Management Strategies of Major Hepatobiliary Cysts - A Retrospective Study of 145 Consecutive Patients (original) (raw)

Management and long-term follow-up of hepatic cysts

The American Journal of Surgery, 2001

To provide an algorithm for the management of hepatic cysts through an analysis of our series over 16 years. Method: We reviewed the surgical management and outcome of patients with hepatic cysts between 1984 and 2000 at a single institution. Data were collected by chart review, telephone interview, and follow-up hepatic ultrasonography. Results: Forty-four patients (36 females, 8 males) underwent a total of 46 operations for hepatic cysts (mean size 12.0 Ϯ 5.2 cm) with a mean follow-up of 5.1 Ϯ 4.0 years. We treated 28 simple cysts, 4 polycystic liver disease (PCLD), 7 cystadenomas, 2 hydatid cysts, 1 cystadenocarcinoma, 1 endometrioma, and 1 hepatic foregut cyst. Operations included simple drainage, wide unroofing (open and laparoscopic), and hepatic resection. Four patients experienced a symptomatic recurrence after definitive treatment; 3 of these patients had PCLD. Four of the 7 patients with cystadenomas had undergone previous operations that required subsequent definitive resection without a recurrence. Conclusions: The preoperative distinction between simple cysts and cystadenomas/cystadenocarcinomas can be difficult, yet the management is different. Unroofing is a safe and effective operation for patients with simple cysts. Patients with PCLD frequently have recurrences. Cystadenomas should be completely resected owing to the likelihood of recurrence after partial excision and the risk of eventual cystadenocarcinoma. We present a treatment algorithm for the preoperative evaluation and management of hepatic cysts based on the largest number of patients with the longest follow-up reported to date.

Cystic lesions in the liver: benign or malignant?

Acta chirurgica Belgica

A 65-year old patient is presented with an ultrasound showing multiple cysts in liver and both kidneys. Computed tomography scan (CT-scan) showed a cyst in the right liver lobe with a largest diameter of 12 cm, suspicious for cystadenocarcinoma. Further staging showed no extrahepatic metastasis. Considering possible malignancy, aspiration of the cyst was not an option because of the risk for ent-metastasis. Resection of the tumour was considered as the best treatment. Peroperatively the cyst was localized with ultrasound, after which an extended right hepatectomy was performed. No peroperative complications occurred. Histological diagnosis was a cyst, originating in dilated von Meyenburg complexes. No signs of a biliary cystadenoma or malignant deformation were observed. A CT-scan 1 year postoperatively showed some other small cysts in the left liver lobe, the patient was free of any complaints. The differential diagnosis in cases of asymptomatic liver cysts will be discussed.

CYSTIC LIVER LESIONS: A COMPREHENSIVE REVIEW (Atena Editora)

CYSTIC LIVER LESIONS: A COMPREHENSIVE REVIEW (Atena Editora), 2022

Introduction: Cystic lesions of the liver (LCF) are frequent findings in clinical practice and have an asymptomatic course in most cases. However, there is diagnostic diversity. Advances in imaging methods such as ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) have allowed greater assertiveness, which allows the surgeon to establish an appropriate therapeutic approach. Objective: To review the literature and compile the concordance of characteristics in the diagnosis of LCF. Method: Bibliographic review of digital databases and physical literature from the last decades. Results: The Simple Hepatic Cyst is a formation with fluid content and can reach up to 1% of incidence in necropsies. On US, an anechoic, unilocular, fluid-filled area with no visible walls is observed. On CT, the lesion is well-defined, filled with fluid with water-like attenuation. It was verified that the Polycystic Liver Disease, an autosomal dominant disease, frequents 40% of the diagnoses of LCF. The characteristic on CT is multiple, homogeneous, hypoattenuated lesions with regular contours. Hydatid cysts have the liver as the main site, causing LCF in 52% to 77% of cases. They are caused by infection with E. granulosus. On CT, well-defined hypoattenuating lesions with wall calcification are found. Hepatobiliary cystadenoma is a rare LCF considered to be neoplastic, with an incidence of around 5%. Malignancy can be seen in 5 to 15% of cases. On CT, a uni or multilocular hypoattenuating mass with septations is found. Caroli's Disease also known as congenital ectatic cavernous communication of the biliary tract characterized by saccular dilatation of the intrahepatic ducts, multiple calculi; has an incidence of 1 in 1,000,000. On CT, dilated and hypoattenuated cystic structures are observed. Corresponding to a small part of the LCF there are also the Traumatic Cysts. As the nomenclature says, they occur after trauma that leads to the disjunction of the bile ducts or the formation of subcapsular hematoma. On CT, lacerations and/or hematomas with low parenchymal attenuation are found. Conclusion: LCFs have different characteristics from each other. The diagnosis depends on armed propaedeutics and, the more accurate it is, the more effective treatment will be possible.

