Non-Parasitic Cystic Diseases of the Liver

• Non-parasitic cystic lesions of the liver are common (up to 5-20% of the population), mainly simple cysts, and increasing in incidence with age. Most of them are asymptomatic and diagnosed incidentally at abdominal surgery or radiological studies for unrelated disease.

• Symptomatic simple cysts and polycystic liver disease are frequently treated by deroofing or partial hepatectomy (associated or not with deroofing of residual cysts). In selected cases, liver transplantation can represent the only definitive treatment, especially if portal hypertension or cirrhosis is present. Percutaneous aspiration, with or without sclerotherapy, can be useful to determine if symptoms are related to the cysts to be treated, or it can be used rarely as a definitive treatment (when associated with sclerotherapy).

• Neoplastic cysts include benign biliary cystadenoma and cystadenocarcinoma. Cystadenoma originates from intrahepatic bile ducts and may undergo malignant transformation to biliary cystadenocarcinoma, and therefore require more aggressive management.

• Cystic biliary dilatation of Caroli’s disease is frequently associated with complications, especially hepatolithiasis and recurrent cholangitis. Liver resection is the treatment of choice for unilobar disease, and it can be associated with contra-lateral clearance of stones in bilobar disease. Treatment of diffuse disease is challenging, sometimes requiring liver transplantation as a definitive treatment.

• Other rare cystic lesions of the liver include cystic metastases or primary tumors and post-traumatic cysts among others. They should have individualized treatment.