Skip to main content

Advertisement

SpringerLink
Log in

Benign Solid Tumors of the Liver: Management in the Modern Era

  • Review Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Recently, there has been a growing interest in solid benign liver tumors as the understanding of the pathogenesis and molecular underpinning of these lesions continues to evolve. We herein provide an evidence-based review of benign solid liver tumors with particular emphasis on the diagnosis and management of such tumors.

Methods

A search of all available literature on benign hepatic tumors through a search of the MEDLINE/PubMed electronic database was conducted.

Results

New diagnostic and management protocols for benign liver tumors have emerged, as well as new insights into the molecular pathogenesis. In turn, these data have spawned a number of new studies seeking to correlate molecular, clinicopathological, and clinical outcomes for benign liver tumors. In addition, significant advances in surgical techniques and perioperative care have reduced the morbidity and mortality of liver surgery. Despite current data that supports conservative management for many patients with benign liver tumors, patients with severe preoperative symptomatic disease seem to benefit substantially from surgical treatment based on quality of life data.

Conclusion

Future studies should seek to further advance our understanding of the underlying pathogenesis and natural history of benign liver tumors in order to provide clinicians with evidence-based guidelines to optimize treatment of patients with these lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Abbreviations

HCA:

Hepatocellular adenoma

FNH:

Focal nodular hyperplasia

IHCA:

Inflammatory HCA

CT:

Computed tomography

MRI:

Magnetic resonance imaging

OCP:

Oral contraceptive

MODY:

Maturity onset diabetes of the young

References

  1. Rebouissou S, Bioulac-Sage P and Zucman-Rossi J: Molecular pathogenesis of focal nodular hyperplasia and hepatocellular adenoma. J Hepatol, 2008. 48(1): p. 163–70.

    Article  CAS  PubMed  Google Scholar 

  2. Zucman-Rossi J, Jeannot E, Nhieu JT, et al.: Genotype-phenotype correlation in hepatocellular adenoma: new classification and relationship with HCC. Hepatology, 2006. 43(3): p. 515–24.

    Article  CAS  PubMed  Google Scholar 

  3. Karhunen PJ: Benign hepatic tumours and tumour like conditions in men. J Clin Pathol, 1986. 39(2): p. 183–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Reddy KR, Kligerman S, Levi J, et al.: Benign and solid tumors of the liver: relationship to sex, age, size of tumors, and outcome. Am Surg, 2001. 67(2): p. 173–8.

    CAS  PubMed  Google Scholar 

  5. Gandolfi L, Leo P, Solmi L, et al.: Natural history of hepatic haemangiomas: clinical and ultrasound study. Gut, 1991. 32(6): p. 677–80.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Gemer O, Moscovici O, Ben-Horin CL, et al.: Oral contraceptives and liver hemangioma: a case–control study. Acta Obstet Gynecol Scand, 2004. 83(12): p. 1199–201.

    Article  PubMed  Google Scholar 

  7. Glinkova V, Shevah O, Boaz M, Levine A, and Shirin H: Hepatic haemangiomas: possible association with female sex hormones. Gut, 2004. 53(9): p. 1352–5.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Saegusa T, Ito K, Oba N, et al.: Enlargement of multiple cavernous hemangioma of the liver in association with pregnancy. Intern Med, 1995. 34(3): p. 207–11.

    Article  CAS  PubMed  Google Scholar 

  9. Conter RL and Longmire WP, Jr.: Recurrent hepatic hemangiomas. Possible association with estrogen therapy. Ann Surg, 1988. 207(2): p. 115–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Xiao X, Hong L and Sheng M: Promoting effect of estrogen on the proliferation of hemangioma vascular endothelial cells in vitro. J Pediatr Surg, 1999. 34(11): p. 1603–5.

    Article  CAS  PubMed  Google Scholar 

  11. Buell JF, Tranchart H, Cannon R and Dagher I: Management of benign hepatic tumors. Surg Clin North Am, 2010. 90(4): p. 719–35.

    Article  PubMed  Google Scholar 

  12. Etemadi A, Golozar A, Ghassabian A, et al.: Cavernous hemangioma of the liver: factors affecting disease progression in general hepatology practice. Eur J Gastroenterol Hepatol, 2011. 23(4): p. 354–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Terkivatan T, Vrijland WW, Den Hoed PT, et al.: Size of lesion is not a criterion for resection during management of giant liver haemangioma. Br J Surg, 2002. 89(10): p. 1240–4.

