Complex Cystic Liver Lesions: Classification, Diagnosis, and Management

Overview

Journal Ann Gastroenterol

Specialty Gastroenterology

Date 2024 May 23

PMID 38779639

Authors

Evangelos G Baltagiannis

Athina Tsili

Anna Goussia

Anastasia Glantzouni

Konstantinos Frigkas

Antonia Charchanti

Georgios K Glantzounis

Ilias P Gomatos

Affiliations

Soon will be listed here.

Abstract

Cystic liver disease has been increasingly reported in the literature, with a prevalence as high as 15-18%. Hepatic cysts are usually discovered incidentally, while their characterization and classification rely on improved imaging modalities. Complex cystic liver lesions comprise a wide variety of novel, re-introduced, and re-classified clinical entities. This spectrum of disorders ranges from non-neoplastic conditions to benign and malignant tumors. Their clinicopathological features, prognostic factors, and oncogenic pathways are incompletely understood. Despite representing a heterogeneous group of disorders, they can have similar clinical and imaging characteristics. As a result, the diagnosis and management of complex liver cysts can become quite challenging. Furthermore, inappropriate diagnosis and management can lead to high morbidity and mortality. In this review, we aim to offer up-to-date insight into the diagnosis, classification, and management of the most common complex cystic liver lesions.

References

Williams D, Vitellas K, Sheafor D . Biliary cystadenocarcinoma: seven year follow-up and the role of MRI and MRCP. Magn Reson Imaging. 2002; 19(9):1203-8. DOI: 10.1016/s0730-725x(01)00453-2. View

Klompenhouwer A, Cate D, Willemssen F, Bramer W, Doukas M, de Man R . The impact of imaging on the surgical management of biliary cystadenomas and cystadenocarcinomas; a systematic review. HPB (Oxford). 2019; 21(10):1257-1267. DOI: 10.1016/j.hpb.2019.04.004. View

Wu C, Yeh Y, Tsuei Y, Huang L, Lin C, Liu C . Comparative radiological pathological study of biliary intraductal tubulopapillary neoplasm and biliary intraductal papillary mucinous neoplasm. Abdom Radiol (NY). 2017; 42(10):2460-2469. DOI: 10.1007/s00261-017-1167-7. View

Chen X, Cen C, Xie H, Zhou L, Wen H, Zheng S . The Comparison of 2 New Promising Weapons for the Treatment of Hydatid Cyst Disease: PAIR and Laparoscopic Therapy. Surg Laparosc Endosc Percutan Tech. 2015; 25(4):358-62. DOI: 10.1097/SLE.0000000000000177. View

Boyum J, Sheedy S, Graham R, Olson J, Babcock A, Bolan C . Hepatic Mucinous Cystic Neoplasm Versus Simple Biliary Cyst: Assessment of Distinguishing Imaging Features Using CT and MRI. AJR Am J Roentgenol. 2020; 216(2):403-411. DOI: 10.2214/AJR.20.22768. View

Strasberg S, Chapman W . Enucleation of Biliary Cystadenomas: a Review. J Gastrointest Surg. 2021; 25(10):2700-2706. DOI: 10.1007/s11605-021-05106-x. View

Langer J, Rose D, Keystone J, Taylor B, Langer B . Diagnosis and management of hydatid disease of the liver. A 15-year North American experience. Ann Surg. 1984; 199(4):412-7. PMC: 1353359. DOI: 10.1097/00000658-198404000-00007. View

Zurli L, Dembinski J, Robert B, Regimbeau J . Atypic large hepatic cyst with persistent elevated CA19.9 serum value: utility of intracystic CA72.4 dosage for a mini-invasive management. Clin J Gastroenterol. 2020; 14(1):258-262. DOI: 10.1007/s12328-020-01292-4. View

Marrero J, Ahn J, Reddy K . ACG clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol. 2014; 109(9):1328-47. DOI: 10.1038/ajg.2014.213. View

10.

Brunetti E, Junghanss T . Update on cystic hydatid disease. Curr Opin Infect Dis. 2009; 22(5):497-502. DOI: 10.1097/QCO.0b013e328330331c. View

11.

Park H, Kim S, Kim H, Lee S, Hong G, Byun J . Intraductal Papillary Neoplasm of the Bile Duct: Clinical, Imaging, and Pathologic Features. AJR Am J Roentgenol. 2018; 211(1):67-75. DOI: 10.2214/AJR.17.19261. View

12.

Vilgrain V, SILBERMANN O, Benhamou J, Nahum H . MR imaging in intracystic hemorrhage of simple hepatic cysts. Abdom Imaging. 1993; 18(2):164-7. DOI: 10.1007/BF00198056. View

13.

Wijnands T, Ronot M, Gevers T, Benzimra J, Schultze Kool L, Vilgrain V . Predictors of treatment response following aspiration sclerotherapy of hepatic cysts: an international pooled analysis of individual patient data. Eur Radiol. 2016; 27(2):741-748. PMC: 5209423. DOI: 10.1007/s00330-016-4363-x. View

14.

Kim K, Choi J, Park Y, Lee W, Kim B . Biliary cystadenoma of the liver. J Hepatobiliary Pancreat Surg. 1999; 5(3):348-52. DOI: 10.1007/s005340050058. View

15.

Ravinder P, Parija S, Rao K . Evaluation of human hydatid disease before and after surgery and chemotherapy by demonstration of hydatid antigens and antibodies in serum. J Med Microbiol. 1997; 46(10):859-64. DOI: 10.1099/00222615-46-10-859. View

16.

Konstadoulakis M, Gomatos I, Albanopoulos K, Alexakis N, Leandros E . Laparoscopic fenestration for the treatment of patients with severe adult polycystic liver disease. Am J Surg. 2005; 189(1):71-5. DOI: 10.1016/j.amjsurg.2004.03.011. View

17.

Gharbi H, Hassine W, Brauner M, Dupuch K . Ultrasound examination of the hydatic liver. Radiology. 1981; 139(2):459-63. DOI: 10.1148/radiology.139.2.7220891. View

18.

Kim H, Yu E, Byun J, Hong S, Kim K, Lee J . CT differentiation of mucin-producing cystic neoplasms of the liver from solitary bile duct cysts. AJR Am J Roentgenol. 2013; 202(1):83-91. DOI: 10.2214/AJR.12.9170. View

19.

Wheeler D, EDMONDSON H . Cystadenoma with mesenchymal stroma (CMS) in the liver and bile ducts. A clinicopathologic study of 17 cases, 4 with malignant change. Cancer. 1985; 56(6):1434-45. DOI: 10.1002/1097-0142(19850915)56:6<1434::aid-cncr2820560635>3.0.co;2-f. View

20.

Meddings L, Myers R, Hubbard J, Shaheen A, Laupland K, Dixon E . A population-based study of pyogenic liver abscesses in the United States: incidence, mortality, and temporal trends. Am J Gastroenterol. 2009; 105(1):117-24. DOI: 10.1038/ajg.2009.614. View