Most cysts and masses found in the liver are benign, and the majority are discovered incidentally on an ultrasound or CT done for another reason. Simple cysts and haemangiomas generally need only observation. A hydatid cyst, by contrast, is a parasitic disease and does require treatment. The decision to operate rests on the type and size of the cyst, whether it causes symptoms, and whether imaging shows any suspicious feature.
"There is a cyst in your liver" is a sentence that worries most patients. In fact this finding usually emerges incidentally on an ultrasound or CT done for another reason, and the great majority are benign. The real question is telling apart the cyst that can simply be watched from the one that needs treating.
Simple Liver Cyst
The commonest type. It is a thin-walled sac filled with clear fluid, arising from developmental differences in the bile ducts present from birth. It is not infectious and does not turn into cancer.
Small simple cysts cause no symptoms and need no treatment. Only when they become very large do they cause fullness, a sense of pressure and occasionally pain in the right upper abdomen. Laparoscopic removal of the roof of the cyst (fenestration) can be performed in that situation.
The ultrasound appearance of a simple cyst is typical: a smooth-walled, entirely empty structure with increased brightness behind it. Where that appearance is clear, no further investigation is needed.
Haemangioma
The commonest benign mass in the liver, made up of a tangle of blood vessels. It is present in around 5 per cent of the population and is more common in women.
It usually causes no symptoms and needs nothing beyond observation. It does not turn into cancer. Only very large ones, generally above 5 to 10 centimetres, can cause pressure symptoms; surgery arises in those selected cases.
The diagnosis is generally made on contrast CT or MRI; the way a haemangioma takes up contrast is characteristic and no biopsy is needed. On the contrary, biopsy of a haemangioma is avoided because it carries a risk of bleeding.
Hydatid Cyst
The one type of cyst that must be considered separately, because it is a parasitic disease that requires treatment. It is caused by Echinococcus granulosus, a parasite circulating between dogs and farm animals. It reaches humans through water or unwashed vegetables contaminated with parasite eggs, or close contact with dogs.
It occurs in Turkey particularly in regions where livestock farming is widespread, and Mersin and its surroundings are among them.
The cyst can stay silent for years. As it grows it causes pain and fullness in the right upper abdomen. The real risk is this: if the cyst ruptures, its contents spill into the abdominal cavity or the bile ducts, which can cause both a severe allergic reaction and spread of the disease. Infection within the cyst is also possible.
Treatment options depend on the stage and site of the cyst: medication (albendazole), image-guided puncture techniques, and surgery. The aim in surgery is to remove the cyst without spilling its contents into the abdominal cavity, which calls for particular technical care.
Other Masses
Focal nodular hyperplasia. Benign, and generally observed.
Hepatocellular adenoma. Benign, but carries a risk of bleeding and, rarely, malignant change. It is associated with oral contraceptive use. Surgery is considered for larger ones.
Malignant masses. These may be a primary liver cancer (hepatocellular carcinoma) or a metastasis spread from another organ. Colon cancer is among the tumours that most often spread to the liver. When a suspicious mass is found in the liver, a primary tumour elsewhere is therefore also looked for.
When Should You Be Concerned?
Further assessment is needed in the following situations:
- Marked growth of the cyst or mass on follow-up
- Irregular borders, a thick wall, septations or solid components on imaging
- Persistent pain in the right upper abdomen
- Accompanying jaundice, weight loss or fever
- A known history of cancer
- Detection on a background of cirrhosis or chronic hepatitis B or C
Follow-Up and the Decision to Treat
For typical-looking, symptom-free findings such as simple cysts and haemangiomas, an ultrasound at set intervals is generally enough. Where the appearance is typical and there is no growth, the intervals lengthen over time.
The decision to operate weighs the type and size of the cyst, whether it causes symptoms and its features on imaging. The laparoscopic approach is used in suitable cases. For a hydatid cyst, the decision follows a separate assessment based on the stage of disease and the site of the cyst.
Laparoscopic Solid Organ Surgery at Gazi University
In 2011 Op. Dr. Ersan Semerci completed the Laparoscopic Solid Organ Surgery Course held at the Department of General Surgery, Gazi University in Ankara. That course deals directly with minimally invasive procedures on the liver, spleen and pancreas.
Liver and gallbladder surgery is among the official specialty areas listed on his hospital profile. The more than 5,000 laparoscopic cholecystectomies he has performed over his career also mean working with this anatomical region regularly.
His scientific work includes experimental research on liver and intestinal circulation, among them a study on intestinal ischaemia and reperfusion injury published in the Tohoku Journal of Experimental Medicine.
Op. Dr. Ersan Semerci has practised in Mersin since 2010 and currently works at VM Medicalpark Mersin Hospital.
Op. Dr. Ersan Semerci has practised in Mersin since 2010 and currently works at VM Medicalpark Mersin Hospital. Consultations and operations in Liver Cyst are carried out at this hospital. Patients travelling from Mersin and neighbouring provinces can book via WhatsApp.
Book on WhatsAppA cyst was found in my liver. Is it cancer?
Most cysts found in the liver are benign. Simple cysts and haemangiomas do not turn into cancer. Masses with suspicious features are assessed with further imaging.
Does a simple liver cyst need surgery?
Usually not. Small simple cysts that cause no symptoms are simply observed. Surgery arises where a cyst grows very large and causes pressure symptoms.
Is a hydatid cyst contagious?
It does not pass from person to person. It is acquired through water or unwashed vegetables contaminated with parasite eggs, or close contact with dogs. Hand hygiene and washing vegetables well are therefore effective in prevention.
Is a haemangioma biopsied?
No. Because a haemangioma is a tangle of blood vessels, biopsy carries a risk of bleeding. The diagnosis is made with contrast CT or MRI.
How often should a liver cyst be checked?
For typical-looking cysts causing no symptoms, an annual ultrasound is generally enough. Where there is no growth the intervals can lengthen over time. Your doctor will set the exact follow-up plan.
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For Liver Cyst and related symptoms you can book an appointment at VM Medicalpark Mersin Hospital. Mezitli / Mersin, Turkey, weekdays 09:00-17:00.
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