    Article  CAS  PubMed  Google Scholar 

  14. Hasan HY, Hinshaw JL, Borman EJ, et al.: Assessing Normal Growth of Hepatic Hemangiomas During Long-term Follow-up. JAMA Surg, 2014.

  15. Kasabach HH and Merritt KK: Capillary hemangioma with extensive purpura: report of a case. American Journal of Diseases of Children, 1940. 59(5): p. 1063–1070.

    Article  Google Scholar 

  16. Aiura K, Ohshima R, Matsumoto K, et al.: Spontaneous rupture of liver hemangioma: risk factors for rupture. J Hepatobiliary Pancreat Surg, 1996. 3(3): p. 308–312.

    Article  Google Scholar 

  17. Jain V, Ramachandran V, Garg R, et al.: Spontaneous rupture of a giant hepatic hemangioma–sequential management with transcatheter arterial embolization and resection. Saudi journal of gastroenterology: official journal of the Saudi Gastroenterology Association, 2010. 16(2): p. 116.

    Article  Google Scholar 

  18. Beatty JS, Mitchell JW, Holsten SB and Ferdinand C: Traumatic rupture of a previously undiagnosed giant hepatic hemangioma. The American surgeon, 2013. 79(9): p. 314–315.

    Google Scholar 

  19. Gilon D, Slater PE and Benbassat J: Can decision analysis help in the management of giant hemangioma of the liver? J Clin Gastroenterol, 1991. 13(3): p. 255–8.

    Article  CAS  PubMed  Google Scholar 

  20. Chen ZY, Qi QH and Dong ZL: Etiology and management of hemorrhage in spontaneous liver rupture: a report of 70 cases. World J Gastroenterol, 2002. 8(6): p. 1063–6.

    PubMed  Google Scholar 

  21. Caseiro-Alves F, Brito J, Araujo AE, et al.: Liver haemangioma: common and uncommon findings and how to improve the differential diagnosis. European radiology, 2007. 17(6): p. 1544–1554.

    Article  PubMed  Google Scholar 

  22. Baer HU, Dennison AR, Mouton W, et al.: Enucleation of giant hemangiomas of the liver. Technical and pathologic aspects of a neglected procedure. Ann Surg, 1992. 216(6): p. 673–6.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  23. Farges O, Daradkeh S and Bismuth H: Cavernous hemangiomas of the liver: are there any indications for resection. World journal of surgery, 1995. 19(1): p. 19–24.

    Article  CAS  PubMed  Google Scholar 

  24. Yoon SS, Charny CK, Fong Y, et al.: Diagnosis, management, and outcomes of 115 patients with hepatic hemangioma. J Am Coll Surg, 2003. 197(3): p. 392–402.

    Article  PubMed  Google Scholar 

  25. Weimann A, Ringe B, Klempnauer J, et al.: Benign liver tumors: differential diagnosis and indications for surgery. World J Surg, 1997. 21(9): p. 983–90; discussion 990–1.

    Article  CAS  PubMed  Google Scholar 

  26. Belghiti J, Cauchy F, Paradis V and Vilgrain V: Diagnosis and management of solid benign liver lesions. Nat Rev Gastroenterol Hepatol, 2014.

  27. Xiao-Hui F, Chun Hung LE, Xiao-Ping Y, et al.: Enucleation of liver hemangiomas: is there a difference in surgical outcomes for centrally or peripherally located lesions? The American Journal of Surgery, 2009. 198(2): p. 184–187.

    Article  Google Scholar 

  28. Loss M, Zulke C, Obed A, Stoltzing O, and Schlitt HJ: Surgical therapy of benign liver tumors. Chirurg, 2008. 79(8): p. 722–8.

    Article  CAS  PubMed  Google Scholar 

  29. Schnelldorfer T, Ware AL, Smoot R, et al.: Management of giant hemangioma of the liver: resection versus observation. J Am Coll Surg, 2010. 211(6): p. 724–30.

    Article  PubMed  Google Scholar 

  30. Erdogan D, Busch OR, Van Delden OM, et al.: Management of liver hemangiomas according to size and symptoms. Journal of gastroenterology and hepatology, 2007. 22(11): p. 1953–1958.

