Hepatic Cysts

Isolated hepatic cysts are commonly detected incidentally on abdominal ultrasonography or CT (1). These cysts are usually asymptomatic and have no clinical significance. The rare congenital polycystic liver is commonly associated with polycystic disease of the kidneys and other organs. It causes progressive nodular hepatomegaly (sometimes massive) in adults. Nevertheless, hepatocellular function is remarkably well preserved, and portal hypertension rarely develops. Occasionally, very large cysts cause pain or symptoms from compression of other organs. In these instances, intervention such as cyst marsupialization or drainage can be considered; however, cysts often recur. Thus, rarely, significant symptoms or quality-of-life issues warrant consideration of liver transplantation.

Other hepatic cysts include the following:

• Hydatid (echinococcal) cysts: This disease is caused by the cyst-like larvae of the Echinococcus granulosus tapeworm; humans usually become infected by fecal-oral transmission after coming in direct contact with the stool of infected animals (eg, dogs, sheep).

• Caroli disease: This rare, autosomal recessive disorder is characterized by segmental cystic dilation of intrahepatic bile ducts; it often becomes symptomatic in adulthood, with stone formation, cholangitis, and sometimes cholangiocarcinoma.

• Cystadenoma: This rare disorder sometimes causes pain or anorexia and is evident on ultrasonography; treatment is cyst resection.

• Cystadenocarcinoma: This rare disorder is probably secondary to malignant transformation of a cystadenoma and is often multilobular; treatment is liver resection.

• Other true cystic tumors: These tumors are rare.