Hepatic Cystadenoma - Causes, Types, Symptoms, Diagnosis, and Treatment

What Is Hepatic Cystadenoma?

Hepatic cystadenoma is also called biliary (bile duct) cystadenoma of the liver. It occurs in both intrahepatic (inside the liver) and extrahepatic (outside the liver) sites. Intrahepatic sites are more common. They are generally multilocular (comprising many cells) cysts. The hepatic or biliary cystadenoma resembles a cyst (a fluid-filled cavity) and is usually found while performing imaging studies for another disease. The article talks in detail about the causes, types, and treatment of hepatic cystadenoma.

What Causes Hepatic Cystadenoma?

Though the causes of hepatic cystadenoma are unclear, certain factors mentioned below predispose to the disease.

• A strong hormonal (estrogen and progesterone) influence is noted in females with hepatic cystadenoma.

• Some environmental factors like exposure to tobacco, alcohol consumption, chemicals like polyvinyl chloride (used in making plastics), ultraviolet rays from the sun, and being overweight contribute to the development of cancer.

What Are the Types of Hepatic Cystadenoma?

• Mucinous: Mucinous cystadenoma is the most common type that appears in females in the intrahepatic region (inside the liver). The involvement of other organs like the common bile duct, gallbladder, and hepatic ducts is less common. Mucinous cystadenoma is covered with single or multiple walls and filled with mucinous fluid, serous fluid, or blood.

• Serous: Serous cystadenoma has a smooth outer layer filled with clear fluid with single or multiple thin walls.

What Are the Symptoms of Hepatic Cystadenoma?

• Pain in the right upper abdominal region above the stomach.

• Nausea and vomiting.

• Abdominal distention (abnormal, outward swelling of the stomach).

• Jaundice (yellow color skin and eyes).

What Are the Tests That Help Find Hepatic Cystadenoma?

1. Physical Examination: The doctor performs a physical exam to look for signs of jaundice, and ascites, check the abdomen for the presence of any mass or lump, and check for liver or spleen enlargement.

2. Liver Function Tests (LFT): A liver function test is a type of blood test done to figure out the cause of liver disease. The liver has certain enzymes like alkaline phosphatase (ALP), alanine transaminase (ALT), aspartate transaminase (AST), gamma-glutamyl transferase (GGT), bilirubin, and lactate dehydrogenase (LD) that are checked for their normal ranges. Elevation in the levels of alkaline phosphatase (ALP) and serum bilirubin suggests hepatic cystadenoma.

3. Complete Blood Count: The blood has certain components like red blood cells, white blood cells, hemoglobin, and platelets. These components are checked for any changes in their normal ranges. Changes in the levels of any of the components denote an infection.

4. Carbohydrate Antigen 19-9 (CA 19-9): Carbohydrate antigens are tumor markers that are elevated in many types of cancerous and non-cancerous conditions.

5. Carcinoembryonic Antigen (CEA): Carcinoembryonic antigen is a protein that is present in the tissues of a developing infant. The presence of this antigen in higher amounts in an adult suggests the cancer is spreading. In a healthy adult, the CEA is present at low levels or is sometimes absent.

6. Cyst Fluid Analysis: The fluid from the cyst is evaluated to check for the presence of tumor markers through laparoscopy. In laparoscopy, a slender tube with a camera is attached to view the internal organs. The tube is introduced into the belly region through a small cut made in the stomach.

7. Ultrasound Abdomen: Ultrasound is an imaging technique that uses high-frequency sound waves to obtain pictures of the internal structures or organs inside the body. An ultrasound scan of the abdomen helps the physician figure out if there is a liver disease or not.

8. CT Scan: Computerized tomography (CT) is also an imaging procedure in which a series of X-ray images are taken at different angles with the help of a computer screen. The organ or internal structure pictures obtained at various angulations give a detailed and internal view of the structures.