    Article  PubMed  Google Scholar 

  31. Mezhir JJ, Fourman LT, Do RK, et al.: Changes in the management of benign liver tumours: an analysis of 285 patients. HPB, 2013. 15(2): p. 156–163.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Bioulac-Sage P, Laumonier H, Rullier A, et al.: Over-expression of glutamine synthetase in focal nodular hyperplasia: a novel easy diagnostic tool in surgical pathology. Liver Int, 2009. 29(3): p. 459–65.

    Article  PubMed  Google Scholar 

  33. Maillette de Buy Wenniger L, Terpstra V and Beuers U: Focal nodular hyperplasia and hepatic adenoma: epidemiology and pathology. Dig Surg, 2010;27(1):24–31.

    Article  PubMed  Google Scholar 

  34. Bioulac-Sage P, Cubel G, Balabaud C and Zucman-Rossi J: Revisiting the pathology of resected benign hepatocellular nodules using new immunohistochemical markers. Seminars in liver disease, 2011. 31: p. 091–103.

    Article  CAS  Google Scholar 

  35. Wanless IR, Mawdsley C and Adams R: On the pathogenesis of focal nodular hyperplasia of the liver. Hepatology, 1985. 5(6): p. 1194–1200.

    Article  CAS  PubMed  Google Scholar 

  36. Suri C, Jones PF, Patan S, et al.: Requisite role of angiopoietin-1, a ligand for the TIE2 receptor, during embryonic angiogenesis. Cell, 1996. 87(7): p. 1171–80.

    Article  CAS  PubMed  Google Scholar 

  37. Ijichi H, Taketomi A, Yoshizumi T, et al.: Hyperbaric oxygen induces vascular endothelial growth factor and reduces liver injury in regenerating rat liver after partial hepatectomy. J Hepatol, 2006. 45(1): p. 28–34.

    Article  CAS  PubMed  Google Scholar 

  38. Navarro AP, Gomez D, Lamb CM, Brooks A, and Cameron IC: Focal nodular hyperplasia: a review of current indications for and outcomes of hepatic resection. HPB (Oxford), 2014. 16(6): p. 503–11.

    Article  Google Scholar 

  39. Nguyen BN, Flejou JF, Terris B, Belghiti J, and Degott C: Focal nodular hyperplasia of the liver: a comprehensive pathologic study of 305 lesions and recognition of new histologic forms. Am J Surg Pathol, 1999. 23(12): p. 1441–54.

    Article  CAS  PubMed  Google Scholar 

  40. Shortell C and Schwartz S: Hepatic adenoma and focal nodular hyperplasia. Surgery, gynecology & obstetrics, 1991. 173(5): p. 426–431.

    CAS  Google Scholar 

  41. Aldinger K, Ben-Menachem Y and Whalen G: Focal nodular hyperplasia of the liver associated with high-dosage estrogens. Archives of internal medicine, 1977. 137(3): p. 357–359.

    Article  CAS  PubMed  Google Scholar 

  42. Fechner RE: Benign hepatic lesions and orally administered contraceptives: A report of seven cases and a critical analysis of the literature. Human pathology, 1977. 8(3): p. 255–268.

    Article  CAS  PubMed  Google Scholar 

  43. Mathieu D, Kobeiter H, Maison P, et al.: Oral contraceptive use and focal nodular hyperplasia of the liver. Gastroenterology, 2000. 118(3): p. 560–564.

    Article  CAS  PubMed  Google Scholar 

  44. Gaffey MJ, Iezzoni JC and Weiss LM: Clonal analysis of focal nodular hyperplasia of the liver. Am J Pathol, 1996. 148(4): p. 1089–96.

    PubMed Central  CAS  PubMed  Google Scholar 

  45. D’Halluin V, Vilgrain V, Pelletier G, et al.: Natural history of focal nodular hyperplasia. A retrospective study of 44 cases. Gastroenterol Clin Biol, 2001. 25(11): p. 1008–10.

    PubMed  Google Scholar 

  46. Di Stasi M, Caturelli E, De Sio I, et al.: Natural history of focal nodular hyperplasia of the liver: an ultrasound study. J Clin Ultrasound, 1996. 24(7): p. 345–50.

    Article  PubMed  Google Scholar 

  47. Palmucci S: Focal liver lesions detection and characterization: The advantages of gadoxetic acid-enhanced liver MRI. World J Hepatol, 2014. 6(7): p. 477–85.

