Biliary cystadenomas are uncommon benign cystic neoplasms of the liver.
Biliary cystadenomas occur predominantly in middle-aged patients and are more common in women 1.
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
Biliary cystadenomas are cystic neoplasms that may be either unilocular or multilocular. Only rarely are they found in the extrahepatic biliary tree and gallbladder.
Histologically cystadenomas are composed of multiple cysts lined by cuboidal or columnar epithelium that resembles normal biliary epithelium 1.
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.
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.
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.
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.
General imaging differential considerations include other cystic liver lesions, including:
- 1. Levy AD, Murakata LA, Abbott RM et-al. From the archives of the AFIP. Benign tumors and tumorlike lesions of the gallbladder and extrahepatic bile ducts: radiologic-pathologic correlation. Armed Forces Institute of Pathology. Radiographics. 22 (2): 387-413. Radiographics (full text) - Pubmed citation
- 2. Lewin M, Mourra N, Honigman I et-al. Assessment of MRI and MRCP in diagnosis of biliary cystadenoma and cystadenocarcinoma. Eur Radiol. 2006;16 (2): 407-13. doi:10.1007/s00330-005-2822-x - Pubmed citation
- 3. Horton KM, Bluemke DA, Hruban RH et-al. CT and MR imaging of benign hepatic and biliary tumors. Radiographics. 19 (2): 431-51. Radiographics (citation) - Pubmed citation