Biliary cystadenoma and cystadenocarcinoma: Clinical-imaging-pathologic correlation with emphasis on the importance of ovarian stroma

PURPOSE: To evaluate cross-sectional imaging in the distinction of biliary cystadenoma from cystadenocarcinoma and in the determination of the presence of ovarian stroma. MATERIALS AND METHODS: In 34 patients, radiologic studies and specimen photographs and descriptions were reviewed retrospectively without knowledge of the patient group. Histologic features were reviewed without knowledge of the radiologic findings and analyzed for epithelial and stromal components. Correlation was made between the radiologic findings, gross morphologic features, internal fluid characteristics, and histologic features. RESULTS: The 34 patients had 27 biliary cystadenomas, 22 with ovarian stroma, and seven cystadenocarcinomas, four with ovarian stroma. Gross morphologic and imaging features suggestive of biliary cystadenocarcinoma included internal septation and nodularity. Septation without nodularity was seen only in biliary cystadenoma. Nonbilious fluid was the only feature associated with the presence of ovarian stroma but was not distinguishable on images. CONCLUSION: Imaging studies accurately reflect the nodularity and septation seen grossly to distinguish biliary cystadenoma and cystadenocarcinoma but do not allow distinction of the presence or absence of ovarian stroma.