    Article  PubMed Central  PubMed  Google Scholar 

  48. Bashir MR, Gupta RT, Davenport MS, et al.: Hepatocellular carcinoma in a North American population: does hepatobiliary MR imaging with Gd-EOB-DTPA improve sensitivity and confidence for diagnosis? J Magn Reson Imaging, 2013. 37(2): p. 398–406.

    Article  PubMed  Google Scholar 

  49. KG I: Benign tumors of the liver. Medical Clinics of North America 59 (4): 995–1013. July 1975, 1975.

  50. Vilgrain V: Focal nodular hyperplasia. Eur J Radiol, 2006. 58(2): p. 236–45.

    Article  PubMed  Google Scholar 

  51. Paradis V, Benzekri A, Dargere D, et al.: Telangiectatic focal nodular hyperplasia: a variant of hepatocellular adenoma. Gastroenterology, 2004. 126(5): p. 1323–9.

    Article  PubMed  Google Scholar 

  52. Galanski M, Jördens S and Weidemann J: Diagnosis and differential diagnosis of benign liver tumors and tumor-like lesions. Chirurg, 2008. 79(8): p. 707–721.

    Article  CAS  PubMed  Google Scholar 

  53. Skalický T, Treska V, Sutnar A, et al.: Surgical treatment of benign liver tumours-indications and results. Zentralblatt fur Chirurgie, 2009. 134(2): p. 141–144.

  54. Ehrl D, Rothaug K, Herzog P, Hofer B, and Rau H-G: “Incidentaloma” of the Liver: Management of a Diagnostic and Therapeutic Dilemma. HPB Surgery, 2012. 2012.

  55. Mezhir JJ, Fourman LT, Do RK, et al.: Changes in the management of benign liver tumours: an analysis of 285 patients. HPB (Oxford), 2013. 15(2): p. 156–63.

    Article  Google Scholar 

  56. Perrakis A, Demir R, Muller V, et al.: Management of the focal nodular hyperplasia of the liver: evaluation of the surgical treatment comparing with observation only. Am J Surg, 2012. 204(5): p. 689–96.

    Article  PubMed  Google Scholar 

  57. Jeannot E, Wendum D, Paye F, et al.: Hepatocellular adenoma displaying a HNF1alpha inactivation in a patient with familial adenomatous polyposis coli. J Hepatol, 2006. 45(6): p. 883–6.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  58. Rooks JB, Ory HW, Ishak KG, et al.: Epidemiology of hepatocellular adenoma. The role of oral contraceptive use. JAMA, 1979. 242(7): p. 644–8.

    Article  CAS  PubMed  Google Scholar 

  59. Klatskin G: Hepatic tumors: possible relationship to use of oral contraceptives. Gastroenterology, 1977. 73(2): p. 386–394.

    CAS  PubMed  Google Scholar 

  60. Baum J, Bookstein J, Holtz F and Klein E: Possible association between benign hepatomas and oral contraceptives. The Lancet, 1973. 302(7835): p. 926–929.

    Article  Google Scholar 

  61. Chang CY, Hernandez-Prera JC, Roayaie S, Schwartz M, and Thung SN: Changing epidemiology of hepatocellular adenoma in the United States: review of the literature. Int J Hepatol, 2013. 2013: p. 604860.

    PubMed Central  PubMed  Google Scholar 

  62. Carrasco D, Barrachina M, Prieto M and Berenguer J: Clomiphene citrate and liver-cell adenoma. N Engl J Med, 1984. 310(17): p. 1120–1.

    Article  CAS  PubMed  Google Scholar 

  63. Dokmak S, Paradis V, Vilgrain V, et al.: A single-center surgical experience of 122 patients with single and multiple hepatocellular adenomas. Gastroenterology, 2009. 137(5): p. 1698–1705.

    Article  PubMed  Google Scholar 

  64. Vázquez J, Jaime J and Marigil MA: Liver-cell adenoma in an epileptic man on barbiturates. 1989.

  65. Nime F, Pickren JW, Vana J, et al.: The histology of liver tumors in oral contraceptive users observed during a national survey by the American College of Surgeons Commission on Cancer. Cancer, 1979. 44(4): p. 1481–9.

    Article  CAS  PubMed  Google Scholar 

  66. Rosenberg L: The risk of liver neoplasia in relation to combined oral contraceptive use. Contraception, 1991. 43(6): p. 643–652.

