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Gutartige Lebertumoren

Benign liver tumours

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Zusammenfassung

Die 3 klinisch relevantesten benignen Lebertumoren und tumorartigen Leberläsionen, das (kavernöse) Hämangiom, die fokale noduläre Hyperplasie (FNH) und das Leberzelladenom (HCA), werden meistens als Zufallsbefunde im Rahmen einer abdominellen Ultraschalluntersuchung diagnostiziert. Mittels dynamischer kontrastmittelverstärkter Bildgebung (v. a. der Magnetresonanztomographie) lässt sich die Diagnose in den allermeisten Fällen sichern, sodass eine Histologie für die definitive Diagnosestellung nur noch in Ausnahmefällen notwendig ist. Bei vorbekannter chronischer Hepatopathie/Leberzirrhose oder extrahepatischer maligner Erkrankung muss die Diagnose – benigner Lebertumor – jedoch immer kritisch hinterfragt werden. Beim Leberhämangiom und der FNH ist fast immer von einem unkomplizierten Verlauf auszugehen; ein rein konservatives Vorgehen ohne gezieltes Langzeit-Follow-up wird daher empfohlen. Beim wesentlich selteneren HCA kommt es jedoch, insbesondere ab einer Größe von 5 cm, zu einem Anstieg der Komplikationen. Neben der Neigung zur spontanen Ruptur und Blutung (in bis zu 30 % der Fälle) besteht in Abhängigkeit vom Wachstumsverhalten, Geschlecht und histologischen bzw. molekularem Subtyp (β-HCA) die Gefahr einer malignen Transformation in ein hepatozelluläres Karzinom (HCC). Nach Absetzen einer oraler Kontrazeption und Gewichtsreduktion ist primär ein konservatives Vorgehen unter engmaschiger Überwachung gerechtfertigt. Im Verlauf größenprogrediente Läsionen, Läsionen die weiterhin >5 cm messen und symptomatische HCA sollten jedoch konsequent reseziert werden. Bei Männern sollte aufgrund des höheren Entartungsrisikos das HCA unabhängig von der Größe reseziert werden.

Abstract

The three clinically most relevant benign liver tumors and intrahepatic tumor-like lesions are (cavernous) hemangiomas, focal nodular hyperplasias (FNH) and hepatic adenomas (HCA). Most frequently, these lesions are detected as incidental findings in the context of abdominal ultrasound examinations and diagnosis can be accurately confirmed by dynamic, contrast-enhanced imaging (especially magnetic resonance imaging). Thus, liver histology is only required in rare, ambiguous cases. Importantly, the diagnosis of a benign liver lesion must be questioned and critically evaluated in all patients with pre-existing chronic liver disease, cirrhosis or known extrahepatic malignancies. Since the clinical course of hemangiomas and FNH is favorable and without complications, conservative strategies without long-term surveillance are usually recommended. However, in HCA occurrence of complications is directly related to the size of the lesion and comprises rupture or bleeding in approximately 30 % of the cases when size exceeds 5 cm. Depending on the proliferative capacity, gender, histological as well as molecular subtype (i. e. β‑HCA), risk of malignant transformation into hepatocellular carcinoma is also increased. Treatment strategies for HCAs primarily involve discontinuation of oral contraceptives, weight reduction and close monitoring of the lesions. If this approach is unsuccessful and lesions display progressive growth or cause persistent symptoms, resection should be performed. For HCA in men, resection is generally recommended regardless of the lesion size due to increased risk of malignant transformation.

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Authors and Affiliations

  1. I. Medizinische Klinik und Poliklinik/Cirrhose Centrum Mainz (CCM), Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland

    M.-A. Wörns, C. Labenz & J. U. Marquardt

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  1. M.-A. Wörns
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Correspondence to M.-A. Wörns.

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M.-A. Wörns, C. Labenz und J. U. Marquardt geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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M. Müller-Schilling, Regensburg

G. Gerken, Essen

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Wörns, MA., Labenz, C. & Marquardt, J.U. Gutartige Lebertumoren. Gastroenterologe 11, 349–358 (2016). https://doi.org/10.1007/s11377-016-0094-4

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