Diagnosis and Treatment of Liver Cystadenocarcinoma: Report of 18 Cases

Abstract

Objective: To discuss the diagnosis and treatment of liver cystadenocarcinoma. Methods: The clinical, imaging, and pathological data of 18 patients with liver cystadenocarcinoma between January 2000 and December 2004 in our hospital were retrospectively analyzed. Results: The liver cystadenocarcinoma was seen in males and females (m/f: 9/9); mean age was 51 years. Ultrasonography revealed cystic parenchymatous mass echoes of fluid predominance with uneven margins. Nonenhanced CT revealed intrahepatic low-density space occupying shadows with nodular protrusions on the margins in all cases. Enhancement CT revealed that part of the nodular protrusions and tissues around the lesions were enhanced and the delayed phase disappeared. 66.67% (12/18) of the lesions were more than 10 cm in diameter. The diagnosis of liver cystadenocarcinoma was confirmed by postoperative pathology in all cases. Of these patients, 12 lesions were in the left lobe, 3 in the right lobe, 1 in the mid lobe, 1 in the right and left lobe, and 1 in the caudate lobe. Of the 18 patients, 6 had completely resect the cystadenocarcinoma, 2 were surgically explored, one received TAE+fine needle aspiration cytology+injection of chemotherapy drugs, and 9 underwent radical hepatectomy+choledochostomy or T-tube drainage, in which, one patient underwent choledochostomy+left hepatectomy+radical gastrectomy for cancer+lymphadenectomy; one patient underwent resection of the cystadenocarcinoma, who had relapse 20 months after the initial procedure. The patient received repeat resect for the recurrent cystadenocarcinoma+cholangio-jejunostomy. Six months later she had another relapse and received repeat resect (only PMCT) for the recurrent cystadenocarcinoma. The patient died from cholangiopleural fistula after third time operation (PMCT) was attempted perioperatively. Seven patients died of metastatic disease after operation. The remaining 10 patients were alive without cancer recurrence or metastasis (mean follow-up 20 months). Conclusion: Liver cystadenocarcinoma is rarely seen and grows slowly. It shows some typical clinical and imaging features. The crux for diagnosing and treating liver cystadenocarcinoma is how familiar the surgeon is with the pathology and clinical features of the condition. Prolonged survival can be achieved by radical resection of the tumor.