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Biliary cystadenoma

A biliary cystadenoma is an uncommon benign cystic neoplasm 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. Potential symptoms 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 (see extrahepatic biliary cystadenoma).

Histologically cystadenomas are composed of multiple cysts lined by cuboidal or columnar epithelium that resembles normal biliary epithelium 1.

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

At US, 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 (HU = 0) to quite hyperattenuating if the cyst has been complicated by recent hemorrhage.

Calcifications of septa or cyst wall may be seen. Additionally the septa may enhance following administration of contrast.

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 tumors, they may recur after excision and have potential to develop into biliary cystadenocarcinomas.

Differential diagnosis

General imaging differential considerations include other cystic liver lesions, including :

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