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Dear Ask The Doctor:
61 year old male was noted to have incidental liver cyst on abdomenal CT. Follow up 1 week lated confirmed the low density areas seen in the liver represents cyst. 2 small hyperechoic area probably small hemangiomas caannot be seen with certainty of previous CT. Radiologist recommends follow up with US. Question when does one evaluate liver cyst for cystadenoma vs cystadenomacarcinoma? Past history of radical prosatectomy in 2006. Continued follow up shows no sign of reoccurent cancer with PSA levels.
Answer:Liver cysts occur in approximately 5% of the population. However, only about 5% of these patients ever develop symptoms. In general, cysts are thin-walled structures that contain fluid. Most cysts are single, although some patients may have several. The symptoms associated with liver cysts include upper abdominal fullness, discomfort, or pain.
Unlike simple liver cysts, cystic tumors are actually growths that may become malignant over the course of many years. The benign cystic tumor seen most frequently is called a cystadenoma; its malignant counterpart is a cystadenocarcinoma.
US and CT scans are the best imaging studies to rule out cystic tumors, which contain both liquid and solid areas. Because of the possibility of malignancy, cystic tumors must be completely removed surgically with an open (not laparoscopic) operation especially if changes are noted. The recurrence rate after surgery is very low and the long-term prognosis is excellent. It would be recommended for this patient to have a follow up examination yearly with imaging studies, especially with a history of prostate cancer that can metastasize to the liver. If a change in the size or appearance is noted and other symptoms are found a surgical biopsy or resection might be needed in the future.
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