Abstracts
1998 Digestive Disease Week

#1041

BILIARY CYSTADENOMA: AN ONGOING DIAGNOSTIC CHALLENGE. T.J. VanderMeer, T.D. Sielaff, A. Blumenfeld, B.R. Taylor, and B. Langer. The Toronto Hospital and the University of Toronto. Toronto, CANADA.

Biliary cystadenoma is a rare benign cystic liver lesion which may be difficult to diagnose by radiologic and histologic criteria. This review of eleven patients treated surgically between 1980 and 1997 illustrates the clinical, radiologic, and pathologic features which distinguish this tumor from other liver cysts.

The patients were all women. Their mean age at presentation was 44 years (range:
24-68 years). Presenting complaints included mild chronic abdominal pain (4 patients), acute abdominal pain (1), and jaundice (1). Five patients were diagnosed incidentally during investigations for unrelated illnesses.

Five patients were misdiagnosed initially as having simple cysts (4) or biliary duplication (1) by clinical and pathologic criteria between 1980 and 1994. These patients were treated with partial excision and all cysts progressed. A total of 17 operations were performed in these five patients until complete removal was accomplished by liver resection (3), cystectomy (1), or the disease was arrested with percutaneous, intracystic injection of 5-fluourouracil (1). There were no deaths but a total of ten complications were noted: intra-abdominal abcess (3), biliary fistula (2), wound infection (2), portal vein thrombosis (1), incisional hernia (1), and pulmonary edema (1).

Six patients were correctly diagnosed with biliary cystadenomas based on clinical features and pre-operative imaging between 1987 and 1997. Radiologic characteristics included solid components in the cyst wall, septations, and multiple loculations with fluid of different densities. One stage excision was accomplished by liver resection (5) or cystectomy (1). There were no deaths and one complication, an incisional hernia, was noted in these six patients. The diagnoses were confirmed by one or more of the following histologic features: papillary projections, columnar epithelium, mucin production, spindle cell stroma, and immunohistochemical staining for CEA. No tumor recurrence has occurred in the ten patients having complete excision during a median follow-up of 30 months (range: 1-71 months).

The diagnosis of biliary cystadenoma requires a high level of suspicion and understanding of the clinical, radiologic, and pathologic features of the disease. Complete removal by either cystectomy or liver resection is necessary to prevent tumor recurrence and its associated complications.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.