The Diagnosis and Management of Benign Hepatic Tumors

Abstract

Benign hepatic tumors include a broad spectrum of regenerative and true neoplastic processes. Because of advances in imaging studies such as computed tomography (CT) and magnetic resonance imaging (MRI) as well as progress in immunohistochemistry, accurate diagnosis can now be made in a large percentage of patients without surgical laparotomy or resection. This article will focus on the pathogenesis, diagnosis, and management of focal benign lesions of the liver. Many of these tumors present with typical features in various imaging studies. On occasions, biopsies are required and/or surgical removal is needed. The most common benign hepatic tumors include cavernous hemangioma, focal nodular hyperplasia, hepatic adenoma, and nodular regenerative hyperplasia. In the majority of cases of benign hepatic tumors, patients are asymptomatic, and no treatment is indicated. The main indication for treatment is the presence of significant clinical symptoms or suspicion of malignancy or fear of malignant transformation.

Hepatic adenomas: Presumed innocent until proven to be beta-catenin mutated

“…Additionally, glycogen storage diseases, especially Type I (von Gierke) and Type III, are known risk factors for the development of hepatic adenoma. 2,5 In this condition, the tumors often times occur in multiple with a higher propensity to undergo malignant transformation. Macroscopically, HA presents as a solitary, yellowish mass due to lipid accumulation and gives a pseudo-encapsulated appearance because of the compression of adjacent hepatic tissue.…”

“…6 Some of the histological features include areas of fatty deposits and hemorrhage, cord-or plate-like arrangements of larger hepatocytes containing excessive glycogen and fat, sinusoidal dilatation (the result of the effects of arterial pressure as these tumors lack a portal venous supply), absent bile ductules, and presence of few and non-functioning Kupffer cells. 2,6 The extensive hypervascularity and a lack of a true capsule makes this tumor prone to hemorrhage.…”

“…2,6 The tumors can regress in size following discontinuation of inciting factors such as oral contraceptives; at other times they continue to exhibit a stable or progressive disease. However, the risk of associated hemorrhage and neoplastic transformation is always present.…”

“…The prognosis and fate of various lesions, such as focal nodular hyperplasia (FNH), nodular regenerative hyperplasia (NRH) and hemangiomas are better understood and the management is mainly conservative unless there are associated symptoms or more importantly, if malignancy cannot be ruled out. 1,2 However, management of hepatic adenomas (HA), a rare benign hepatic tumor, is considerably more challenging. Adenomas have been classically associated with the use of estrogen-containing oral contraceptives or androgencontaining steroid anabolics.…”

Liver Transplantation in Children With Glycogen Storage Diseases: Risk Assessment and Necessity of This Procedure

“…Аде-номы, связанные с гликогенозами, обычно мно-жественные, мелкие и неинкапсулированные [26], тогда как при других заболеваниях печени чаще обнаруживаются солитарные, крупные, четко огра-ниченные аденомы [9,19]. Было показано, что око-ло 50% аденом, связанных с гликогенозом I типа, в последующем могут увеличиваться в количестве и размерах [41].…”