Benign Liver Tumors

The most common benign liver tumors include hepatic hemangiomas, focal nodular hyperplasia, and hepatic adenomas. These tumors are mostly asymptomatic and/or found incidentally on abdominal imaging. While these tumors are benign, large lesions can cause symptoms such as upper abdominal pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain, or produce complications such as bleeding. Malignant potential is a concern for hepatic adenoma, depending on risk factors. The diagnosis is based on imaging studies, with characteristic findings defining the tumor. Biopsy generally is reserved for equivocal cases. Management is observation for most small, asymptomatic, and non-growing tumors. However, high-risk factors, symptoms, increasing tumor size, and complications dictate the need for surgical intervention.

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Overview

Introduction

  • Most common benign liver tumors:
    • Hepatic hemangioma
    • Focal nodular hyperplasia (FNH)
    • Hepatocellular adenoma (HCA) or hepatic adenoma
  • Clinical significance:
    • These lesions can cause symptoms and complications.
    • Some lesions have a risk of developing hepatocellular carcinoma Hepatocellular carcinoma Hepatocellular carcinoma (HCC) typically arises in a chronically diseased or cirrhotic liver and is the most common primary liver cancer. Diagnosis may include ultrasound, CT, MRI, biopsy (if inconclusive imaging), and/or biomarkers. Hepatocellular Carcinoma (HCC) and Liver Metastases ( HCC HCC Hepatocellular carcinoma (HCC) typically arises in a chronically diseased or cirrhotic liver and is the most common primary liver cancer. Diagnosis may include ultrasound, CT, MRI, biopsy (if inconclusive imaging), and/or biomarkers. Hepatocellular Carcinoma (HCC) and Liver Metastases).

Epidemiology

  • Advances in imaging have led to many incidental findings.
  • Liver Liver The liver is the largest gland in the human body. The liver is found in the superior right quadrant of the abdomen and weighs approximately 1.5 kilograms. Its main functions are detoxification, metabolism, nutrient storage (e.g., iron and vitamins), synthesis of coagulation factors, formation of bile, filtration, and storage of blood. Liver lesions are noted in the following imaging studies:
    • Ultrasound (US)
    • Computed tomography (CT) scan 
    • Magnetic resonance imaging (MRI) 
  • Incidental hepatobiliary detection in screening chest CT: prevalence of 6%
  • Epidemiologic findings for benign tumors:
    • Hepatic or cavernous hemangioma:
      • Most common benign liver tumor
      • Prevalence: 0.4%–20% of the population
      • Women > men
      • Often found at 30–50 years of age
    • FNH:
      • 2nd-most common benign liver tumor
      • Prevalence: 2%–3% of the population
      • Women > men
      • Often found at 35–50 years of age
    • HCA:
      • Rare
      • Women > men
      • Diagnosed frequently at 35–40 years of age