9. MRI Scan: Magnetic resonance imaging (MRI) is also a diagnostic imaging technique that uses a strong magnetic field and high-frequency radio waves. It helps get a detailed view of the internal structures in a printed image format. This helps the physician get an idea of the disease and plan the treatment.

10. Endoscopic Retrograde Cholangiopancreatography (ERCP): This technique uses a flexible tube with a light to view and takes an X-ray of the bile duct. The tube is inserted into the upper digestive tract through the mouth, and the images are captured.

11. Magnetic Resonance Cholangiopancreatography (MRCP): This imaging technique uses high-frequency radio waves in a magnetic resonance field to make a copy of the internal structures in a picture format and view the bile duct.

12. Fine Needle Aspiration Biopsy: A small portion of the tumor is removed with the help of a fine needle to view the pathological changes at a microscopic level.

How Is Hepatic Cystadenoma Treated?

• Medication Discontinuation: Females who take tablets containing estrogen or progesterone or oral contraceptives (birth control pills) should be recommended to stop consuming the medication.

• Enucleation: If the tumor size is small, enucleation will be performed. Enucleation is the complete removal of the tumor.

• Surgical Resection: Surgical resection of the tumor completely with a layer of the liver is the choice of treatment for hepatic cystadenoma. This will prevent the recurrence of the tumor.

• Liver Transplant: A liver transplant will be recommended when the tumor is extended into both lobes of the liver. This is rarely done, as a liver transplant cannot be performed if the tumor has spread to other organs.

What Are the Complications of Hepatic Cystadenoma?

• Malignant Transformation: The benign tumor becomes cancerous.

• Obstructive Jaundice: Yellowish discoloration of the skin and eyes due to a block in the bile duct (a structure resembling a tube that carries bile from the liver and gallbladder to the pancreas and the intestine).

• Bleeding: The cystadenoma can burst and result in bleeding.

• Rupture: The cystadenoma bursts or ruptures when there is increased pressure in the cyst.

• Infection: The liver plays a key role in immune regulation and the removal of waste substances from the blood. When there is a lesion in the liver, it is unable to perform its functions normally. This leads to incomplete elimination of toxins from the body and does not effectively fight the invading bacteria or viruses, leading to infections.

• Ascites: It is an inflammation of the stomach due to abnormal fluid accumulation.

• Inferior Vena Cava Obstruction: This is the blockage or narrowing of the inferior vena cava. The inferior vena cava is a wide-ranging blood vessel without valves that carries blood from the legs, back, stomach, and pelvic region to the heart.

Who Is at Risk of Developing Hepatic Cystadenoma?

Females who consume birth control pills or hormonal tablets that contain estrogen and progesterone for a long time are at risk. Estrogen is a hormone that plays an essential role in the sexual and reproductive phases of females. The progesterone hormone plays a major role in the menstrual cycle and pregnancy.

The condition mainly occurs in people between 30 to 50 years of age who have a high chance of developing hepatic cystadenoma. There may be 20 to 30 percent chances of hepatic cystadenoma becoming cancerous.

What Is the Prognosis of Hepatic Cystadenoma?

The prognosis of hepatic cystadenoma is good with complete surgical resection (a layer of the liver is removed along with the tumor). However, if the surgical resection is not done properly or the tumor is not removed completely, the remnants will cause the tumor to recur.

Conclusion:

Hepatic cystadenoma is a rare and non-cancerous tumor. It is asymptomatic, and it is usually found while undergoing a regular check-up or while performing imaging diagnostic studies for another disease. This is most common in women who consume birth control pills for a long time. This tumor, if left untreated, can become cancerous and can cause death. Though it is asymptomatic, a few symptoms like jaundice, abdominal pain, and vomiting occur. Visiting the doctor if any of the symptoms appear will help the physician find the disease and start the treatment procedures. Treating the tumor by surgical removal is the first choice of treatment. Detecting the disease early and getting an appropriate treatment will reduce risks and improve the lifespan of the patient.