Management and outcomes of complex cystic masses with malignant transformation

Document Type

Conference Proceeding

Publication Date


Publication Title

Am J Gastroenterol


Introduction: Liver cysts are generally simple and benign; we describe the presentation and outcomes of 3 patients with rare complex cystic tumors that emphasize the broad differential diagnosis for this condition. Case Description/Methods: The records of 3 patients were reviewed with respect to presenting symptoms, their management and clinical outcomes. A 47 year old male with a history of pancreatic neuroendocrine tumor and liver metastases underwent a multivisceral transplant including the liver. Three years later he complained of postprandial right upper quadrant (RUQ) and chest pain. A new 13 cm cystic lesion was found in his liver. Surgical resection of the mass was performed revealing an angiosarcoma with epithelioid features. The patient's condition rapidly deteriorated with weakness and muscle wasting. Given the aggressive nature of the tumor and patient debility, the patient was admitted to hospice. A 38 year old female presented with postprandial RUQ pain and CT showed a 2.5 cm complex cystic liver mass with growth compared to prior imaging. The mass was surgically removed. Pathology showed a mucinous cystic tumor with a few foci of high grade neoplasia. Followup imaging shows continued resolution of disease without need for adjuvant therapy. The third case, a 63 year old female, has a history of hypothyroidism and an asymptomatic 4 cm complex liver cyst for a decade until it rapidly started growing to 7.6 cm with RUQ pain. Laparoscopic marsupialization with fenestration revealed a biliary cystadenoma. Follow up imaging showed a 4 cm cystic area secondary to residual inflammation. Discussion: The majority of hepatic cysts are benign and less than 5 % are malignant. Imaging characteristics may provide insight into discerning benign epatic cysts from malignant ones. Complex cysts have many septations and contain hemorrhagic or proteinaceous fluid. Biliary cystadenoma, which is premalignant, and biliary cystadenocarcinoma usually present as complex cysts. Mucinous cystic neoplasms of the liver are very rare, usually complex, premalignant, yet definitive diagnosis is challenging. Primary hepatic angiosarcomas are seen in middle aged patients; these have a propensity for local recurrence and malignant change. These cases emphasize the importance of the follow up and an early intervention of incidentally found hepatic large complex cysts.

PubMed ID

Not assigned.





First Page