From the Guidelines
Large benign liver cysts that grow significantly in women are most likely caused by the influence of oestrogens, which play a pivotal role in the development and growth of these cysts, particularly in patients with polycystic liver disease (PLD) 1. The growth of these cysts is thought to be driven by the effects of oestrogens, with epidemiological and experimental evidence supporting this theory 1.
- The use of exogenous female sex hormones, such as oral contraceptives, is likely to exacerbate the growth of these cysts, and clinicians are advised to discourage their use in female patients with PLD 1.
- Pregnancy may also have an impact on the growth of liver cysts, although the evidence is controversial, with some studies suggesting an increase in liver volume after pregnancy, while others find no association 1.
- In vitro fertilisation, which involves exposure to high levels of oestradiol, may also aggravate hepatic cyst growth, although the evidence is limited 1.
- Alternative contraceptive options, such as levonorgestrel-releasing intrauterine devices, may be considered, although their effect on PLD growth is unknown 1. The management of large benign liver cysts in women should take into account the potential impact of oestrogens on cyst growth, and treatment options should be individualized based on the patient's symptoms and disease severity.
From the Research
Causes of Large Benign Liver Cysts in Women
- The main risk factors for growth of liver cysts include female sex, exogenous oestrogen use, and multiple pregnancies 2.
- Processes involved in hepatic cystogenesis include ductal plate malformation with concomitant abnormal fluid secretion, altered cell-matrix interaction, and cholangiocyte hyperproliferation 2.
- Polycystic liver disease (PLD) is usually a benign disease, but can cause debilitating abdominal symptoms in some patients, and is associated with two genetically distinct diseases: isolated polycystic liver disease (PCLD) and autosomal dominant polycystic kidney disease (ADPKD) 2, 3.
Diagnosis and Treatment of Liver Cysts
- Conventional or contrast ultrasonography, abdominal computed tomography, and magnetic resonance imaging can be used to characterize liver cysts 4.
- Therapeutic abstention with or without iconographic monitoring constitutes the optimal management of many benign liver cysts without clinical repercussions 4.
- Treatments for symptomatic or potentially aggressive lesions may include fenestration, puncture with sclerotherapy, or surgical resection 4, 5, 6.
- Liver resection and cyst fenestration can provide immediate and sustained relief of symptoms and improvement in quality of life for selected patients with severe symptomatic polycystic liver disease 5, 6.