From the Guidelines
No monitoring is required for a 0.6 cm simple cyst in liver segments 4 and 6 found on ultrasound in a 64-year-old man. Simple hepatic cysts are benign lesions that typically follow an indolent course without significant changes in size over time, as stated in the EASL clinical practice guidelines on the management of cystic liver diseases 1. According to these guidelines, there is no indication for follow-up of simple hepatic cysts, regardless of size. The patient can be reassured that this is a benign finding requiring no specific management, unless they become symptomatic, in which case imaging (ultrasound first) will assess the size and look for complications and compression 1. Key points to consider include:
- Simple hepatic cysts are benign and typically do not require follow-up or intervention
- The cyst in question is small (0.6 cm) and likely to remain stable in size
- Symptomatic hepatic cysts can be treated surgically or with percutaneous aspiration sclerotherapy, but this is not relevant in this asymptomatic case
- The patient should be informed that if they develop symptoms such as right upper quadrant pain, or if future imaging for unrelated reasons shows significant growth or changing characteristics of the cyst, then reassessment would be warranted 1.
From the Research
Diagnosis and Treatment of Liver Cysts
- Simple liver cysts are common and usually benign, requiring little to no treatment 2, 3, 4.
- The patient in question has a small simple cyst measuring 0.6 cm, which is likely to be asymptomatic and benign.
- Asymptomatic simple cysts in the liver require no treatment 3, 4.
Monitoring and Follow-up
- There is no clear consensus on the need for monitoring small simple liver cysts 3, 4.
- However, it is essential to differentiate simple and complex cysts to determine the appropriate management 3.
- Complex cysts or those with suspicious features may require further evaluation and treatment 3, 4.
Treatment Options
- Treatment is indicated in symptomatic cysts or those suspicious for malignant or premalignant features 3, 4.
- Treatment modalities include fenestration, aspiration sclerotherapy, or surgical resection 3, 4.
- Unroofing is associated with a high recurrence rate (>20%), and cyst enucleation may be a better surgical treatment option 5.