Diagnostic uncertainty of hepatobiliary cystadenoma: Report of 11 cases and review of the literature

AbstractObjectivesThis research was conducted to highlight the pre-operative diagnostic uncertainty of hepatobiliary cystadenomas and to suggest strategies to improve its diagnostic yield.MethodsAll consecutive patients admitted with hepatobiliary cystadenomas from July 2007 to July 2014 were recruited in this study. The following information was retrieved from the medical records of eligible patients: demographics, clinical features, laboratory tests, imaging results, operative procedures, frozen sections, complications, histopathology, outpatient follow-up, and morbidity and mortality.ResultsEleven total patients with a diagnosis of hepatobiliary cystadenomas were treated in our unit. Abdominal ultrasounds and computed tomography (CT) scans were performed in all patients; magnetic resonant imaging (MRI) was performed in three patients with suspicion of hepatobiliary cystadenomas. Six patients underwent a definitive surgery; five patients were incorrectly diagnosed with non-hepatobiliary cystadenoma liver cysts (2 hydatid cysts and 3 simple cysts) by the pre-operative ultrasound and CT scan. These five patients underwent surgical deroofing. The frozen section was positive in two patients and was falsely negative in one patient who was diagnosed with simple cysts. The final histopathology results identified hepatobiliary cystadenomas in all patients.ConclusionsHepatobiliary cystadenomas are rare and are frequently misdiagnosed as hepatic cystic lesions with resultant inadequate surgical treatments. A diagnosis of hepatobiliary cystadenomas should be considered in all patients with atypical liver cystic lesions. Further pre-operative assessment with MRIs and intra-operative frozen sections may improve the diagnostic yield and provide an opportunity for a definitive radical resection