General comparison of hepatic tumors

  • It is important to distinguish benign tumors from malignancy, as management and prognosis are affected.
  • An outline of differentiating characteristics is summarized below.
Table: Comparison of liver tumors
Hepatic hemangioma Focal nodular hyperplasia Hepatocellular adenoma Hepatocellular carcinoma
Characteristics and pathologic features Cavernous vascular spaces Central stellate scar + portal tracts, bile ductules, Kupffer cells Sheets of enlarged hepatocytes; no portal tracts or bile ductules Well-differentiated (similar to normal hepatocytes); poorly differentiated (marked cytologic atypia)
Predominant gender affected Women Women Women Men
Clinical history Oral contraceptive pills (OCPs) may affect growth. OCP effect not proven; little or no effect on development or growth OCPs, anabolic steroids a factor History of cirrhosis Cirrhosis Cirrhosis is a late stage of hepatic parenchymal necrosis and scarring (fibrosis) most commonly due to hepatitis C infection and alcoholic liver disease. Patients may present with jaundice, ascites, and hepatosplenomegaly. Cirrhosis can also cause complications such as hepatic encephalopathy, portal hypertension, portal vein thrombosis, and hepatorenal syndrome. Cirrhosis and risk factors (e.g., hepatitis B Hepatitis B Hepatitis B virus (HBV) is a partially double-stranded DNA virus, which belongs to the Orthohepadnavirus genus and the Hepadnaviridae family. Most individuals with acute HBV infection are asymptomatic or have mild, self-limiting symptoms. Chronic infection can be asymptomatic or create hepatic inflammation, leading to liver cirrhosis and hepatocellular carcinoma (HCC). Hepatitis B Virus)
Malignancy potential None None Yes N/A
MRI (contrast): arterial phase Peripheral nodular enhancement Early homogeneous/diffuse enhancement Well-demarcated enhancement; heterogeneous (due to hemorrhage, necrosis, steatosis) Hyperenhancement
MRI (contrast): venous phase Progressive centripetal fill-in Isointense with central scar enhancement Variable Variable Variables represent information about something that can change. The design of the measurement scales, or of the methods for obtaining information, will determine the data gathered and the characteristics of that data. As a result, a variable can be qualitative or quantitative, and may be further classified into subgroups. Types of Variables late phase
  • Inflammatory: Enhancement persists.
  • HNF1-ɑ mutation Mutation Genetic mutations are errors in DNA that can cause protein misfolding and dysfunction. There are various types of mutations, including chromosomal, point, frameshift, and expansion mutations. Types of Mutations: Arterial enhancement does not persist.
Portal venous washout
Additional key points
  • Can use technetium-99m pertechnetate-labeled red blood cell scan
  • Biopsy not recommended (high risk of hemorrhage)
60%–70% positive uptake in sulfur colloid scan No MRI-specific pattern was identified for β-catenin–mutated HCA. Rim enhancement on delayed post-contrast images causing a capsule-appearance: relatively specific for HCC HCC Hepatocellular carcinoma (HCC) typically arises in a chronically diseased or cirrhotic liver and is the most common primary liver cancer. Diagnosis may include ultrasound, CT, MRI, biopsy (if inconclusive imaging), and/or biomarkers. Hepatocellular Carcinoma (HCC) and Liver Metastases

Hemangioma

Features

  • Gross examination: 
    • Often solitary, but may present as multiple lesions
    • Red-brown spongy mass, frequently with a capsule
    • Size:
      • Most are < 5 cm
      • If the lesion is ≥ 10 cm: giant hemangioma
    • Location: frequently in the right lobe
  • Microscopic examination:
    • Consists of cavernous vascular spaces, with a layer of endothelium
    • May contain thrombi

Pathogenesis

  • Unclear pathogenetic process
  • Believed to result from a congenital vascular malformation, with dilation as the growth pattern 
  • Risk factors: Estrogen such as in OCPs or pregnancy Pregnancy Pregnancy is the time period between fertilization of an oocyte and delivery of a fetus approximately 9 months later. The 1st sign of pregnancy is typically a missed menstrual period, after which, pregnancy should be confirmed clinically based on a positive β-hCG test (typically a qualitative urine test) and pelvic ultrasound. Pregnancy: Diagnosis, Maternal Physiology, and Routine Care may promote its growth.

Clinical presentation

  • Typically asymptomatic
  • Frequently discovered incidentally on imaging studies
  • May cause right upper quadrant (RUQ) pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain/fullness
  • If large enough (> 10 cm), may compress other organs and manifest as nausea, early satiety, and bloating
  • Physical examination often normal, but may show a palpable liver mass
  • Kasabach-Merritt syndrome: 
    • A giant hemangioma may cause this rare coagulation disorder.
    • Associated with thrombocytopenia Thrombocytopenia Thrombocytopenia occurs when the platelet count is < 150,000 per microliter. The normal range for platelets is usually 150,000-450,000/µL of whole blood. Thrombocytopenia can be a result of decreased production, increased destruction, or splenic sequestration of platelets. Patients are often asymptomatic until platelet counts are < 50,000/µL. Thrombocytopenia, consumption coagulopathy, and bleeding
    • Mortality rate of up to 37%

Diagnosis

  • Ultrasound: 
    • Homogeneous hyperechoic mass
    • Doppler can show blood flow within the hemangioma.
    • With contrast: 
      • Enhanced ultrasound signal from the flowing blood
      • Arterial phase: peripheral nodular enhancement 
      • Late phase: continued enhancement, with centripetal filling-in
  • MRI:
    • Well-demarcated homogeneous mass 
    • Hypointense lesion on T1; high signal intensity on T2-weighted images
    • With contrast: peripheral nodular enhancement, with progression centripetally
  • CT: 
    • Without contrast: well-demarcated hypodense mass
    • With contrast: peripheral enhancement on early phase and with centripetal filling seen on late phase
  • Biopsy is not recommended:
    • Risks of hemorrhage or rupture with invasive procedure
    • Low diagnostic yield

