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home - Liver - Liver Masses - Cystadenoma Written by Dr Sebastian Zeki

Knows the epidemiology pathology clinical presentation and natural
history of benign tumours of the liver

Can define a programme of investigation and characterisation of
benign liver lesions including haemangioma focal modular
hyperplasia and adenoma

Demonstrates ability to make an appropriate differential diagnosis
Formulates appropriate plan of management
Recognises importance of the role of multidisciplinary team in
diagnosis and management



Understands the epidemiology risk factors pathology prevalence
and range of presentations of HCC

Knows the appropriate investigation and staging of the disease
Aware of treatment options including trans-arterial
chemoembolisation (TACE) radiofrequency ablation (RFA) local
ethanol injection

Appreciates the indications and contraindications of each and how
the most appropriate is selected Aware of surgical treatment options

Aware of role of surveillance and referral for specialist multidisciplinary management including liaison with oncology

Appreciates the indications and contraindications of each modality of
treatment and how the most appropriate is selected

Understands the process of selection of patients for liver resection or

Appreciates Involvement of multi-disciplinary team in management
decisions close liaison with surgical radiology oncology and
pathology colleagues


EpidemiologyThis is a rare cystic liver parenchyma tumour or, less frequently, in the extrahepatic bile ducts.It occurs in adults.It is more common in females.The tumours grow to a large size and required surgical intervention in most reports. Clinical manifestationsUpper abdominal mass, abdominal discomfort or pain, and anorexia can occur.It is present for several years prior to diagnosis in several patients.Many patients are asymptomatic. Imaging studies On USS, a hypoechoic lesion with thickened irregular walls and occasional internal echoes representing debris and wall nodularity can be seen.On CT it appears as a low attenuated mass, which may be uni- or multilocular, or may have septations.The cyst wall is usually thickened and/or irregular on CT. Treatment 15% get transformation of the cyst lining so all patients need resection by enucleation from the surround-ing liver. Cystadenoma Histopathology A cystadenoma is usually a multilocular cystic lesion with a smooth exter-nal surface, and a thin wall with smooth internal lining.The cyst frequently contains blood or chocolate-coloured material.Microscopically, cystadenomas are lined by biliary type mucus-secreting cuboidal or columnar epithelium, supported by dense cellular (mesenchymal) fibrous stroma resembling ovarian tissue.The lining is surrounded by a loose and less cellular layer of collagen. The treatment of CystadenocarcinomasResection is potentially curable.Enucleation assoc with increased risk of recurrence. Arise from cystadenomas.Usually in the elderly with better prognosis than cholangiocarcinoma Cystadenocarcinoma Cystadenocarcinomas look similar to cystadenomas but generally have a thick wall that may show large tissue masses protruding from the internal cyst lining.Dont aspirate as can cause seeding These findings are generally indicative of a complicated cyst, which may represent a simple cyst with previous bleeding, a neoplastic cyst such as a cystadenoma, cystadenocarcinoma, or rarely a metastasis. This is in contrast to a simple cyst, which is typically devoid of septations and has imperceptible walls Written by Dr Sebastian Zeki

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