Biliary Cystadenoma: A Suggested “Cystamatic” Approach?

Excerpt

A 45-year-old woman was referred to our clinic in 2014 for evaluations of a recurrent hepatic cyst incidentally discovered by computed tomography (CT) scan approximately 10 years prior to referral. Since its radiographic appearance was consistent with a simple cyst, no intervention was recommended. She developed right upper quadrant and epigastric pain in 2011, prompting a repeat CT scan that demonstrated the diameter of the cyst to have increased to ~12 cm. Though it was still thought to be a simple cyst, given her new symptoms and modest growth in cyst size, she underwent a laparoscopic cyst fenestration with biopsy of the cyst wall. Although the final pathological examination revealed a hepatobiliary cystadenoma with ovarian-type stroma, no action was taken beyond surveillance. Symptoms recurred after her operation; the abdominal pain intensified after she became pregnant. Magnetic resonance imaging (MRI) repeated in 2013 demonstrated a 14-cm hepatic cystic mass with a thin septation. Complete blood count and comprehensive metabolic panel were normal with the exception of a mildly elevated serum alkaline phosphatase (140 μ/mL). Serum cancer antigen 19–9 was slightly elevated (70 μ/mL). …