cystadenoma, Mucinous / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome