Introduction and Objective. Biliary cystadenoma is a rare benign neoplasm of the liver with less than 200 cases being reported allover the world. We report a series of 13 cases highlighting the radiological findings and problems related to its management. Materials and Methods. Records of thirteen patients who underwent surgery for biliary cystadenomas, between March 2006 and October 2011, were reviewed retrospectively. Results. Majority of the patients were females (11 out of 13), with a median age of 46 (23–65) years. The most frequent symptom was abdominal pain (92%). Seven patients had presented with history of previous surgery for liver lesions. Five patients had presented with recurrence after partial resection for a suspected hydatid cyst and two after surgery for presumed simple liver cyst. Ten of the 13 patients had complete resection of the cyst with enucleation in 3 patients, 2 of whom in addition required T-tube drainage of the bile duct. There has been no recurrence during the follow-up period ranging from 3 months to 5 years. Conclusion. Biliary cystadenoma must be differentiated from other benign cysts. Hepatic resection or cyst enucleation is the recommended treatment option. 1. Introduction Biliary cystadenomas are rare cystic lesions of the liver. They account for less than 5% of nonparasitic cysts of the liver [1] and occur frequently in middle-aged women. The size varies from 1.5 to 35？cm [2, 3]. These cysts need to be differentiated from other cystic lesions such as simple cysts, hydatid cysts, abscesses, hematomas, and polycystic liver disease. Biliary cystadenomas were first described in 1943 [4]; less than 200 cases have been reported till date. They are often benign lesions with a malignant potential [3, 5, 6]. They develop from either an aberrant bile duct or directly from a primitive hepatobiliary stem cell [1, 7, 8]. Majority are intrahepatic (85%) [6, 7, 9–11], fewer are extra hepatic [5–7, 12] and occasionally are seen to arise from the gall bladder [9, 12]. There is difficulty in differentiating a benign from a malignant biliary cystadenoma and hence these lesions should always be resected. One cannot always reliably distinguish a simple cyst or a hydatid cyst from a benign biliary cystadenoma. In such situations, deroofing, marsupialization, or partial resection of the suspected cysts has resulted in a very high rate of recurrence (>90%) [13]. We report a series of 13 cases highlighting the radiological interpretation of biliary cystadenomas, issues on surgical management, and postoperative followup for recurrence. 2.
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