The liver is considered as a vulnerable site for the cystic lesions. There are many types of tumors that may grow at this specified site of the human body and lead to the poor quality of life in the patients. These all kind of lesions should be investigated separately to provide the accurate diagnosis which differentiates all of them including; simple cysts, degradation of metastatic tumors, hematomas, bilomas, abscesses, polycystic liver disease (PCLD), parasitic disorders, Caroli disorder, and biliary cystadenoma.
Biliary cystadenoma is as prevalent as 5% to 11% of the cases of liver lesions which is followed by mature autopsy successions and bigger cystic developments.
What is Biliary Cystadenoma?
Biliary or hepatic cystadenoma is the benign neoplasm of the liver located in the right lobe and mainly imitative from the hepatic epithelium.
These cysts mostly appear as multi-ocular but in some cases may grow as uni-ocular lesions. The cystic oculars are majorly surrounded by a thick but smooth stringy capsule. Internally the cysts have many separations as well as a number of papillary projections covered by columnar hepatic epithelia. This epithelium is characterized by the mucous secretions and mainly located at the intraluminal sites. In some cases, this epithelium is further covered by a layer of smooth muscle cells commonly called the compact mesenchymal stroma. This whole body is further covered by a final loose lining of collagen which mainly carries the blood capillaries, bile ducts, and a number of nerves. In these cysts, a pure connection to the hepatic tree is rarely observed. Macroscopically, these may appear as polypoidal tumors.
These hepatic cystic lesions may vary in size from 1.5 to 15 cm in diameter and the weight can be estimated as high as 6000 grams.
Approximately 85% of the cases involve the biliary parenchyma and biliary tract as the most vulnerable site for the adoption of neoplasms. The very first case of biliary cystadenoma was reported in 1892 by a scientist named Keen which majorly accounted for 5% of all the reported hepatic lesions.
Biliary Cystadenoma Symptoms
Clinically, these hepatic neoplasms may vary in their manifestations which majorly depend upon the size and location of the tumor. Mainly the following signs and symptoms are observed in most of the cases which may include;
- Severe and frequent pain in the upper right quadrant
- Obstructive jaundice
- Tangible hepatic edges or masses
- Increase in the abdominal circumference (in case of larger tumors)
- Dyspepsia
- Anorexia
- Weight loss is observed in a few cases
- Frequent nausea and vomiting
In many cases a few complications have been observed after the adoption of biliary cystadenoma which may include;
- Frequent bleeding
- Rupture
- Obstructive jaundice
- Malignant transformation
- Parasitic infections
- Outlet obstructionof the gastric region
- Ascites
- Inferior vena cava obstruction
Biliary Cystadenoma Causes
According to many scientific studies it has been observed that these biliary cystadenomas mainly originate from the precursors of the embryonic tissues. It has been examined that the intra-hepatic regions are more vulnerable to this slowly growing tumor in comparison to the extra-hepatic areas.
It has been observed that the female population is at more risk for this type of malignant tumors than the male population. It has also been suggested that the chances of growth in the size of these tumors are more in women. The reason for this situation is justified by the explanations of the two factors including; pregnancy and use of oral contraceptives which majorly lead to the high hormonal dependency resulting in the growth of the cyst.
Biliary Cystadenoma Treatment
A few medical management procedures for the hepatic cystadenoma have been found but they have not proven their effectiveness in this regard. So in this case, a wise decision is considered helpful which involves the discontinuation of the hormonal treatments until completion of the proper studies of the estrogen and progesterone.
In this situation, professionals recommend the surgical removal of the tumor as a treatment of choice to improve the quality of life among patients. Complete removal of the cyst is recommended as it will result in productive outcomes such as the absence of recurrences and malignancies of the tumor. But to follow this procedure a few precautions or guidelines should be kept in mind, including;
- Complete removal is required in some cases where the growth of the cyst is high and it also has the chances to grow really fast as well as the presence of adenocarcinoma may lead to this choice of treatment.
In the case of minor lesions where the cyst is located in the central region and closer to the biliary hilum, professionals may recommend only the enucleation to save the left biliary parenchyma. As the cystadenomas are covered by a dense layer of cells and blunt cutting of this portion will not lead to any leaking or bleeding, so enucleation can be considered as an option.