Biliary cystadenoma a case report

Amarjeet E. Tandur, Solaimuthu Rajagopal, Rahul K. Mishra, Ajay H. Bhandarwar, Guru Baradwaj, Bhushan Pathe


Biliary cystadenoma (BCA) is a rare cystic neoplasm of liver with malignant potential and female predominance, mostly asymptomatic that will lead to late identification. BCAs are mostly do not communicate with Biliary tract but communication was reported in some studies, BCA has higher rate of recurrence after incomplete removal so the standard management is complete resection or partial hepatectomy. We report a case of BCA in 72-year aged female with ECOG score 3. Computed tomography showed BCA involving segment II, III, IV and VIII of liver without any malignant features, which was treated with laparoscopic deroofing with omentopexy and no recurrence at 1 year follow up. We used indocyanine green-fluorescent image to look for biliary communication. This study aims to report that minimal accesses surgery with deroofing and omentopexy can be alternative treatment for BCA without any malignant features in a poor performance status and use of Indocyanine green-fluorescent image to avoid biliary injury and rule out communication.


Biliary cystadenoma, Liver cyst, Indocyanine green-fluorescent imaging, Minimal access surgery

Full Text:



Soares KC, Arnaoutakis DJ, Kamel I, Anders R, Adams RB, Bauer TW, Pawlik TM. Cystic neoplasms of the liver: biliary cystadenoma and cystadenocarcinoma. J Am Coll Surg. 2014;218(1):119-28.

Brittingham C, Tuma F. Hepatic Cystadenoma. In: StatPearls. Treasure Island: StatPearls Publishing; 2021.

Peh KH, Eugene Chan BT. Biliary cystadenoma: A rare occurrence. Med J Malaysia. 2020;75(3):307-8.

Morris M, Anderson C, Drake L, Redfield S, Subramony C, Vanderlan W. Giant biliary cystadenoma. J Surg Case Rep. 2012 Sep;2012(9):15.

Jwa EK, Hwang S. Clinicopathological features and post-resection outcomes of biliary cystadenoma and cystadenocarcinoma of the liver. Ann Hepatobiliary Pancreat Surg. 2017;21(3):107-113.

Tholomier C, Wang Y, Aleynikova O, Vanounou T, Pelletier JS. Biliary mucinous cystic neoplasm mimicking a hydatid cyst: a case report and literature review. BMC Gastroenterol. 2019;19(1):103.

Zhang YM, Shi R, Hou JC, Liu ZR, Cui ZL, et al. Liver tumor boundaries identified intraoperatively using real-time indocyanine green fluorescence imaging. J Cancer Res Clin Oncol. 2017;143(1):51-8.

Rossi G, Tarasconi A, Baiocchi G, Angelis GL, Gaiani F, Mario F, Catena F, et al. Fluorescence guided surgery in liver tumors: applications and advantages. Acta Biomed. 2018;89(9-S):135-40.

Benedicenti S, Molfino S, Alfano MS, Molteni B, Porsio P, Portolani N, Baiocchi GL. Indocyanine-Green Fluorescence-GUIDED Liver Resection of Metastasis from Squamous Cell Carcinoma Invading the Biliary Tree. Case Rep Gastrointest Med. 2018;5849816.

Vlek SL, Dam DA, Rubinstein SM, Lange KESM, Schoonmade LJ, Tuynman JB, et al. Biliary tract visualization using near-infrared imaging with indocyanine green during laparoscopic cholecystectomy: results of a systematic review. Surg Endosc. 2017;31(7):2731-42.

Abo T, Nanashima A, Tobinaga S, Hidaka S, Taura N, Takagi K, et al. Usefulness of intraoperative diagnosis of hepatic tumors located at the liver surface and hepatic segmental visualization using indocyanine green-photodynamic eye imaging. Eur J Surg Oncol. 2015;41(2):257-64.

Nakaseko Y, Ishizawa T, Saiura A. Fluorescence-guided surgery for liver tumors. J Surg Oncol. 2018;118(2):324-31.

Joel JM, Jeyasingh SD, Kalyanaraman S. Biliary Cystadenoma: A Case Report. J Clin Diagn Res. 2016;10(2):19-20.

Ahanatha PS, Velayutham V, Perumal S, Ulagendra PS, Lakshmanan A, Ramaswami S, et al. Biliary cystadenomas: a case for complete resection. HPB Surg. 2012;501705.

Chen YW, Li CH, Liu Z, Dong JH, Zhang WZ, Jiang K. Surgical management of biliary cystadenoma and cystadenocarcinoma of the liver. Genet Mol Res. 2014;13(3):6383-90.

Billington PD, Prescott RJ, Lapsia S. Diagnosis of a biliary cystadenoma demonstrating communication with the biliary system by MRI using a hepatocyte-specific contrast agent. Br J Radiol. 2012 Feb;85(1010):35-6.

Manouras A, Markogiannakis H, Lagoudianakis E, Katergiannakis V. Biliary cystadenoma with mesenchymal stroma: report of a case and review of the literature. World J Gastroenterol. 2006;12(37):6062-9.

Averbukh LD, Wu DC, Cho WC, Wu GY. Biliary Mucinous Cystadenoma: A Review of the Literature. J Clin Transl Hepatol. 2019;7(2):149-53.

Treska V, Ferda J, Daum O, Liska V, Skalicky T, Bruha J. Intrahepatic biliary cystadenoma-diagnosis and treatment options. Turk J Gastroenterol. 2016;27(3):252-6.

Thomas KT, Welch D, Trueblood A, Sulur P, Wise P, Gorden DL, et al. Effective treatment of biliary cystadenoma. Ann Surg. 2005;241(5):769-73.

Safari MT, Shahrokh S, Miri MB, Foroughi F, Sadeghi A. Biliary mucinous cystic neoplasm: a case report and review of the literature. Gastroenterol Hepatol Bed Bench. 2016;9(l1):88-92.