Biliary cystadenoma
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Biliary cystadenomas are uncommon benign cystic neoplasms of the liver.
Epidemiology
Biliary cystadenomas occur predominantly in middle-aged patients and are more common in women 1.
Clinical presentation
The clinical presentation of biliary cystadenomas is variable, depending on the size and location of the tumour. Symptoms and signs may include 1:
- right upper quadrant pain
- obstructive jaundice
- palpable liver edge or mass
- increasing abdominal girth (large tumours)
- nausea and vomiting
Pathology
Biliary cystadenomas are cystic neoplasms that may be either unilocular or multilocular. Only rarely are they found in the extrahepatic biliary tree and gallbladder.
HistologicallyThe criteria for cystadenomas are composed of multiple include 1,6
- cysts lined by cuboidal or columnar epithelium that resembles normal biliary epithelium
1. - usually no communication with the bile ducts
- variable amount of mucin-producing epithelium
- associated with ovarian-type subepithelial stroma
Radiographic features
Biliary cystadenomas range in size from 3 to 40 cm and can be either unilocular or multilocular. Unfortunately, there are no specific imaging features that permit reliable differentiation of biliary cystadenoma from biliary cystadenocarcinoma.
Ultrasound
A biliary cystadenoma appears as a unilocular or multilocular cyst with enhanced through transmission. The content of the cysts may range from completely anechoic to having low-level echoes from blood products, mucin, or proteinaceous fluid.
Mural nodules and papillary projections may project into the cyst lumen. If septal or wall calcification is present then acoustic shadowing may be seen.
CT
As is the case with ultrasound, the appearance of the cyst fluid on CT is variable depending on its composition. It can range from that of water (0 HU) to quite hyperattenuating if the cyst has been complicated by recent haemorrhage.
Calcifications of septa or cyst wall may be seen. Additionally, the septa may enhance following administration of contrast.
Focal upstream bile duct dilatation and perilesional THAD are described features associated with cystadenomas due to their mass effect over the bile ducts and portal venous flow (cf. hepatic cysts) 5.
MRI
The MR signal intensity of biliary cystadenoma is variable on both T1- and T2-weighted images, depending on the content of the cyst fluid.
Treatment and prognosis
Although biliary cystadenomas are benign tumours, they may recur after excision and have the potential for malignant degeneration into biliary cystadenocarcinomas.
Differential diagnosis
General imaging differential considerations include other cystic liver lesions, including:
-</ul><h4>Pathology</h4><p>Biliary cystadenomas are cystic neoplasms that may be either unilocular or multilocular. Only rarely are they found in the extrahepatic biliary tree and gallbladder.</p><p>Histologically cystadenomas are composed of multiple cysts lined by cuboidal or columnar epithelium that resembles normal biliary epithelium <sup>1</sup>.</p><h4>Radiographic features</h4><p>Biliary cystadenomas range in size from 3 to 40 cm and can be either unilocular or multilocular. Unfortunately, there are no specific imaging features that permit reliable differentiation of biliary cystadenoma from <a href="/articles/biliary-cystadenocarcinoma">biliary cystadenocarcinoma</a>.</p><h5>Ultrasound</h5><p>A biliary cystadenoma appears as a unilocular or multilocular cyst with enhanced through transmission. The content of the cysts may range from completely anechoic to having low-level echoes from blood products, mucin, or proteinaceous fluid.</p><p>Mural nodules and papillary projections may project into the cyst lumen. If septal or wall calcification is present then acoustic shadowing may be seen.</p><h5>CT</h5><p>As is the case with ultrasound, the appearance of the cyst fluid on CT is variable depending on its composition. It can range from that of water (0 HU) to quite hyperattenuating if the cyst has been complicated by recent haemorrhage.</p><p>Calcifications of septa or cyst wall may be seen. Additionally, the septa may enhance following administration of contrast.