Management

  • Observation if asymptomatic:
    • ≤ 5 cm: no further imaging
    • > 5 cm: 
      • Repeat imaging in 6–12 months. 
      • If lesion is stable (growth rate ≤ 3 mm/year), no further testing
  • Consider surgery (liver resection or enucleation):
    • Persistent symptoms and/or rapid enlargement (> 3 mm/year)
    • Symptomatic patients
  • Transcatheter arterial embolization can be used to decrease lesion size prior to surgery.

Focal Nodular Hyperplasia

Features

  • Gross examination: 
    • Firm, solitary lesion, without a capsule
    • Characteristic central stellate scar (multiple branches from an artery radiating to the periphery)
    • Size: often < 5 cm
    • Location: usually subcapsular 
    • FNH has atypical variants.
  • Microscopic examination:
    • Grouped hepatocytes, divided by fibrous septa, radiating from the central scar
    • Septa contain arteries Arteries Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles. Arteries, portal veins Veins Veins are tubular collections of cells, which transport deoxygenated blood and waste from the capillary beds back to the heart. Veins are classified into 3 types: small veins/venules, medium veins, and large veins. Each type contains 3 primary layers: tunica intima, tunica media, and tunica adventitia. Veins, bile ductules, and Kupffer cells.
    • Strong cytoplasmic glutamine synthetase staining within groups of hepatocytes
Classic focal nodular hyperplasia

Histologic features of classic FNH: Tumor was subdivided into nodules by fibrous septa (A, white arrowhead) originating from a central scar (A, white arrow). Malformed arteries Arteries Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles. Arteries (B, black arrow) and bile ductular proliferation are demonstrated (B, black arrowhead).

Image: “Histological features of the classic focal nodular hyperplasia” by Department of Radiology, PLA General Hospital, #28 Fuxing Road, Beijing, 100853, China. License: CC BY 4.0

Pathogenesis

  • Regenerative response of hepatocytes to altered perfusion from anomalous arteries Arteries Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles. Arteries (in the center of the nodule) 
  • No malignant potential
  • Increased risk of FNH in hereditary hemorrhagic telangiectasia

Clinical presentation

  • Asymptomatic
  • Often found incidentally on imaging
  • If symptomatic, commonly the symptom is abdominal pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain.
  • Physical examination: usually normal, but may show an abdominal mass

Diagnosis

  • US:
    • Non-contrast: isoechoic mass
    • With contrast:
      • FNH: enhancement sustained in arterial phase and early venous phase
      • Central arteries Arteries Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles. Arteries seen with spoke-wheel pattern on arterial phase (centrifugal)
  • MRI scan: 
    • Highest diagnostic accuracy
    • Pre-contrast: isointense on T1; slightly hyperintense on T2-weighted images
    • With contrast: 
      • Arterial phase: rapid/early homogeneously enhanced hypervascular mass
      • Delayed phase: isointense mass, with enhancement of the central scar
  • CT scan:
    • Pre-contrast: isodense
    • With contrast:
      • Arterial phase: homogeneous hyperdense lesion 
      • Venous phase: isodense, similar to liver parenchyma; the central scar becomes hyperdense.
  • Nuclear medicine (technetium-99m sulfur colloid scan): 
    • Increased uptake of sulfur colloid (Kupffer cell activity) is seen in 60%–70% of patients. 
    • Helps to differentiate FNH from adenoma (which has no Kupffer cell activity)
  • If imaging findings are not typical of FNH, a biopsy may be required.
Focal nodular hyperplasia

Computed tomography findings of FNH: Mixed phase (hepatic arterial phase/portal venous phase during hepatic enhancement) shows intense homogeneous enhancement with hypodense focal central scar (a); on delayed phase (b), the lesion appears substantially isodense to liver parenchyma with persistent enhancement of central scar.

