Solitary cystic lesions of the liver: Its diagnosis and Treatment

Suh, Kyung Suk; Roh, Hye Rin; Lee, Hyuk Joon; Kim, Sun Whe; Kim, Sang Joon; Park, Yong Hyun; Lee, Kuhn Uk

Abstract

BACKGROUND/AIMS: With the advances in imaging modalities, the incidental diagnoses of solitary cystic lesions of the liver are increasing. The aim of this study is to establish the strategy of differential diagnosis and treatment in the patients with solitary cystic lesions of the liver
METHODS
Forty three solitary cystic lesions of the liver treated surgically at Seoul National University Hospital from January 1981 to December 1998 were reviewed retrospectively. The clinicopathologic features, postoperative courses and their long-term results were analysed.
RESULTS
There were fifteen congenital nonparasitic cysts (simple cysts), 3 Caroli's diseases, 4 hydatid cysts, 2 traumatic cysts, 1 cystic hamartoma, 10 biliary cystadenomas, and 8 biliary cystadenocarcinomas. Twenty six hepatic resections, 12 excisions, 3 marsupializations, 1 cystojejunostomy, and 1 cystic wall biopsy were performed. There were 4 biliary leakages and 2 intraabdominal abscesses after surgery, and three out of them resulted from the communications with the biliary trees. Cystic fluid analysis or radiologic study could not offer the accurate diagonosis. Two patients who had biliary cystadenoma and biliary cystadenocarcinoma, respectively, and underwent marsupializations with preoperative misdiagnosis of simple cyst resulted in death due to recurrent tumors.
CONCLUSION
In exploring every case of solitary cystic lesion of the liver, presence of biliary communication and cystic malignancy should be considered unless simple cyst is highly suggested.