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  1. I J Beckingham,
  2. J E J Krige

    Tumours of the liver may be cystic or solid, benign or malignant. Most are asymptomatic, with patients having normal liver function, and they are increasingly discovered incidentally during ultrasonography or computed tomography. Although most tumours are benign and require no treatment, it is important for non-specialists to be able to identify lesions that require further investigation and thus avoid unnecessary biopsy. Modern imaging combined with recent technical advances in liver surgery can now offer many patients safe and potentially curative resections for malignant, as well as benign, conditions affecting the liver.

    Liver biopsy of a tumour mass should be reserved for patients with suspected malignancy who are not suitable for surgery and in whom the diagnosis may have clinical impact—for example, ovarian or neuroendocrine tumours, carcinoid, or lymphoma

    Characteristics of simple cysts

    • Thin walled

    • Contain clear fluid

    • Contain no septa or debris

    • Surrounded by normal liver tissue

    • Usually asymptomatic

    • Present in 1% of population

    Cystic liver lesions

    Cystic lesions of the liver are easily identified by ultrasonography. Over 95% are simple cysts. Asymptomatic cysts are regarded as congenital malformations and require no further investigation or treatment as complications are rare. Aspiration and injection of sclerosants should be avoided as it may cause bleeding and infection and does not resolve the cyst. Rarely, simple cysts can grow very large and produce compressive symptoms. These are managed by limited surgical excision of the cyst wall (cyst fenestration), which can usually be done laparoscopically.

    Polycystic liver disease

    About half of patients with simple cysts have two or more cysts. True polycystic liver disease is seen as part of adult polycystic kidney disease, an uncommon autosomal dominant disease that progresses to renal failure. Patients nearly always have multiple renal cysts, which usually precede development of liver cysts. Liver function is normal, and most patients have no symptoms. Occasionally the cysts cause …

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