Appropriate diagnosis of biliary cystic tumors: comparison with atypical hepatic simple cysts

Background Biliary cystadenoma (BCA) and biliary cystadenocarcinoma (BCAC) are often confused with other intrahepatic cystic diseases. Aims The aims of this study were to investigate predictive factors of biliary cystic tumor (BCT) and clinical characteristic of BCAC. Methods We retrospectively reviewed preoperative diagnoses, overall characteristics and postoperative outcome of 20 BCTs and 19 cystadenoma-mimicking simple cysts that were pathologically confirmed. Results Comparing with atypical simple cysts, symptoms, left-lobe cyst, thick wall, septation, mural nodule, bile duct dilatation and an increase of serum alkaline phosphatase were associated with BCTs. However, on multivariate analysis, mural nodule, left-lobe cyst, and an increase of serum alkaline phosphatase were significantly frequent in BCTs with odds ratios of 75.5, 13.8, and 33.0, respectively. Among the 20 BCTs, seven BCACs were diagnosed. The characteristics of BCACs were mural nodule (P < 0.01), intrahepatic cyst debris (P < 0.01), and bile duct dilation (P=0.04). Cystic fluid analysis provided no significant differences between BCT and simple cyst. After fine needle aspiration cytology of BCTs, all except one BCAC with atypical cell showed nonspecific findings. After complete surgical excision (97.4% of patients), only one patient with BCAC had recurrence during 29 months of follow-up period. Conclusion In hepatic cysts with mural nodule, left-lobe cyst or increment of serum alkaline phosphatase seem to be indicative of BCTs in the diagnosis of suspicious hepatic cyst. Intracystic debris, bile duct dilation, and mural nodule may be suggestive clinical features of malignancy in BCTs. Eur J Gastroenterol Hepatol 22: 989-996 (C) 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.Seidel R, 2007, EUR RADIOL, V17, P1380, DOI 10.1007/s00330-006-0475-zKIM HG, 2006, KOREAN J GASTROENTER, V47, P5OH TH, 2006, KOREAN J GASTROENTER, V47, P379Koffron A, 2004, SURGERY, V136, P926, DOI 10.1016/j.surg.2004.06.031Carrim ZI, 2003, CLIN RADIOL, V58, P626, DOI 10.1016/S0009-9260(03)00165-XHai S, 2003, J GASTROENTEROL, V38, P759, DOI 10.1007/s00535-003-1142-7Heinze G, 2002, STAT MED, V21, P2409, DOI 10.1002/sim.1047Regev A, 2001, J AM COLL SURGEONS, V193, P36Mortele KJ, 2001, RADIOGRAPHICS, V21, P895Hagiwara A, 2001, BRIT J RADIOL, V74, P270Kinoshita H, 2001, HEPATO-GASTROENTEROL, V48, P250Hwang IK, 2000, J COMPUT ASSIST TOMO, V24, P652BLUMGART LH, 2000, SURG LIVER BILIARY Tde la Palavesa MMF, 1999, J CLIN ULTRASOUND, V27, P210ASAHARA T, 1999, HIROSHIMA J MED SCI, V48, P45VuilleminBodaghi V, 1997, GASTROEN CLIN BIOL, V21, P394MATHIEU D, 1997, MAGN RESON IMAGING C, V5, P255BUETOW PC, 1997, MAGN RESON IMAGING C, V5, P289Lee JH, 1996, J GASTROENTEROL, V31, P732DEVANEY K, 1994, AM J SURG PATHOL, V18, P1078WEE A, 1993, ACTA CYTOL, V37, P966LUNDSTEDT C, 1991, ACTA RADIOL, V32, P518CHEUNG YK, 1991, CLIN RADIOL, V43, P183PALACIOS E, 1990, GASTROINTEST RADIOL, V15, P313DAGRADI A, 1990, CHIR ITAL, V42, P100PINTO MM, 1989, ACTA CYTOL, V33, P852KOROBKIN M, 1989, AM J ROENTGENOL, V153, P507LEWIS WD, 1988, ARCH SURG-CHICAGO, V123, P563WHEELER DA, 1985, CANCER-AM CANCER SOC, V56, P1434MENDELSON DS, 1983, AM J ROENTGENOL, V140, P463WOODS GL, 1981, CANCER, V47, P2936FEDERLE MP, 1981, AM J ROENTGENOL, V136, P345ISHAK KG, 1977, CANCER, V39, P322BLOUSTEIN PA, 1977, AM J GASTROENTEROL, V67, P40