Liver and intrahepatic bile ducts - tumor
Benign tumors / conditions
Biliary cystadenoma

Author: Shilpa Jain, M.D. (see Authors page)

Revised: 15 November 2017, last major update July 2012

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Biliary cystadenoma[TI] liver

Cite this page: Jain, S. Biliary cystadenoma. PathologyOutlines.com website. http://pathologyoutlines.com/topic/livertumorbiliarycystadenoma.html. Accessed December 17th, 2017.
Definition / general
  • Less than 5% of all hepatic solitary cysts
  • 95% occur in women, mean age 45 years (range 2 - 87 years)
  • 84% are intrahepatic, also in common bile duct (6%), hepatic ducts (4%), cystic duct (4%), gallbladder (2%)
  • Single and multiloculated with predilection for right lobe of the liver
  • Associated with polycystic liver disease, abnormal hepatobiliary anatomy
  • Usually slow growing with good prognosis after surgical excision, although 25% have coexisting malignancy
  • Complications: intracystic hemorrhage, bacterial infection, spontaneous rupture, recurrence, malignant transformation
Laboratory
  • Elevated CA 19-9 (in cases with ovarian type stroma) and CEA in cyst fluid and serum
Radiology description
  • Calcification in 20% (resemble echinococcal cyst)
Case reports
Treatment
  • Complete excision (rarely has delayed recurrence)
Gross description
  • Encapsulated, solitary, mean 15 cm (range 3 - 30 cm), usually mucinous, multilocular by definition (locules have varied sizes)
  • Contains up to several liters of fluid
  • Smooth inner surface with few trabeculations or polypoid cystic projections
  • Rarely contains gallstones
  • Nodules of solid tissue suggests malignancy
Gross images

Images hosted on other servers:

Large, smooth lined cyst



Images contributed by Dr. Nasir Uddin, The Aga Khan University Hospital (Pakistan):
Microscopic (histologic) description
  • Usually mucinous: lined by single layer of columnar cuboidal mucinous epithelium with basal nuclei and apical mucin
  • 3 types:
    1. Hepatobiliary cystadenoma with mesenchymal stroma
    2. Without mesenchymal stroma
    3. Intraductal polypoid with mesenchymal stroma
  • Spindle cell ovarian type stroma only in women (resembles pancreatic mucinous cystic neoplasms)
  • Spindle cells may contain fat and smooth muscle
  • May have collagenous zone above stroma (resembling collagenous colitis)
  • Capsule composed of dense collagen with blood vessels, variable bile ducts
  • May have squamous or intestinal metaplasia, often neuroendocrine cells; may have dysplastic or borderline foci
  • May have ulceration with macrophages containing lipofuscin or hemosiderin, cholesterol clefts with foreign body giant cell reaction or calcification
  • No / rare atypia, no / rare mitotic figures; no communication with the bile ducts
  • Serous: lined by bland, flat to cuboidal cells with clear, glycogen rich cytoplasm, no spindle cell stroma; no mucin; may represent hepatic metastasis from pancreatic serous cystadenocarcinoma
Microscopic (histologic) images

Images hosted on PathOut server:

Case of the Week #70:


Various images



Images hosted on other servers:

Images contributed by Dr. Nasir Uddin, The Aga Khan University Hospital (Pakistan):

Cyst lined by tall columnar mucinous epithelium resting on ovarian type stroma

Positive stains
Differential diagnosis
  • Borderline tumor: high grade dysplasia and complex architecture
  • Foregut / ciliated cyst: asymptomatic, males, unilocular, present in segment IV, ciliated columnar / cuboidal epithelial lining with subepithelial connective tissue surrounded by a muscle layer
  • Invasive tumor: put through numerous sections to exclude invasion