</p><p>Focal upstream bile duct dilatation and perilesional <a title="THAD" href="/articles/transient-hepatic-attenuation-differences">THAD</a> are described features associated with cystadenomas due to their mass effect over the bile ducts and portal venous flow (cf. <a title="Hepatic cysts" href="/articles/simple-hepatic-cyst">hepatic cysts</a>) <sup>5</sup>. </p><h5>MRI</h5><p>The MR signal intensity of biliary cystadenoma is variable on both T1- and T2-weighted images, depending on the content of the cyst fluid.</p><h4>Treatment and prognosis</h4><p>Although biliary cystadenomas are benign tumours, they may recur after excision and have the potential for malignant degeneration into <a href="/articles/biliary-cystadenocarcinoma">biliary cystadenocarcinomas</a>.</p><h4>Differential diagnosis</h4><p>General imaging differential considerations include other <a href="/articles/cystic-lesions-of-the-liver-differential">cystic liver lesions</a>, including:</p><ul>- +</ul><h4>Pathology</h4><p>Biliary cystadenomas are cystic neoplasms that may be either unilocular or multilocular. Only rarely are they found in the extrahepatic biliary tree and gallbladder.</p><p>The criteria for cystadenomas include <sup>1,6</sup></p><ul>
- +<li>cysts lined by cuboidal or columnar epithelium that resembles normal biliary epithelium</li>
- +<li>usually no communication with the bile ducts</li>
- +<li>variable amount of mucin-producing epithelium</li>
- +<li>associated with ovarian-type subepithelial stroma</li>
- +</ul><h4>Radiographic features</h4><p>Biliary cystadenomas range in size from 3 to 40 cm and can be either unilocular or multilocular. Unfortunately, there are no specific imaging features that permit reliable differentiation of biliary cystadenoma from <a href="/articles/biliary-cystadenocarcinoma">biliary cystadenocarcinoma</a>.</p><h5>Ultrasound</h5><p>A biliary cystadenoma appears as a unilocular or multilocular cyst with enhanced through transmission. The content of the cysts may range from completely anechoic to having low-level echoes from blood products, mucin, or proteinaceous fluid.</p><p>Mural nodules and papillary projections may project into the cyst lumen. If septal or wall calcification is present then acoustic shadowing may be seen.</p><h5>CT</h5><p>As is the case with ultrasound, the appearance of the cyst fluid on CT is variable depending on its composition. It can range from that of water (0 HU) to quite hyperattenuating if the cyst has been complicated by recent haemorrhage.</p><p>Calcifications of septa or cyst wall may be seen. Additionally, the septa may enhance following administration of contrast.</p><p>Focal upstream bile duct dilatation and perilesional <a href="/articles/transient-hepatic-attenuation-differences">THAD</a> are described features associated with cystadenomas due to their mass effect over the bile ducts and portal venous flow (cf. <a href="/articles/simple-hepatic-cyst">hepatic cysts</a>) <sup>5</sup>. </p><h5>MRI</h5><p>The MR signal intensity of biliary cystadenoma is variable on both T1- and T2-weighted images, depending on the content of the cyst fluid.</p><h4>Treatment and prognosis</h4><p>Although biliary cystadenomas are benign tumours, they may recur after excision and have the potential for malignant degeneration into <a href="/articles/biliary-cystadenocarcinoma">biliary cystadenocarcinomas</a>.</p><h4>Differential diagnosis</h4><p>General imaging differential considerations include other <a href="/articles/cystic-lesions-of-the-liver-differential">cystic liver lesions</a>, including:</p><ul>
- +<li><a href="/articles/hepatic-cyst">hepatic cyst</a></li>
- +<li><a href="/articles/ipmn-of-the-bile-ducts">IPMN of the bile ducts</a></li>
-<li><a href="/articles/hepatic-cyst">hepatic cyst</a></li>
References changed:
- 6. Zen Y, Pedica F, Patcha VR, Capelli P, Zamboni G, Casaril A, Quaglia A, Nakanuma Y, Heaton N, Portmann B. Mucinous cystic neoplasms of the liver: a clinicopathological study and comparison with intraductal papillary neoplasms of the bile duct. (2011) Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc. 24 (8): 1079-89. <a href="https://doi.org/10.1038/modpathol.2011.71">doi:10.1038/modpathol.2011.71</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/21516077">Pubmed</a> <span class="ref_v4"></span>
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