Pattern of liver cysts with their surgical management

International Journal of Research in Medical Sciences, 2022

Background: Liver cysts are seen in up to 5% of the population. 15-16% of such cysts are symptomatic. Symptomatic cysts are found more commonly in women who are over 50 years of age. Simple hepatic cysts are believed to be congenital in origin. Methods: The observational study was conducted in the department of hepatobiliary department of surgery of

Case Report of Large Simple Hepatic cyst

IOSR Journals , 2019

Most liver cysts are benign, even though early diagnosis plays vital role for proper treatment of parasitic or cancerous subtypes. Simple hepatic cysts may be isolated or multiple and may vary from a few millimeters to several centimeters in diameter. Giant cysts of the liver are uncommon. A 60 years female patient was malnourished and pale. Vitals were stable. On per abdomen examination, a mass felt in right hypochondria region extended up to right lumbar region associated with tenderness, firm in consistency. On percussion it was dull. CT scan revealed a large hypodense lesion in segment VI & VII completely replacing and compressing the right lobe of liver, measuring approximately 21 X 13 cm. No evidence of obvious calcifications. During surgery, large hepatic cyst was noted involving right lobe and left lobe of liver and right dome of diaphragm. Falciparum ligament appears thinner than usual. From this hepatic cyst 2.5 liters of fluid was drained out. Histopathological findings noted were cyst wall showing fibrous tissue, lymphocytes, small ducts lined by cuboidal epithelium and few hepatocytes attached to cyst wall suggestive of simple hepatic cyst. Accurate diagnosis will help for prompt management. Even though most of the hepatic cysts are benign, better to undergo investigations such as CT, Histopathology examination to rule out differential diagnosis and to alleviate any further complications.

Management of Nonparasitic Hepatic Cysts

Journal of the American College of Surgeons, 2009

BACKGROUND: The optimal management of nonparasitic hepatic cysts (NPHC) is a topic of debate. The purpose of this study was to evaluate our 17-year experience with NPHC. STUDY DESIGN: From consecutive patients with NPHC were evaluated and treated at our institution. Seventy-eight patients (60%) had simple hepatic cysts (SHC). The remaining 53 (40%) had polycystic liver disease (PLD). Morbidity, mortality, and recurrence rates for each of the two groups were evaluated.

A cystic hepatic lesion: when to worry?

The West Indian medical journal, 2010

A 16-year old female presented to hospital with abdominal pain. Features on computed tomography raised the possibility of biliary cystadenoma or cystadenocarcinoma. She underwent a liver resection, and histopathology confirmed a serous biliary cystadenoma. This case is presented to highlight the radiological features of this uncommon pre-malignant condition as well as to summarize a management algorithm for cystic liver lesions.

Complications arising in simple and polycystic liver cysts

2012

Liver cysts are common, affecting 5%-10% of the population. Most are asymptomatic, however 5% of patients develop symptoms, sometimes due to complications and will require intervention. There is no consensus on their management because complications are so uncommon. The aim of this study was to perform a collected review of how a series of complications were managed at our institutions. Six different patients presenting with rare complications of liver cysts were obtained from Hepatobiliary Units in the United Kingdom and The Netherlands. History and radiological imaging were obtained from case notes and computerised radiology. As a result, 1 patient admitted with inferior vena