Image: “Fig3” by Department of Surgical and Biomedical Sciences, Division of Radiology 2, Perugia University, S, Maria della Misericordia Hospital, S, Andrea delle Fratte, 06134 Perugia, Italy. License: CC BY 4.0

Management

  • For asymptomatic patients: no routine surveillance recommended as lesion rarely grows
  • For symptomatic patients: may undergo transarterial embolization, radiofrequency ablation, or surgical resection

Hepatocellular Adenoma

Features

  • Gross examination: 
    • Typically a solitary lesion with well-defined margin, but can occur as multiple lesions
    • Varied sizes, from small to several centimeters
    • Lacks a fibrous capsule (risk for rupture and bleeding)
    • Location: often in the right lobe of the liver
  • Microscopic examination:
    • Sheets of enlarged hepatocytes with small nuclei, glycogen, and lipid
    • Large arteries Arteries Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles. Arteries present
    • Generally, no portal tracts or bile ductules (differentiates HCA from FNH); inflammatory subtype is an exception
Hepatic adenoma

Hepatic adenoma: well-differentiated neoplasm composed of normal-appearing hepatocytes arranged in sheets and thin cords with patchy pseudoacinar growth pattern (thin arrows), scattered inflammatory foci, and bands of fibrosis with unpaired large arteries Arteries Arteries are tubular collections of cells that transport oxygenated blood and nutrients from the heart to the tissues of the body. The blood passes through the arteries in order of decreasing luminal diameter, starting in the largest artery (the aorta) and ending in the small arterioles. Arteries are classified into 3 types: large elastic arteries, medium muscular arteries, and small arteries and arterioles. Arteries (thick arrow)

Image: “Hepatic adenoma” by M. I. Montenovo. License: CC BY 4.0

Pathogenesis

  • Benign glandular epithelial tumor, with the following risk factors: 
    • Use of OCPs, anabolic steroids 
    • Genetic syndromes such as glycogen storage diseases and familial adenomatous polyposis Familial Adenomatous Polyposis Familial adenomatous polyposis (FAP) is an autosomal dominant inherited genetic disorder that presents with numerous adenomatous polyps in the colon. Familial adenomatous polyposis is the most common of the polyposis syndromes, which is a group of inherited or acquired conditions characterized by the growth of polyps in the GI tract, associated with other extracolonic features. Familial Adenomatous Polyposis
    • Obesity Obesity Obesity is a condition associated with excess body weight, specifically with the deposition of excessive adipose tissue. Obesity is considered a global epidemic. Major influences come from the western diet and sedentary lifestyles, but the exact mechanisms likely include a mixture of genetic and environmental factors. Obesity, metabolic syndrome Metabolic syndrome Metabolic syndrome is a cluster of conditions that significantly increases the risk for several secondary diseases, notably cardiovascular disease, type 2 diabetes, and nonalcoholic fatty liver. In general, it is agreed that hypertension, insulin resistance/hyperglycemia, and hyperlipidemia, along with central obesity, are components of the metabolic syndrome. Metabolic Syndrome
  • Subtypes based on the molecular behavior of HCA:
    • Adenomas with hepatocyte nuclear factor 1 alpha (HNF1-ɑ) mutation Mutation Genetic mutations are errors in DNA that can cause protein misfolding and dysfunction. There are various types of mutations, including chromosomal, point, frameshift, and expansion mutations. Types of Mutations:
      • 35%–40%
      • Have loss-of-function mutations in the HNF1-ɑ gene
      • Findings: steatosis or prominent fat in hepatocytes
      • Predominantly affects women 
      • Low risk of malignant transformation
      • Associated with mature-onset diabetes of the young (MODY 3)
    • β-catenin–activated HCA:
      • 10%–20% 
      • Associated with mutations of the CTNNB1 (β-catenin) gene or other Wnt pathway components
      • Frequently in men
      • Linked to anabolic steroid use
      • Findings: atypical cytologic features
      • High risk for HCC HCC Hepatocellular carcinoma (HCC) typically arises in a chronically diseased or cirrhotic liver and is the most common primary liver cancer. Diagnosis may include ultrasound, CT, MRI, biopsy (if inconclusive imaging), and/or biomarkers. Hepatocellular Carcinoma (HCC) and Liver Metastases development
    • Inflammatory adenomas:
      • 40%–50%
      • Findings: inflammatory infiltrates, sinusoidal dilation
      • More prevalent in women with obesity or diabetes
    • Unclassified: up to 10%

Clinical presentation

  • May be asymptomatic, but 25% of patients present with RUQ pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain or mass
  • Hemorrhage: higher risk when size is > 5 cm
    • Bleeding into the lesion can manifest as abdominal pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain.
    • In severe cases, rupture into the peritoneum Peritoneum The peritoneum is a serous membrane lining the abdominopelvic cavity. This lining is formed by connective tissue and originates from the mesoderm. The membrane lines both the abdominal walls (as parietal peritoneum) and all of the visceral organs (as visceral peritoneum). Peritoneum and Retroperitoneum presents with severe pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain and hypotension Hypotension Hypotension is defined as low blood pressure, specifically < 90/60 mm Hg, and is most commonly a physiologic response. Hypotension may be mild, serious, or life threatening, depending on the cause. Hypotension.

