Biliary cystadenoma and cystadenocarcinoma history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

History and Symptoms

The clinical presentation is variable, depending on the size and location of the cyst. Abdominal pain, obstructive jaundice, palpable mass, increasing abdominal girth, nausea, and vomiting are common signs and symptoms.

Biliary cystadenomas range in size from 3 to 40 cm. Large cystadenomas may demonstrate mass effect on adjacent organs or may be associated with hepatomegaly.

The clinical presentation of biliary cystadenoma is variable, depending on the size and location of the tumor. Potential symptoms include: right upper quadrant pain obstructive jaundice palpable liver edge or mass increasing abdominal girth (large tumors) nausea and vomiting

Typically, the patient is a middle-aged woman presenting with abdominal pain and/or discomfort, with distension and a palpable mass. Rare presentations include vomiting, dyspepsia, anorexia, and weight loss. Acute presentation is often pain due to intracystic hemorrhage or rupture of the cyst and fever secondary to infection of the cyst. Jaundice is either due to an extrinsic compression of the bile duct, biliary obstruction by an intraluminal tumoural mass, or accretion of mucus secretion from a communicating biliary cystadenoma. Ascites is secondary to compression of the inferior vena cava or the hepatic veins. Cystadenomas are known to increase in size during pregnancy and following oral contraceptives suggesting hormonal dependency. Recurrence of a cyst following partial resection should raise a suspicion of cystadenoma.

Biliary cystadenomas often are diagnosed incidentally[12], during imaging studies such as ultrasound or CT scan[13]. In other cases, non specific signs and symptoms may develop, due to compression of neighboring structures, such as jaundice, signs of cholangitis, cyst infection, hemorrhage. Pain is considered the leading symptom in most series, being present in about 80% of cases. Nausea, vomiting, abdominal fullness and bloating may also be present. Compression of the vena cava or the portal vein may cause lower limb edema or signs of portal hypertension such as splenomegaly.