Benign liver neoplasms

General Considerations

-Cavernous hemangiomas, focal nodular hyperplasia, hepatic adenomas are the most common benign tumors of the liver.

-Cavernous hemangioma: The most common benign neoplasm of the liver; more than 80% occur in women

-Focal nodular hyperplasia: second most common after cavernous hemangiomas; occurs at all ages

-Hepatocellular adenoma occurs most commonly in women aged 20-40; usually caused by oral contraceptives

Symptoms & Signs

Most benign neoplasms are aymptomatic; Palpable abdominal mass, bleeding, nausea, vomiting, early satiety

Diagnosis

Cavernous hemangioma: Ultrasound, CT, MRI

FNH: lesions are identified by the presence of a central scar; CT, Ultrasound shows

Spoke-wheeling

Hepatic adenoma: Ultrasound show hyperechoic mass; Hepatic angiography is the most valuable diagnostic tool.

Treatment

Cavernous hemangioma: if symptomatic, surgical resection

Focal nodular hyperplasia & OCPs: no need to discontinue OCPs; annual ultrasonography for 2-3 years; if symptomatic, resection

Hepatocellular adenoma: resection, percutaneous radiofrequency ablation

-Resection is advised in all patients in whom the tumor causes symptoms or measures > 5 cm in diameter, even in the absence of symptoms

-Resection is also recommended even for an adenoma measuring < 5 cm in diameter if a beta-catenin gene mutation is present in a biopsy sample