Diagnosis

  • US: 
    • Without contrast: nonspecific heterogeneous mass
    • With contrast: hyperenhancement from periphery to center (centripetal)
  • CT scan: 
    • Without contrast: isodense lesion
    • With contrast: 
      • Arterial phase: may have peripheral enhancement 
      • Portal venous phase: with centripetal flow
    • If with areas of hemorrhage, necrosis, and calcification, adenoma appears heterogeneous.
  • MRI with contrast:
    • Superior to other modalities for HCA diagnosis
    • Arterial phase: well-demarcated, enhanced lesion (heterogeneous due to hemorrhage, necrosis, steatosis)
    • Pattern in later phases correlates with molecular subtypes in majority of cases (inflammatory and HNF1-ɑ type):
      • Inflammatory adenoma: Arterial enhancement persists into the portal venous and delayed phases.
      • HCA with HNF1-ɑ mutation Mutation Genetic mutations are errors in DNA that can cause protein misfolding and dysfunction. There are various types of mutations, including chromosomal, point, frameshift, and expansion mutations. Types of Mutations: Arterial enhancement does not persist.
      • β-catenin–activated HCA: no specific MRI characteristics
  • Core needle biopsy: for clarification if imaging is equivocal
Benign liver disease mri with adenoma with bleeding

Magnetic resonance imaging in a patient with adenoma with bleeding: white arrow, hematoma; black arrow, hepatic adenoma.
A: T2 sequence with fat saturation shows a hepatic subcapsular nodule with hyposignal.
B: Pre-contrast T1 sequence shows a lesion with hypersignal, signifying products of hemoglobin degradation.
C: Post-contrast T1 sequence in the arterial phase emphasizes the hepatic lesion.

Image: “MRI” by Enio Campos AMICO, José Roberto ALVES et al. License: CC BY 4.0

Management

  • Discontinue anabolic steroids or OCPs.
  • Weight loss
  • Observation and surveillance:
    • Women with tumor < 5 cm: contrast-enhanced MRI in 6 months and annually thereafter if there is no growth
    • Asymptomatic women, tumor > 5 cm with OCP use:
      • May try OCP discontinuation
      • If MRI shows lesion remains > 5 cm after 6 months, proceed with surgical resection.
  • Surgical resection:
    • Tumor is > 5 cm: surgical resection due to increased risk of rupture, bleeding, or malignant transformation
    • Men with HCA (regardless of size)
    • Proven β-catenin mutation Mutation Genetic mutations are errors in DNA that can cause protein misfolding and dysfunction. There are various types of mutations, including chromosomal, point, frameshift, and expansion mutations. Types of Mutations
  • Transarterial embolization: 
    • Tumor complicated by bleeding and hemodynamic instability
    • If after the procedure there is residual lesion noted on follow-up imaging, perform surgical resection.

