Diagnosis

Hepatic cyst

Etiology

Cystic hepatic lesions range from benign lesions to malignant and potentially lethal conditions [dtf]. Less than 4% of hepatic cysts are symptomatic, but larger cysts, especially those greater than 5 cm, have a higher association with symptomatic manifestation [nzq].

Clinical classification [ka6]

• Infectious:

  • Parasitic: Hydatid/echinococcal cysts, Amoebic abscess

  • Non-parasitic: Pyogenic abscess, Fungal microabscess

• Non-infectious:

  • Benign:

    • Simple liver cysts (most common) are congenital originating from biliary ducts that do not connect to the biliary system

    • Polycystic liver disease

    • Bile duct hamartoma

    • Caroli disease

    • Cavernous hemangioma

    • Intrahepatic pseudocyst

  • Premalignant:

    • Biliary cystadenoma: female:male-ratio: 9:1

    • Intraductal papillary neoplasm of bile duct

    • Caroli disease

    • Bile duct hamaartomas

  • Malignant:

    • Biliary cystadenoma / cystadenocarcinoma

    • Cystic HCC

    • Cystic liver metastasis

    • Undifferentiated embryonal sarcoma / carcinoma

  • Traumatic:

    • Biloma

    • Seroma

    • Hematoma

Complications [4y8]

• Hemorrhage

• Rupture

• Bile duct torsion

• Infection,

• Compression of the biliary tree

• Malignant transformation

• Anaphylactic shock (hydatid cyst)

• Budd-Chiari syndrome

• Inferior vena cava thrombus

• Liver failure

Epidemiology

Incidence per 100.000 [rss][ka6]

Prevalence per 100.000 [rss][ka6]

Approach

• Blood test: GGT, CEA, CA 19-9

• Abdominal x-ray

• Altrasound abdomen

• CT abdomen

• MRI abdomen

• Biopsy

• FNA

• Serelogy

Treatment

1. Asymptomatic simple cyst do not require intervention other than regular follow up [4y8]

2. Symptomatic benign cyst (hemorrhage, rupture, infection, bile obstruction): [ka6]

   • Fenestration

   • Aspiration sclerotherapy: tetracycline, ethanol, or ethanolamine

   • Surgical resection:

     • Cyst excision

     • Liver resection

     • Liver transplantation

3. Echinococcal cyst: Liver resection

4. Biliary cystadenoma: Cyst enucleation, liver resection, ablation

5. Biliary cystadenocarcinoma: Radical resection with a wide (> 2 cm) surgical margin

6. Polycystic liver disease:

   • Pharmacotherapy: Somatostatin receptor antagonist, mTOR inhibitor, estrogen receptor antagonists, vasopressin receptor antagonists

   • Surgery: Cyst aspiration with sclerosis, open or laparoscopic cyst fenestration, combined hepatic resection and fenestration, transarterial embolization and liver transplantation

Differential diagnoses

Benign liver tumor, Caroli disease, Cholangiocarcinoma, Hamartoma, Hemangioma, Hematoma, Hepatocellular carcinoma, Liver abscess, Polycystic kidney disease, Sarcoma