SSAT/AHPBA Joint Symposium on Evaluation and Treatment of Benign Liver Lesions

Abstract

Background Benign liver lesions are common incidental radiologic findings. Methods Experts convened in 2011 at a Society for Surgery of the Alimentary Tract/ Americas Hepato-Pancreato-Biliary Association joint symposium to discuss the evaluation and treatment of benign liver lesions. Results Most benign liver lesions can be accurately diagnosed with high-quality imaging, including ultrasonography, multiphase computed tomography, and magnetic resonance imaging, particularly with hepatocyte-specific contrast agents. Percutaneous biopsy is reserved for lesions that cannot be characterized radiographically, and its accuracy is improved with immunophenotypic markers. Hepatic cysts are the most commonly diagnosed benign liver lesions; these must be distinguished from malignant cystic lesions, which are rare. Among the solid benign liver lesions, hemangiomas and focal nodular hyperplasia seldom require treatment. In contrast, hepatocellular adenomas are associated with a risk for complications. A new classification system for hepatocellular adenomas based on genetic and phenotypic features can help guide patient care. In patients who are symptomatic or at risk for complications, multidisciplinary evaluation and treatment based on clinicopathologic, radiographic, and molecular analysis is needed. Conclusions Most benign liver lesions can be accurately diagnosed radiographically and do not require treatment. Treatment is necessary for patients with symptoms or at risk for complications.

Is This Patient’s Liver Mass Cancer?

“…Ms. BP was scheduled for follow-up per consensus guidelines ( Figure 3 ). As stated by Chun and colleagues (2013) , “Guidelines for surgical management of HCAs include resection of all adenomas in men, regardless of lesion size, given their risk of malignant transformation, resection of adenomas associated with symptoms or hemorrhage, observation off oral contraceptives for adenomas ≤ 5 cm in women, and resection of adenomas > 5 cm in women.” Liver lesions can be frightening for patients and caregivers, but by understanding their characteristics, including presentation, implications, and potential causes, care can be focused on necessary earlier interventions to improve outcomes. l…”