Editorial
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jun 21, 2008; 14(23): 3616-3620
Published online Jun 21, 2008. doi: 10.3748/wjg.14.3616
Cystic tumors of the liver: A practical approach
Paolo Del Poggio, Marco Buonocore
Paolo Del Poggio, Marco Buonocore, Hepatology Unit, Treviglio Hospital, Treviglio (Bg) 24047, Italy
Author contributions: Del Poggio P and Buonocore M wrote the paper and contributed equally to the work.
Correspondence to: Paolo Del Poggio, Hepatology Unit, Treviglio Hospital (Bg), Treviglio (Bg) 24047, Italy. pdpoggio@ospedale.treviglio.bg.it
Telephone: +39-036-3424494
Fax: +39-036-3424561
Received: March 13, 2008
Revised: April 22, 2008
Accepted: April 29, 2008
Published online: June 21, 2008
Abstract

Biliary cyst tumors (cystadenoma and cystadeno-carcinoma) are an indication for liver resection. They account for only 5% of all solitary cystic lesions of the liver, but differential diagnosis with multiloculated or complicated biliary cysts, atypical hemangiomas, hamartomas and lymphangiomas may be difficult. The most frequent challenge is to differentiate biliary cyst tumors from hemorrhagic cysts. Computerized tomography (CT) and magnetic resonance imaging (MRI) are often not diagnostic and in these cases fine needle aspiration (FNA) is used to confirm the presence of atypical biliary cells. FNA, however, lacks adequate sensitivity and specificity and should always be used in conjunction with imaging. Pre-operative differentiation of cystadenoma from cystadenocarcinoma is impossible and surgery must be performed if a biliary cyst tumor is suspected. When multiple cystic lesions are observed throughout the liver parenchyma, it is important to exclude liver metastasis, of which colonic cancer is the most common primary site. Multiple biliary hamartomas (von Meyenburg complex) can appear as a mixture of solid and cystic lesions and can be confused with cystic metastasis. Strong and uniform T2 hyperintensity on MRI is usually diagnostic, but occasionally a percutaneous biopsy may be required.

Keywords: Biliary cyst tumor; Liver cystic neoplasia; Cystadenoma; Cystadenocarcinoma; Atypical hepatic cysts