Differential Diagnosis

  • HCC HCC Hepatocellular carcinoma (HCC) typically arises in a chronically diseased or cirrhotic liver and is the most common primary liver cancer. Diagnosis may include ultrasound, CT, MRI, biopsy (if inconclusive imaging), and/or biomarkers. Hepatocellular Carcinoma (HCC) and Liver Metastases: a type of cancer that develops in patients with liver cirrhosis Cirrhosis Cirrhosis is a late stage of hepatic parenchymal necrosis and scarring (fibrosis) most commonly due to hepatitis C infection and alcoholic liver disease. Patients may present with jaundice, ascites, and hepatosplenomegaly. Cirrhosis can also cause complications such as hepatic encephalopathy, portal hypertension, portal vein thrombosis, and hepatorenal syndrome. Cirrhosis. Typically presents with abdominal pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain and is found on imaging of the liver. Treatment is with surgery, radiation, and chemotherapy. There are specific imaging features of hepatic hemangioma (peripheral enhancement) and FNH (central stellate scar) that can help to differentiate these tumors from HCC HCC Hepatocellular carcinoma (HCC) typically arises in a chronically diseased or cirrhotic liver and is the most common primary liver cancer. Diagnosis may include ultrasound, CT, MRI, biopsy (if inconclusive imaging), and/or biomarkers. Hepatocellular Carcinoma (HCC) and Liver Metastases. Further differentiation may require a biopsy of the lesion.
  • Liver Liver The liver is the largest gland in the human body. The liver is found in the superior right quadrant of the abdomen and weighs approximately 1.5 kilograms. Its main functions are detoxification, metabolism, nutrient storage (e.g., iron and vitamins), synthesis of coagulation factors, formation of bile, filtration, and storage of blood. Liver metastases: present as masses in the liver parenchyma. These lesions are seen as multiple ring-enhancing lesions of the liver on contrast CT scan, which help distinguish them from benign lesions. Patients often have a history of extrahepatic malignancy that makes metastasis a more likely cause of liver lesions. 
  • Liver Liver The liver is the largest gland in the human body. The liver is found in the superior right quadrant of the abdomen and weighs approximately 1.5 kilograms. Its main functions are detoxification, metabolism, nutrient storage (e.g., iron and vitamins), synthesis of coagulation factors, formation of bile, filtration, and storage of blood. Liver abscess: presents as a mass in the liver parenchymal due to infection in the liver. Patients often present with diarrhea Diarrhea Diarrhea is defined as ≥ 3 watery or loose stools in a 24-hour period. There are a multitude of etiologies, which can be classified based on the underlying mechanism of disease. The duration of symptoms (acute or chronic) and characteristics of the stools (e.g., watery, bloody, steatorrheic, mucoid) can help guide further diagnostic evaluation. Diarrhea (in cases of amebic liver abscess), abdominal pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain, and/or fever Fever Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin. Fever. Systemic symptoms help differentiate abscesses from other tumors. 
  • Hepatic cysts: benign liquid-filled lesions on the liver, often presenting as incidental liver masses. On ultrasound, the cyst is an anechoic, round lesion with dorsal acoustic enhancement. On CT scan, the cyst is seen as a well-delimited lesion with no contrast enhancement, which helps to differentiate hepatic cysts from benign liver tumors.

References

  1. Chopra, S. (2019). Focal nodular hyperplasia. Runyon, B., Robson, K. (Eds). UpToDate. Retrieved 22 Nov 2020 from https://www.uptodate.com/contents/focal-nodular-hyperplasia
  2. Colombo, M. (2020). EASL Clinical Practice Guidelines on the Management of Benign Liver Tumors. Retrieved 22 Nov 2020 from https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/cld.933
  3. Curry, M., Chopra, S. (2019). Hepatic hemangioma. Lindor, K., Robson, K. (Eds). UpToDate. Retrieved 22 Nov 2020 from https://www.uptodate.com/contents/hepatic-hemangioma
  4. Friedman L.S. (2021). Benign liver neoplasms. Papadakis M.A., & McPhee S.J., & Rabow M.W.(Eds.), Current Medical Diagnosis & Treatment 2021. McGraw-Hill.
  5. Gill, R., Kakar, S. (2020). In Kumar, V., Abbas, A. K., Aster, J.C., (Eds.), Robbins & Cotran Pathologic Basis of Disease. (10th ed., pp. 865-867). Elsevier, Inc
  6. Leon, M., Chavez, L., Surani, S. (2020). Hepatic hemangioma: what internists need to know. World J Gastroenterol. 26(1): 11–20. doi: 10.3748/wjg.v26.i1.11
  7. Llovet J.M. (2018). Tumors of the liver and biliary tree. Jameson J, & Fauci A.S., & Kasper D.L., & Hauser S.L., & Longo D.L., & Loscalzo J (Eds.), Harrison’s Principles of Internal Medicine, 20e. McGraw-Hill.
  8. Raveendran, S., Lu, Z. (2018). A short review on early HCC: MRI findings and pathological diagnosis. Radiology of Infectious Diseases, Volume 5, Issue 2, pp. 91-97. https://doi.org/10.1016/j.jrid.2017.08.008
  9. Shreenath, A., Kahloon, A. (2020). Hepatic Adenoma. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK513264/

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