    Article  CAS  PubMed  Google Scholar 

  67. Leese T, Farges O and Bismuth H: Liver cell adenomas. A 12-year surgical experience from a specialist hepato-biliary unit. Ann Surg, 1988. 208(5): p. 558–64.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  68. Bioulac-Sage P, Taouji S, Possenti L and Balabaud C: Hepatocellular adenoma subtypes: the impact of overweight and obesity. Liver Int, 2012. 32(8): p. 1217–21.

    Article  PubMed  Google Scholar 

  69. van Aalten SM, de Man RA, JN IJ and Terkivatan T: Systematic review of haemorrhage and rupture of hepatocellular adenomas. Br J Surg, 2012. 99(7): p. 911–6.

  70. Deneve JL, Pawlik TM, Cunningham S, et al.: Liver cell adenoma: a multicenter analysis of risk factors for rupture and malignancy. Ann Surg Oncol, 2009. 16(3): p. 640–8.

    Article  PubMed  Google Scholar 

  71. Bieze M, Phoa SS, Verheij J, van Lienden KP, and van Gulik TM: Risk factors for bleeding in hepatocellular adenoma. Br J Surg, 2014. 101(7): p. 847–55.

    Article  CAS  PubMed  Google Scholar 

  72. van Aalten SM, Verheij J, Terkivatan T, et al.: Validation of a liver adenoma classification system in a tertiary referral centre: implications for clinical practice. J Hepatol, 2011. 55(1): p. 120–5.

    Article  PubMed  Google Scholar 

  73. Farges O, Ferreira N, Dokmak S, et al.: Changing trends in malignant transformation of hepatocellular adenoma. Gut, 2011. 60(1): p. 85–9.

    Article  PubMed  Google Scholar 

  74. Stoot JH, Coelen RJ, De Jong MC and Dejong CH: Malignant transformation of hepatocellular adenomas into hepatocellular carcinomas: a systematic review including more than 1600 adenoma cases. HPB, 2010. 12(8): p. 509–522.

    Article  PubMed Central  PubMed  Google Scholar 

  75. Micchelli ST, Vivekanandan P, Boitnott JK, et al.: Malignant transformation of hepatic adenomas. Mod Pathol, 2008. 21(4): p. 491–7.

    Article  CAS  PubMed  Google Scholar 

  76. Kim DH, Kim SU, Nam DH, et al.: A case of hepatocellular carcinoma within hepatocellular adenoma in a non-cirrhotic male. The Korean journal of internal medicine, 2009. 24(2): p. 147–152.

    Article  PubMed Central  PubMed  Google Scholar 

  77. Velazquez I and Alter BP: Androgens and liver tumors: Fanconi's anemia and non-Fanconi's conditions. Am J Hematol, 2004. 77(3): p. 257–67.

    Article  PubMed  Google Scholar 

  78. Gorayski P, Thompson CH, Subhash H and Thomas AC: Hepatocellular carcinoma associated with recreational anabolic steroid use. British journal of sports medicine, 2008. 42(1): p. 74–75.

    Article  CAS  PubMed  Google Scholar 

  79. Franco LM, Krishnamurthy V, Bali D, et al.: Hepatocellular carcinoma in glycogen storage disease type Ia: a case series. J Inherit Metab Dis, 2005. 28(2): p. 153–62.

    Article  CAS  PubMed  Google Scholar 

  80. Dokmak S, Cauchy F and Belghiti J: Resection, transplantation and local regional therapies for liver adenomas. Expert Rev Gastroenterol Hepatol, 2014: p. 1–8.

  81. Bioulac-Sage P, Laumonier H, Couchy G, et al.: Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience. Hepatology, 2009. 50(2): p. 481–9.

    Article  PubMed  Google Scholar 

  82. Balabaud C, Al-Rabih WR, Chen P-J, et al.: Focal nodular hyperplasia and hepatocellular adenoma around the world viewed through the scope of the immunopathological classification. International journal of hepatology, 2013. 2013.

  83. Stoot J, Van Der Linden E, Terpstra O and Schaapherder A: Life-saving therapy for haemorrhaging liver adenomas using selective arterial embolization. British journal of surgery, 2007. 94(10): p. 1249–1253.

    Article  CAS  PubMed  Google Scholar 

  84. Erdogan D, Busch OR, van Delden OM, et al.: Management of spontaneous haemorrhage and rupture of hepatocellular adenomas. A single centre experience. Liver Int, 2006. 26(4): p. 433–8.

