Welcome back. Thanks for joining me on this discussion of benign liver masses in this section
of general surgery. Today, we’ll talk about two of the more common presentations of benign tumors,
a hepatic adenoma and a hemangioma. Hepatic adenomas are commonly associated with birth control
use and may have the tendency to rupture and bleed. In distinction, hemangioma is the most common
tumor of the liver, benign tumor that is. Generally speaking, it’s found in young to middle age women.
As a surgeon, when I’m in the patient’s abdomen, I commonly see asymptomatic hemangiomas
when I look at the liver. It’s usually of no clinical consequence and it’s a vascular malformation.
Physical findings may include right upper quadrant abdominal pain. But the vast majority of patients
with both adenomas and hemangiomas are asymptomatic. You may get some routine labs.
The chemistry may be absolutely normal. In fact, the CBC is likely to be normal unless the patient
is actively bleeding. This may result in a decrease in the hematocrit. Liver function tests are usually
not very helpful for hemangiomas or adenomas. This is a cross sectional CT scan of the abdomen
and pelvis. It demonstrates a centrally located hepatic adenoma. This looks a little bit different
in the previous CT scans and is again a cross sectional CT scan of the abdomen and pelvis
demonstrating hemangioma with particular or specific vascular filling or at different contrast phases.
Medical management of hepatic adenomas include stopping oral contraceptives if feasible.
Sometimes it needs to be operated on if they’re enlarging rapidly, causing pain, or potentially bleeding.
Hemangiomas are largely observed. Rarely, a surgery is necessary. Of course, if it’s enlarging rapidly
causing pain and bleeding similarly to the adenoma, we would offer surgery. Let me pose a question
to you. How do you differentiate between a focal nodular hyperplasia versus an adenoma?
I’ll give you a second to think about this. The answer is a sulfur colloid scan.