International Journal of Molecular Medical Science, 2025, Vol.15, No.1, 33-41 http://medscipublisher.com/index.php/ijmms 37 5 Management and Therapeutic Strategies 5.1 Conservative management Conservative management is the cornerstone for asymptomatic or minimally symptomatic liver cyst patients. This approach primarily involves regular imaging, such as ultrasound or MRI, to monitor cyst growth and detect complications. Patients are advised to modify their lifestyle, including dietary changes to alleviate abdominal distension and avoiding high-impact physical activities to reduce discomfort (Savige et al., 2015). In cases of Polycystic Liver Disease (PLD) associated with Autosomal Dominant Polycystic Kidney Disease (ADPKD), monitoring renal function is essential due to the potential impact of concurrent kidney disease. Hormonal factors, especially estrogen, have been shown to exacerbate cyst progression, and women are therefore advised to avoid estrogen-containing therapies (Chen et al., 2022). Conservative measures focus on symptom control and delaying the need for invasive interventions. This guideline emphasizes the importance of counseling female patients with PLD and ADPKD about the risks associated with pregnancy and exogenous estrogen exposure, as these factors can exacerbate cyst progression. 5.2 Pharmacological interventions Pharmacological interventions are tailored to target the molecular mechanisms underlying cyst growth and expansion (Freda et al., 2005). Somatostatin analogues, such as octreotide and lanreotide, are well-documented for reducing liver volume by inhibiting cyclic AMP (cAMP) production in cholangiocytes, thus decreasing fluid secretion into cysts. Clinical trials have demonstrated the efficacy of these drugs in improving symptoms and quality of life in patients with PLD (Lantinga et al., 2016; van Aerts et al., 2018). Another promising class of drugs includes mTOR inhibitors like rapamycin, which reduce abnormal cellular proliferation by targeting dysregulated mTOR signaling pathways. These inhibitors have shown potential in preclinical models, although their clinical use requires further validation (Ellis et al., 2022). Additionally, adenylyl cyclase inhibitors represent an innovative approach to suppressing cAMP-dependent pathways, further limiting cyst growth (Spirli et al., 2017). Emerging experimental therapies, such as endoplasmic reticulum (ER) stress modulators like 4-phenylbutyric acid, also offer new possibilities for intervention in hepatic cystogenesis (Masyuk et al., 2021). 5.3 Surgical and transplantation options For patients with severe symptoms or complications that are refractory to conservative or pharmacological treatments, surgical options become necessary. Percutaneous sclerotherapy is a minimally invasive procedure that involves aspirating cyst fluid and injecting a sclerosing agent to collapse the cyst. This method is effective for managing solitary or dominant cysts causing significant symptoms. For patients with larger cyst burdens, surgical fenestration is a viable option. This procedure involves removing the cyst walls to reduce pressure and provide symptom relief, although recurrence rates can limit its long-term efficacy (Giuliani et al., 2015). Liver resection, which entails removing a portion of the liver containing the cyst clusters, may be indicated in localized disease, especially when combined with fenestration for comprehensive symptom management. In cases of diffuse PLD or end-stage liver disease, liver transplantation remains the definitive curative approach. Advances in surgical techniques and immunosuppressive therapies have improved outcomes, making transplantation a viable option for patients with advanced disease (Masyuk et al., 2021). The choice of surgical intervention depends on the extent of the disease, patient health, and the presence of comorbidities. 6 Case Studies 6.1 Autosomal dominant polycystic kidney disease patients Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a hereditary disorder characterized by progressive renal and extra-renal cyst formation, with the liver being the most common site of extra-renal involvement. A case involving a 45-year-old female with ADPKD highlights the complexity of managing liver cysts in this condition. The patient initially presented with severe abdominal distension, early satiety, and dyspnea due to massive hepatomegaly caused by numerous liver cysts. Imaging studies confirmed a significant cyst burden with a total
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