    Article  PubMed  Google Scholar 

  85. Marini P, Vilgrain V and Belghiti J: Management of spontaneous rupture of liver tumours. Dig Surg, 2002. 19(2): p. 109–13.

    Article  CAS  PubMed  Google Scholar 

  86. Terkivatan T, de Wilt JH, de Man RA, et al.: Treatment of ruptured hepatocellular adenoma. Br J Surg, 2001. 88(2): p. 207–9.

    Article  CAS  PubMed  Google Scholar 

  87. van Vledder MG, van Aalten SM, Terkivatan T, et al.: Safety and efficacy of radiofrequency ablation for hepatocellular adenoma. J Vasc Interv Radiol, 2011. 22(6): p. 787–93.

    Article  PubMed  Google Scholar 

  88. Karkar AM, Tang LH, Kashikar ND, et al.: Management of hepatocellular adenoma: comparison of resection, embolization and observation. HPB, 2013. 15(3): p. 235–243.

    Article  PubMed Central  PubMed  Google Scholar 

  89. Fernandez-Pineda I and Cabello-Laureano R: Differential diagnosis and management of liver tumors in infants. World J Hepatol, 2014. 6(7): p. 486–95.

    Article  PubMed Central  PubMed  Google Scholar 

  90. Delgado J, Jaramillo D, Ho-Fung V, Fisher MJ, and Anupindi SA: MRI features of plexiform neurofibromas involving the liver and pancreas in children with neurofibromatosis type 1. Clin Radiol, 2014. 69(6): p. e280-4.

    Article  PubMed  Google Scholar 

  91. Kneuertz PJ, Marsh JW, de Jong MC, et al.: Improvements in quality of life after surgery for benign hepatic tumors: Results from a dual center analysis. Surgery, 2012. 152(2): p. 193–201.

    Article  PubMed  Google Scholar 

  92. Kamphues C, Engel S, Denecke T, et al.: Safety of liver resection and effect on quality of life in patients with benign hepatic disease: single center experience. BMC Surg, 2011. 11: p. 16.

    Article  PubMed Central  PubMed  Google Scholar 

  93. Nault JC and Zucman Rossi J: Molecular classification of hepatocellular adenomas. International journal of hepatology, 2013. 2013.

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, The Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA

    Georgios Antonios Margonis, Gaya Spolverato & Timothy M. Pawlik

  2. Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA

    Aslam Ejaz

  3. Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA

    Neda Rastegar & Robert Anders

  4. Department of Radiology, The Johns Hopkins Hospital, Baltimore, MD, USA

    Ihab R. Kamel

Authors
  1. Georgios Antonios Margonis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aslam Ejaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gaya Spolverato
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Neda Rastegar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Robert Anders
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ihab R. Kamel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Timothy M. Pawlik
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Timothy M. Pawlik.

Additional information

Dr. Margonis and Dr. Ejaz contributed equally to the production of this manuscript.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Supplemental Fig. 1

Hemangioma in a 49 year old female. (A) MR coronal thick slab reconstruction better demonstrates enhancing nodules (arrows) at the periphery of the lesion. Incidental note is made of a replaced right hepatic artery (arrowhead) arising from the superior mesenteric artery. The enhancing nodules continue to fill in the portal venous phase (B). Axial T1-weighted images in the hepatic arterial phase (C), portal venous phase (D), and delayed phase (E) show flame-shaped enhancement increasing centrally (arrowheads), characteristic of hemangioma. (GIF 189 kb)

(GIF 203 kb)

(GIF 177 kb)

(GIF 188 kb)

(GIF 187 kb)

High resolution image (TIFF 1433 kb)

High resolution image (TIFF 1434 kb)

High resolution image (TIFF 1433 kb)

High resolution image (TIFF 1433 kb)

High resolution image (TIFF 1434 kb)

Supplemental Fig. 2

Focal nodular hyperplasia in a 27 year old female. Ultrasound in the coronal plane (A) shows a subtle slightly echogenic mass in the right lobe of the liver (arrows). Axial MR T2-weighted (B) images show subtle isointense lesion (arrow) in the right lobe. Axial CT in the hepatic arterial phase (C) shows a homogeneously enhancing nonencapsulated mass (arrow) that becomes iso to slightly hypodense to liver parenchyma in the portal venous phase (D). (E) Delayed (10 minute) phase of enhancement using a hepatobiliary contrast agent demonstrates increased uptake within the lesion (arrow). (GIF 153 kb)

