Rapidly enlarging hepatobiliary cystadenoma

An unusual case of a hepatobiliary cystadenoma caused severe abdominal pain and obstructive jaundice by rapid enlargement in a woman aged 73 years. Magnetic resonance imaging revealed a 12 cm cystic lesion in the left medial segment of the liver and dilatation of the intrahepatic bile ducts. The abdominal pain was worse 4 days later, when magnetic resonance imaging demonstrated enlargement of the cystic lesion, to 14 cm in diameter. Laboratory tests on admission revealed serum alkaline phosphatase, 1342 IU/L; gamma glutamic transpeptidase, 672 IU/L; total serum bilirubin, 7.4 mg/dL; direct bilirubin, 5.8 mg/dL; and carbohydrate antigen 19-9, 37U/mL. Serosanguineous fluid was obtained by emergency percutaneous transhepatic drainage of the cyst, which resolved the patient's abdominal pain. Culture and cytologic examination of the fluid were nondiagnostic. The discharged fluid through dramage tube turned brown, and the total serum bilirubin concentration gradually decreased. Cystography and endoscopic retrograde cholangiography demonstrated communication between the cyst and the intrahepatic bile ducts on the left side of the liver. The cyst was removed by left hepatectomy 14 days after it had been drained. Pathologic examination of the resected specimen confirmed the presence of a hepatobiliary cystadenoma. Although hepatobiliary cystadenoma is a rare benign cystic tumor of the liver, it can become malignant and should thus be excised.