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Benign Liver Tumors

By

Danielle Tholey

, MD, Sidney Kimmel Medical College at Thomas Jefferson University

Last full review/revision Aug 2021| Content last modified Aug 2021
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Benign liver tumors are relatively common. Most are asymptomatic, but some cause hepatomegaly, right upper quadrant discomfort, or intraperitoneal hemorrhage. Most are detected incidentally on ultrasound or other scans (see Imaging Tests of the Liver and Gallbladder Imaging Tests of the Liver and Gallbladder Imaging is essential for accurately diagnosing biliary tract disorders and is important for detecting focal liver lesions (eg, abscess, tumor). It is limited in detecting and diagnosing diffuse... read more Imaging Tests of the Liver and Gallbladder ). Liver tests Laboratory Tests of the Liver and Gallbladder Laboratory tests are generally effective for the following: Detecting hepatic dysfunction Assessing the severity of liver injury Monitoring the course of liver diseases and the response to treatment... read more are usually normal or only slightly abnormal. Diagnosis is usually possible with imaging tests but may require biopsy. Treatment is needed only in a few specific circumstances.

Hepatocellular adenoma

Hepatocellular adenoma is the most important benign tumor to recognize. It occurs primarily in women of childbearing age, particularly those taking oral contraceptives, possibly via estrogen’s effects (1 General references Benign liver tumors are relatively common. Most are asymptomatic, but some cause hepatomegaly, right upper quadrant discomfort, or intraperitoneal hemorrhage. Most are detected incidentally... read more ).

Most adenomas are asymptomatic, but large ones may cause right upper quadrant discomfort. Rarely, adenomas manifest as peritonitis and shock due to rupture and intraperitoneal hemorrhage. Rarely, they become malignant.

Diagnosis is often suspected based on ultrasound or CT results, but biopsy is sometimes needed for confirmation. Gadoxetate-enhanced MRI is more sensitive than CT and can differentiate subtypes of adenomas at increased risk of progressing to malignancy (2 General references Benign liver tumors are relatively common. Most are asymptomatic, but some cause hepatomegaly, right upper quadrant discomfort, or intraperitoneal hemorrhage. Most are detected incidentally... read more ). Recognition of the beta-catenin subtype is particularly important, because it has a 5 to 10% risk of malignant transformation and should be resected.

Adenomas due to contraceptive use may regress if the contraceptive is stopped. If the adenoma does not regress or if it is subcapsular or > 5 cm, surgical resection is often recommended.

Focal nodular hyperplasia

This localized hamartoma may resemble macronodular cirrhosis histologically. Diagnosis is usually based on MRI or CT with contrast; the classic appearance is a lesion with a central scar. But biopsy may be necessary for confirmation. Treatment is rarely needed.

Hemangiomas

Hemangiomas are usually small and asymptomatic; they occur in 1 to 5% of adults. Symptoms are more likely if they are > 4 cm; symptoms include discomfort, fullness, and, less often, anorexia, nausea, early satiety, and pain secondary to bleeding or thrombosis. These tumors often have a characteristic highly vascular appearance. Hemangiomas are found incidentally during ultrasonography, CT, or MRI. CT typically shows a well-demarcated, hypodense mass; when contrast is used, there is early peripheral enhancement, followed by later centrifugal enhancement. Treatment is usually not indicated. Resection can be considered if symptoms are troublesome or if a hemangioma is rapidly enlarging.

In infants, hemangiomas often regress spontaneously by age 2 years. However, large hemangiomas occasionally cause arteriovenous shunting sufficient to cause heart failure and sometimes consumption coagulopathy. In these cases, treatment may include high-dose corticosteroids, sometimes diuretics and digoxin to improve heart function, interferon alfa (given subcutaneously), surgical removal, selective hepatic artery embolization, and, rarely, liver transplantation Liver Transplantation Liver transplantation is the 2nd most common type of solid organ transplantation. (See also Overview of Transplantation.) Indications for liver transplantation include Cirrhosis (70% of transplantations... read more .

Other benign tumors

Benign bile duct adenomas are rare, inconsequential, and usually detected incidentally. They are sometimes mistaken for metastatic cancer.

General references

  • 1. Marrero JA, Ahn J, Rajender Reddy K, et al: ACG clinical guideline: The diagnosis and management of focal liver lesions. Am J Gastroenterol 109(9):1328-1347, 2014. doi: 10.1038/ajg.2014.213

  • 2. Bieze M , van den Esschert JW , Nio CY, et al: Diagnostic accuracy of MRI in differentiating hepatocellular adenoma from focal nodular hyperplasia: prospective study of the additional value of gadoxetate disodium. AJR Am J Roentgenol 199:26– 34, 2012. doi: 10.2214/AJR.11.7750

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