Lecture: liver cysts

This lecture focused on the diagnosis and management of liver cysts.  The simple liver cyst is the second most common liver lesion behind the hemangioma.  A simple cyst requires no therapy and no follow up.  A complex cyst, however, is another story.  A cyst can be complex based on the presence of internal septations, irregular walls, or unusual fluid composition within.  The concern in such cases is the diagnosis of cystadenoma, for any cystadenoma can turn malignant…into a cystadenocarcinoma.  These patients are typically female and symptomatic.  A diagnosis of cystadenoma is reason enough for surgical referral; resection is indicated.

There is a category of polycystic diseases of the liver.  These can be isolated or part of a spectrum of kidney diseases like autosomal dominant polycystic kidney disease (ADPKD) or autosomal recessive polycystic kidney disease (ARPKD).  Caroli disease (biliary sacculations) is associated with the latter.  Caroli syndrome is when congenital hepatic fibrosis is also present. 

Infectious disease is also a consideration with liver cysts.  Common in some parts of the world is echinococcus, a tapeworm that infests certain mammals and can be ingested by humans.  It can find itself to many different organs, but liver and lung are most common. The right lobe is most commonly affected.  The presence of internal daughter cysts is typical.  Management is complex and consultation of an infectious disease expert can help.  Therapy with albendazole for 1-6 months, needle aspiration, hepatic resection are all considerations based on radiographic features (size, location, daughter cysts, calcified walls etc.). 

There is also a miscellaneous group of cystic lesions including metastatic tumors (that become necrotic and fluid within the walls) and abscesses.

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