Question: A 60 year old female presents to your office with CT findings of a liver cyst with internal septations.  Infectious etiologies have already been ruled out.  She inquires about the possibility that this is cancerous.  You recall that some hepatic cysts can become malignant, such as a cystadenoma.  Which of the following about cystadenomas is false?

A. more common in females

B. they can transform into cystadenocarcinoma

C. they are hallmarked by a tubulopapillary architecture

D. they can cause abdominal pain


Answer: Most cystic lesions of the liver are benign.  Rarely, a cyst will be precancerous, such as a cystadenoma, which is thought to be an abnormal embryonic analog of the gallbladder or biliary epithelium.

They are most common in middle aged females, and oftentimes are symptomatic (causing nausea, fullness, bloating or pain).  One radiographic clue is the presence of internal septations.  These septations may be vascular, another clue.  Liver function tests are likely to be normal.

The diagnosis is difficult to make preoperatively, however, so pathology is often needed.  The hallmark of cystadenoma is the presence of regular, cuboidal or columnar epithelium; the presence of tubulopapillary architecture is more suggestive of transformation into cystadenocarcinoma.

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