(GIF 150 kb)

(GIF 142 kb)

(GIF 171 kb)

(GIF 151 kb)

High resolution image (TIFF 1432 kb)

High resolution image (TIFF 1430 kb)

High resolution image (TIFF 1431 kb)

High resolution image (TIFF 1433 kb)

High resolution image (TIFF 1430 kb)

Supplemental Fig. 3

Hepatocellular adenoma in a 37 year old female. Axial MR T-1 out of phase image of the liver (A) shows significant signal loss of the liver mass (arrow). T1-weighted MR image in the portal venous phase (B) shows a heterogeneously enhancing mass. (GIF 178 kb)

(GIF 161 kb)

High resolution image (TIFF 1431 kb)

High resolution image (TIFF 1430 kb)

Supplemental Fig. 4

Nodular regenerative hyperplasia in a 77 year old male with 30-year history of primary biliary cirrhosis. MRI shows multiple masses (arrows) that are hyperintense to the liver parenchyma on T-1 weighted unenhanced image (A) and are isointense to liver parenchyma on T-2 weighted images (B). Subtraction images show minimal signal within the lesions confirming the lack of enhancement (C). There is no wash out of contrast on T1-weighted images in the portal venous phase (D). These findings are consistent with nodular regenerative hyperplasia. (GIF 172 kb)

(GIF 162 kb)

(GIF 171 kb)

(GIF 176 kb)

High resolution image (TIFF 1431 kb)

High resolution image (TIFF 1432 kb)

High resolution image (TIFF 1431 kb)

High resolution image (TIFF 1432 kb)

Supplemental Fig. 5

Biliary hamartomas in a 69 year old female. Axial CT of the liver shows numerous small uniform hypodense lesions scattered throughout both lobes (A). Axial T2-weighted image better demonstrates innumerable small hepatic lesions that are very bright with no septation or nodularity (B). Coronal maximum intensity projection image reconstructed from thin slice T2-weighted images shows the extent of hepatic involvement. The common bile duct (arrow) and the gallbladder (arrowhead) are also seen (C). Lack of internal enhancement was confirmed on T1-weighted image in the portal venous phase (D). (GIF 192 kb)

(GIF 179 kb)

(GIF 181 kb)

(GIF 167 kb)

High resolution image (TIFF 1433 kb)

High resolution image (TIFF 1431 kb)

High resolution image (TIFF 1432 kb)

High resolution image (TIFF 1431 kb)

Supplemental Fig. 6

Angiomyolipoma in a 44 year old female. Axial CT in the hepatic arterial phase (A) and portal venous phase (B) show an indeterminate hypervascular mass with a low attenuation rim (arrow). Axial MR T-1 weighted images of the liver show the mass (arrow) to be hyperintense on the in-phase acquisition (C) with significant signal loss on the out of phase acquisition (D), indicating the presence of lipid. The mass (arrow) has early central enhancement on the hepatic arterial phase (E) and persists in the portal venous phase (F). These findings are consistent with an angiomyolipoma. (GIF 156 kb)

(GIF 153 kb)

(GIF 160 kb)

(GIF 174 kb)

(GIF 143 kb)

(GIF 150 kb)

High resolution image (TIFF 1432 kb)

High resolution image (TIFF 1432 kb)

High resolution image (TIFF 1429 kb)

High resolution image (TIFF 1430 kb)

High resolution image (TIFF 1429 kb)

High resolution image (TIFF 1429 kb)

Supplemental Fig. 7

Plexiform neurofibroma in a 12 year old male. Axial T2-weighted image shows a large hyperintense mass infiltrating the periportal region (arrows), with extensive involvement of both hepatic lobes (A). Central flow void within the tumor (arrowhead) represents a branch of the portal vein. The periportal distribution is the hallmark of liver involvement. Internal enhancement (arrows) is noted on T1-weighted post contrast image (B). The diagnosis was confirmed at biopsy, and is usually associated with neurofibromatosis Type 1. However in this patient it was incidental. (GIF 174 kb)

(GIF 154 kb)

High resolution image (TIFF 1431 kb)

High resolution image (TIFF 1430 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Margonis, G.A., Ejaz, A., Spolverato, G. et al. Benign Solid Tumors of the Liver: Management in the Modern Era. J Gastrointest Surg 19, 1157–1168 (2015). https://doi.org/10.1007/s11605-014-2723-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-014-2723-x

Keywords

Search

Navigation