Biliary cystadenocarcinoma

Last revised by Jeremy Jones on 20 Sep 2021

Biliary cystadenocarcinomas are rare cystic hepatic neoplasms. They can be thought of as a malignant counterpart of biliary cystadenomas.

There is recognized increased female predilection. Its incidence peak is around 60 years of age.

The clinical symptoms are nonspecific and are not distinctive from benign cystic liver lesions unless an invasive growth of the tumor occurs or distant metastases are present.

The vast majority of these neoplasms are intrahepatic (97%) with a small proportion extrahepatic (3%).

Some biliary cystadenomas may rarely develop into a cystadenocarcinoma 9.

Typically seen as a single multilocular cystic tumor with septal or mural nodules 2,5. Imaging cannot reliably differentiate cystadenoma from cystadenocarcinoma, but the presence of septal nodularity may favor the diagnosis of biliary cystadenocarcinoma versus a biliary cystadenoma 3,7.

Discrete soft tissue masses, thick and coarse calcifications, and heterogeneous CT attenuation or MR intensity within the loculi may also be seen, although these features are nonspecific.

Contrast-enhanced ultrasound demonstrates minimal enhancement since the tumors are largely avascular 10. Abnormally increased vascularity may be present peripherally or in the septa.

At MRI, subtraction images may prove helpful for discerning faint mural or septal enhancement.

Surgical removal of the tumor by complete excision is often the treatment of choice. The overall prognosis is considered better than for other malignant tumors of the liver 8.

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