Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1995 Nov;222(5):619–625. doi: 10.1097/00000658-199511000-00003

Extrahepatic biliary cystadenomas and cystadenocarcinoma. Report of seven cases and review of the literature.

W Davies 1, M Chow 1, D Nagorney 1
PMCID: PMC1234988  PMID: 7487208

Abstract

OBJECTIVE: The aim of this investigation was to describe the clinical features, diagnosis, pathologic characteristics, and optimal surgical management for patients with extrahepatic biliary cystadenomas. SUMMARY BACKGROUND DATA: Extrahepatic biliary cystadenomas are rare epithelial neoplasms. The clinical features and optimal surgical management for these lesions have not been defined clearly. The usual presenting symptom is jaundice. These lesions should be considered premalignant and necessitate resection. Sporadic case studies have reported instances of recurrence with local excision. To the authors' knowledge, this study represents the largest collected single series of extrahepatic biliary cystadenomas and reviews previously reported cases. METHODS: The authors reviewed and reported their institutional experience from 1950 to 1993 in treating seven patients with extrahepatic biliary cystadenomas as well as 19 previously reported cases in the literature. RESULTS: A strong female predominance (96.3% of patients reviewed) was associated with extrahepatic biliary cystadenomas. Obstructive jaundice was the most common presenting symptom (85%). Abdominal pain occurred in 50% of patients; other symptoms included fever and hemobilia. The most common site of occurrence was the common hepatic duct (32%). Papillary cystadenoma with foci of invasive adenocarcinoma, thus supporting the malignant potential of cystadenomas, occurred in one patient. Local excision from the wall of the bile duct was performed in 18 patients and was associated with 50% recurrence within a mean follow-up of 13 months (range, 4-24 months). No recurrence was reported after formal sleeve resection and bilioenteric reconstruction. CONCLUSIONS: Extrahepatic biliary cystadenomas can become malignant, and in this study, local surgical excision was associated with a 50% local recurrence rate. Sleeve resection with negative histologic resection margins followed by bilioenteric reconstruction, therefore, is recommended.

Full text

PDF
622

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Burhans R., Myers R. T. Benign neoplasms of the extrahepatic biliary ducts. Am Surg. 1971 Mar;37(3):161–166. [PubMed] [Google Scholar]
  2. Carroll B. A. Biliary cystadenoma and cystadenocarcinoma: gray scale ultrasound appearance. J Clin Ultrasound. 1978 Oct;6(5):337–340. doi: 10.1002/jcu.1870060513. [DOI] [PubMed] [Google Scholar]
  3. Coulter G. N., Baxter J. N. Cystadenoma of the common bile-duct with malignant transformation. Aust N Z J Surg. 1989 Mar;59(3):291–294. doi: 10.1111/j.1445-2197.1989.tb01566.x. [DOI] [PubMed] [Google Scholar]
  4. Forrest M. E., Cho K. J., Shields J. J., Wicks J. D., Silver T. M., McCormick T. L. Biliary cystadenomas: sonographic-angiographic-pathologic correlations. AJR Am J Roentgenol. 1980 Oct;135(4):723–727. doi: 10.2214/ajr.135.4.723. [DOI] [PubMed] [Google Scholar]
  5. Frick M. P., Feinberg S. B. Biliary cystadenoma. AJR Am J Roentgenol. 1982 Aug;139(2):393–395. doi: 10.2214/ajr.139.2.393. [DOI] [PubMed] [Google Scholar]
  6. Hodgson T., Fox S., Bayjoo P. Case report: Extra-hepatic biliary cystadenoma in association with adenomyomatosis of the gall-bladder. Clin Radiol. 1991 Mar;43(3):210–212. doi: 10.1016/s0009-9260(05)80482-9. [DOI] [PubMed] [Google Scholar]
  7. Ishak K. G., Willis G. W., Cummins S. D., Bullock A. A. Biliary cystadenoma and cystadenocarcinoma: report of 14 cases and review of the literature. Cancer. 1977 Jan;39(1):322–338. doi: 10.1002/1097-0142(197701)39:1<322::aid-cncr2820390149>3.0.co;2-p. [DOI] [PubMed] [Google Scholar]
  8. ROGERS K. E. A papillary cystadenoma of the common hepatic duct. Can Med Assoc J. 1946 Dec;55(6):597–599. [PMC free article] [PubMed] [Google Scholar]
  9. Shapiro P. F., Lifvendahl R. A. Tumors of the Extrahepatic Bile-ducts. Ann Surg. 1931 Jul;94(1):61–79. doi: 10.1097/00000658-193107000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Smith J. A., Collier N. A., Gibson R. N. Biliary obstruction due to intraductal tumor. Aust N Z J Surg. 1989 Aug;59(8):625–629. doi: 10.1111/j.1445-2197.1989.tb01645.x. [DOI] [PubMed] [Google Scholar]
  11. Stanley J., Vujic I., Schabel S. I., Gobien R. P., Reines H. D. Evaluation of biliary cystadenoma and cystadenocarcinoma. Gastrointest Radiol. 1983;8(3):245–248. doi: 10.1007/BF01948127. [DOI] [PubMed] [Google Scholar]
  12. THOMPSON J. E., WOLFF M. INTRA-HEPATIC CYSTADENOMA OF BILE DUCT ORIGIN, WITH MALIGNANT ALTERATION. REPORT OF A CASE, TREATED WITH TOTAL LEFT HEPATIC LOBECTOMY. Mil Med. 1965 Mar;130:218–224. [PubMed] [Google Scholar]
  13. Wheeler D. A., Edmondson H. A. Cystadenoma with mesenchymal stroma (CMS) in the liver and bile ducts. A clinicopathologic study of 17 cases, 4 with malignant change. Cancer. 1985 Sep 15;56(6):1434–1445. doi: 10.1002/1097-0142(19850915)56:6<1434::aid-cncr2820560635>3.0.co;2-f. [DOI] [PubMed] [Google Scholar]
  14. Woods G. L. Biliary cystadenocarcinoma: Case report of hepatic malignancy originating in benign cystadenoma. Cancer. 1981 Jun 15;47(12):2936–2940. doi: 10.1002/1097-0142(19810615)47:12<2936::aid-cncr2820471234>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES