22 NATURAL HISTORY OF CONGENITAL SIMPLE HEPATIC CYSTS
Morven Allan, Maria Asimakidou, Mark Davenport
Kings College Hospital, London, United Kingdom

Abstract

Aim:  The prevalence of antenatally-detected hepatic cysts is increasing due to increased use of maternal ultrasonography (US). As precision in antenatal diagnosis is unusual there has been no clear consensus on post-natal management. The aim of the study was to evaluate the natural history and long-term follow up of antenatally-detected simple hepatic cysts.

Methods: Single-centre review of prospectively-maintained dataset (period 1991-2016). Data expressed as median (range). Estimated cyst volume was calculated as 4/3πr3.
Main Results:
32 (69% female) infants presented with an antenatally-detected cyst which, on post-natal imaging, was likely confirmed as a parenchymal hepatic cyst. Gestational age at detection was 23(13-38) weeks. Gestation at birth 39(30-41) weeks with birth weight 3.0(1.6-4.2)kg. Fetal intervention required one case. Postnatally, serial US were performed together with MRI or liver scintigraphy (n=6) if there was diagnostic doubt. Maximum cyst diameter was 30(12-120) mm.

Exophytic cysts with early increase in size (n=3) or cyst irregularity (n=2) prompted surgical intervention which included excision (n=3), marsupialization(n=1) and cyst-jejunostomy(n=1). On histology, two cysts exhibited squamous metaplasia with predominantly cuboidal epithleium but one was reclassified as "epidermoid" in origin with a predominantly squamous lining. 

In the remaining cases (n = 27) (FIG), follow-up was 35.5(4-204)months. Trends were observed including actual volume regression or stability (n=21) and complete resolution (n = 5). Accordingly, with increasing age, and therefore concomitant increase in body weight, those cysts which showed volume stability or regression, implied a relative contraction in the absence of intervention. All remained asymptomatic.

Conclusion:

  • Largest case-series to date of antenatally detected simple hepatic cysts.
  • Most can be managed conservatively and relative regression or resolution is likely.
  • Surgical intervention should be reserved for those which show rapid cyst growth (usually exophytic) or wall irregularity. 

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