Preoperative differential diagnosis between intrahepatic biliary cystadenoma and cystadenocarcinoma: A single-center experience

Table 1 Basic patient information, clinical manifestation, duration of symptoms and pathology

No.	Gender	Age	Clinical characteristics	Duration of symptoms (mo)	Location	Size (cm3)	Pathology
1	Female	30	Abdominal bloating	3	Left lobe	9 × 6 × 5.5	Cystadenoma
2	Female	48	Abdominal bloating	13	Left lobe	5 × 4.5 × 2.5	Cystadenoma
3	Female	51	Abdominal pain	171	Right lobe	9 × 7 × 4	Cystadenoma
4	Female	44	Asymptomatic	52	Left lobe	4.5 × 3 × 2	Cystadenoma
5	Male	55	Asymptomatic	96	Left lobe	3 × 2.5 × 2.5	Cystadenoma
6	Female	77	Asymptomatic	241	Right, left lobe	14 × 10 × 5	Cystadenoma
7	Female	39	Abdominal bloating, pain	99	Left lobe	17.8 × 9.3 × 12.7	Cystadenoma
8	Female	73	Abdominal bloating, pain	12	Left lobe	9 × 5 × 4	Cystadenoma
9	Male	47	Asymptomatic	20	Left, caudate lobe	1.5 × 1 × 0.6	Cystadenoma
10	Female	41	Asymptomatic	120	Right lobe	12 × 8 × 4	Cystadenoma
11	Male	55	Asymptomatic	6	Left lobe	0.6 × 0.6 × 0.6	Cystadenoma
12	Male	50	Abdominal pain	30	Left lobe	5.5 × 3.5 × 2	Cystadenoma
13	Female	63	Abdominal bloating	10	Left lobe	9 × 7 × 7	Cystadenoma
14	Female	36	Asymptomatic	12	Left lobe	6 × 4 × 4	Cystadenoma
15	Female	56	Asymptomatic	3	Right, left lobe	4.5 × 4.5 × 3.5	Cystadenoma
16	Female	54	Abdominal pain	24	Left lobe	2 × 1.8 × 1	Cystadenoma
17	Male	74	Abdominal pain	30	Left lobe	9.5 × 7 × 3.5	Cystadenoma
18	Female	53	Abdominal pain	5	Left lobe	12 × 7.5 × 3	Cystadenoma
19	Female	55	Abdominal bloating	12	Right, left lobe	10 × 7.5 × 4	Cystadenoma
20	Female	76	Abdominal pain	20	Right lobe	11.5 × 8 × 6.5	Cystadenoma
21	Female	44	Fever	8	Right lobe	2.5 × 2 × 1.5	Cystadenoma
22	Female	60	Asymptomatic	22	Left lobe	1.5 × 1 × 0.2	Cystadenocarcinoma
23	Female	47	Abdominal bloating	1	Left lobe	5.5 × 5.5 × 5	Cystadenocarcinoma
24	Male	35	Asymptomatic	1	Left lobe	3.5 × 3 × 3	Cystadenocarcinoma
25	Female	58	Fever, vomit	12	Left lobe	10 × 7 × 5	Cystadenocarcinoma
26	Female	44	Abdominal pain	8	Left lobe	13 × 8 × 7	Cystadenocarcinoma
27	Male	59	Asymptomatic	28	Right, left lobe	11 × 10 × 2	Cystadenocarcinoma
28	Female	46	Abdominal bloating	1.3	Left lobe	4 × 4 × 3	Cystadenocarcinoma
29	Male	52	Abdominal bloating	13	Left lobe	5 × 4 × 2.5	Cystadenocarcinoma
30	Female	57	Abdominal pain, fever, vomiting	2	Left lobe	4 × 3 × 2	Cystadenocarcinoma
31	Female	55	Abdominal pain, nausea	9	Right, left lobe	8 × 7.5 × 7.5	Cystadenocarcinoma
32	Female	74	Abdominal pain	3	Left lobe	30 × 18 × 15	Cystadenocarcinoma
33	Female	41	Abdominal pain, fever, vomiting	72	Left lobe	4 × 3.5 × 1	Cystadenocarcinoma
34	Female	39	Abdominal pain, jaundice	2	Left lobe	10 × 9 × 5	Cystadenocarcinoma
35	Female	46	Chills and fever	3	Right, left lobe	2 × 1.3 × 0.6	Cystadenocarcinoma
36	Female	70	Asymptomatic	43	Left lobe	4.5 × 2.5 × 2	Cystadenocarcinoma
37	Female	51	Asymptomatic	96	Right lobe	5 × 3 × 2	Cystadenocarcinoma
38	Female	37	Abdominal pain, fever, vomiting	31	Right, left lobe	12.5 × 10 × 6	Cystadenocarcinoma
39	Female	51	Abdominal bloating, vomiting	3	Left, caudate lobe	9 × 7.5 × 4.5	Cystadenocarcinoma
40	Female	40	Asymptomatic	1	Left lobe	4.5 × 2.5 × 2	Cystadenocarcinoma
41	Female	51	Asymptomatic	2	Right, left lobe	10 × 8 × 5	Cystadenocarcinoma
42	Male	57	Abdominal pain, jaundice	1	Left lobe	2.5 × 1.7 × 1.5	Cystadenocarcinoma
43	Female	74	Abdominal pain, fever, vomiting	0.5	Left lobe	12 × 8 × 7	Cystadenocarcinoma
44	Male	50	Asymptomatic	2.6	Left lobe	2 × 0.7 × 0.5	Cystadenocarcinoma
45	Male	48	Asymptomatic	31	Left lobe	4 × 4 × 2	Cystadenocarcinoma
46	Female	57	Abdominal pain, fever, vomiting	8	Middle lobe	5.5 × 2.5 × 1.5	Cystadenocarcinoma

Table 2 Preoperative levels of marker proteins

	CEA (ng/mL)	AFP (μg/L)	CA125 (U/mL)	CA19-9 (U/mL)	ALT (U/L)	AST (U/L)	TBIL (μmol/L)	DBIL (μmol/L)
Cystadenoma	1.32 ± 0.72	2.08 ± 1.18	12.51 ± 9.31	22.56 ± 26.30	40.03 ± 61.58	56.07 ± 141.54	19.75 ± 20.32	8.98 ± 16.60
Cystadenocarcinoma	2.02 ± 1.16	3.68 ± 7.02	23.20 ± 21.86	72.55 ± 115.99	30.43 ± 19.43	26.05 ± 14.02	20.02 ± 39.74	10.70 ± 31.14

All the carcinoembryonic antigen (CEA) values in both subgroups were within the normal range: although P = 0.02 between the two groups. There was no statistical significance in the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL) and direct bilirubin (DBIL) before the operation (P > 0.05). However, eight of the 21 patients with cystadenoma and six of the 25 patients with cystadenocarcinoma had remarkable levels of TBIL and DBIL. AFP: Alpha fetoprotein; CA: Carbohydrate antigen.

Table 3 Radiological diagnosis

	Cystadenoma	Cystadenocarcinoma	Other benign tumor	Other malignancy	No qualitative
Cystadenoma subgroup	4	1	9	2	5
Cystadenocarcinoma subgroup	3	3	5	3	11

Ultrasonography, computed tomography or magnetic resonance imaging were not particularly effective modalities for diagnosing these rare lesions.