The liver may also be affected by the formation of one or more cysts: small pockets or cavities filled with liquid. In general, their presence is linked to a benign condition that is unlikely to jeopardize the function of the organ. Only in extreme cases, in fact, can liver transplantation be necessary.
What are the characteristics of cysts and when should surgery be used? We talk about this topic with Dr. Roberto Ceriani, Head of the Hepatological Day Hospital and Interventional Hepatology of Humanitas.
The different types of cysts
The cysts can be simple or multiple. Simple cysts have unknown causes, even if they are believed to have congenital origin and are therefore present from birth; it is assumed that they may come from the progressive dilation of abnormal bile ducts that are unable to develop normal connections with the biliary tree.
In the second case we speak of polycystic liver disease (acronym PCLD), a rare condition. The liver, given the high number of cysts of different volumes present, may experience a significant increase in its size over the years, resulting in abdominal swelling, discomfort or pain. This disease is congenital and is usually associated with polycystic renal disease. Genetic mutations have been identified in the PKD1 and PKD2 genes. Occasionally polycystic liver disease occurs in the absence of polycystic renal disease. It should be noted that simple biliary cysts or those of polycystic liver disease do not evolve into malignant tumors.
Cancer cysts, on the other hand, are rare and are called cystadenomas. They are benign, particularly affecting middle-aged women, and can evolve into cystole adenocarcinomas, which are malignant tumors; instead, they affect both men and women.
Finally, there are the hydatid cysts that are formed as a result of the infection of a parasite, echinococcus. This parasite, which is found all over the world, is particularly widespread in areas where sheep and cattle are reared.
The manifestation symptoms
In most cases, liver cysts are asymptomatic. Large cysts can, however, cause dull pain in the right upper abdominal quadrant. Patients with liver cysts sometimes report abdominal swelling and premature satiety. In some cases, if the cyst is large enough, an abdominal mass may be observed. Rarely their presence can cause jaundice due to compression of the bile ducts, or they can break or twist causing acute abdominal pain.
Diagnosis and treatment
“The diagnosis of liver cysts is made with ultrasound, a method that is easily available, non-invasive and highly sensitive. CT is also highly sensitive, easy to interpret and very useful for deciding and planning treatment. It also allows differential diagnosis between simple and tumor cysts,” explains Dr. Ceriani.
Polycystic hepatopathy or solitary liver cysts only need treatment in symptomatic patients because the risk of lesion-related complications is lower than the risk associated with treatment.
In the presence of symptoms, or if the cysts are very large, the surgical treatment involves the removal of the portion of the wall of the cysts on the surface of the liver (fenestration); the laparoscopic approach is considered the standard of care. A therapeutic alternative is suction combined with sclerosis with alcohol or other agents, but failure or recurrence rates are high.
In polycystic hepatopathy only patients with debilitating pain should be considered for surgery. The objective is to decompress the cystic liver as much as possible by fenestration or, in selected patients, by resection of part of the liver; the recurrence of symptoms with both procedures is high, as new cysts replace those that have been removed. A small number of patients are finally treated with liver transplantation.
