Background: Differentiating hepatic mucinous cystic neoplasms (MCNs) from simple hepatic cysts (SCs) preoperatively is a challenging task. Our aim was to determine whether radiological features on ultrasound scan (USS), CT or MRI, cyst fluid tumour markers, or multidisciplinary team (MDT) outcomes could differentiate MCN from SC. Methods: A retrospective review of radiological features, cyst fluid tumour marker levels and MDT outcomes in 52 patients was performed. Results: There were 13 patients with MCN, 38 with SC and one ciliated foregut cyst. MCNs were more often solitary (p = 0.006). Although no other individual radiological characteristic on USS, CT or MRI was predictive of MCN, MDT outcomes stating that a cyst was complex in nature were highly predictive (p = 0.0007). Cyst fluid carbohydrate antigen 19-9, carcino-embryonic antigen and cancer antigen 125 were unable to differentiate MCN from SC (p = 0.45, p = 0.49, and p = 0.73, respectively). Conclusions: MDT outcomes are of greatest value when trying to differentiate MCN from SC, as well as having a solitary cyst on imaging. Conventional cyst fluid tumour markers are unhelpful. All suspicious cystic liver lesions should be discussed pre-operatively by a hepatobiliary MDT to determine the most appropriate surgical approach.

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;12:6062-6069.
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;85:e35-e36.
O'Shea JS, Shah D, Cooperman AM: Biliary cystadenocarcinoma of extrahepatic duct origin arising in previously benign cystadenoma. Am J Gastroenterol 1987;82:1306-1310.
Fuks D, Voitot H, Paradis V, Belghiti J, Vilgrain V, Farges O: Intracystic concentrations of tumour markers for the diagnosis of cystic liver lesions. Br J Surg 2014;101:408-416.
Mortelé KJ, Ros PR: Cystic focal liver lesions in the adult: differential CT and MR imaging features. Radiographics 2001;21:895-910.
Suriawinata A: Pathology of Malignant Liver Tumors. Massachusetts, UpToDate, 2014.
Khoddami M, Kazemi Aghdam M, Alvandimanesh A: Ciliated hepatic foregut cyst: two case reports in children and review of the literature. Case Rep Med 2013;2013:372017.
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;13:6383-6390.
Wheeler DA, Edmondson HA: Cystadenoma with mesenchymal stroma (CMS) in the liver and bile ducts. A clinicopathologic study of 17 cases, 4 with malignant change. Cancer 1985;56:1434-1445.
Koffron A, Rao S, Ferrario M, Abecassis M: Intrahepatic biliary cystadenoma: role of cyst fluid analysis and surgical management in the laparoscopic era. Surgery 2004;136:926-936.
Choi HK, Lee JK, et al: Differential diagnosis for intrahepatic biliary cystadenoma and hepatic simple cyst: significance of cystic fluid analysis and radiologic findings. J Clin Gastroenterol 2010;44:289-293.
Wang C, Miao R, Liu H, Du X, Liu L, Lu X, Zhao H: Intrahepatic biliary cystadenoma and cystadenocarcinoma: an experience of 30 cases. Dig Liver Dis 2012;44:426-431.
Ammori BJ, Jenkins BL, Lim PC, Prasad KR, Pollard SG, Lodge JP: Surgical strategy for cystic diseases of the liver in a western hepatobiliary center. World J Surg 2002;26:462-469.
Kubota E, Katsumi K, Iida M, Kishimoto A, Ban Y, Nakata K, Takahashi N, Kobayashi K, Andoh K, Takamatsu S, Joh T: Biliary cystadenocarcinoma followed up as benign cystadenoma for 10 years. J Gastroenterol 2003;38:278-282.
Vogt DP, Henderson JM, Chmielewski E: Cystadenoma and cystadenocarcinoma of the liver: a single center experience. J Am Coll Surg 2005;200:727-733.
Federle MP, Filly RA, Moss AA: Cystic hepatic neoplasms: complementary roles of CT and sonography. AJR Am J Roentgenol 1981;136:345-348.
Wahba R, Kleinert R, Dieplinger G, Bangard C, Drebber U, Hölscher AH, Stippel DL: Mucinous cystic neoplasm or non-parasitic liver cyst? - a challenging diagnosis. Hepatogastroenterology 2013;60:585-589.
Seo JK, Kim SH, Lee SH, Park JK, Woo SM, Jeong JB, Hwang JH, Ryu JK, Kim JW, Jeong SH, et al: Appropriate diagnosis of biliary cystic tumors: comparison with atypical hepatic simple cysts. Eur J Gastroenterol Hepatol 2010;22:989-996.
Pinto MM, Kaye AD: Fine needle aspiration of cystic liver lesions. Cytologic examination and carcinoembryonic antigen assay of cyst contents. Acta Cytol 1989;23:852-856.
Taouli B, Koh DM: Diffusion-weighted MR imaging of the liver. Radiology 2010;254:47-66.
Claudon M, Dietrich CF, Choi BI, Cosgrove DO, Kudo M, Nolsøe CP, Piscaglia F, Wilson SR, Barr RG, Chammas MC, et al: Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver - update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall Med 2013;34:11-29.
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