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Approach to the Patient with a Solid Liver Mass

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Hepato-Pancreato-Biliary Malignancies

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Abstract

A solid liver mass could be benign or malignant. In most cases, a mass is identified incidentally in asymptomatic patient or on imaging study done for unrelated symptoms. When symptomatic, pain or discomfort is the usual presenting symptom for a subcapsular located liver mass and could also be due to local mass effect of large or growing lesion. The commonly encountered benign solid hepatic lesion includes hepatic hemangioma, hepatocellular adenoma, focal nodular hyperplasia, and nodular regenerative nodules.

To narrow the differential diagnosis and choose the appropriate diagnostic test, a thorough and detailed history, physical examination, and review of available laboratory and imaging data is critical. In most cases, a specific dynamic cross-sectional imaging of the liver will suffice to establish diagnosis, and biopsy is rarely needed.

Conservative management approach is suggested for most asymptomatic patients with small-size solitary liver mass. The risk of symptoms and/or bleeding of a benign hypervascular liver lesion correlates with the size, number, and location of the lesion(s). These factors must be considered to recommend specific treatment (surgical, embolization, or ablation). Recent advances in molecular analysis studies and immunohistochemical staining led to improved understanding of markers that signal the risk of malignant transformation in some of these benign solid liver lesions (e.g., hepatocellular adenoma). Specific therapy should also be considered for lesions with characteristics of oncogenic potential. Hence, appropriate referral of cases to experienced centers and engaging multidisciplinary team (MDT) early for diagnosis and treatment recommendations is important to improve patient outcome.

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Abbreviations

AFP:

α-fetoprotein

CEA:

carcinoembryonic antigen

CEUS:

contrast-enhanced ultrasound

CRP:

C-reactive protein

CT:

computed tomography

FNH:

focal nodular hyperplasia

Gd-BOPTA:

gadobenate dimeglumine

GGT:

γ-glutamyl transpeptidase

GS:

glutamine synthase

HCA:

hepatocellular adenoma

HCC:

hepatocellular carcinoma

HNF1α:

hepatocyte nuclear factor 1α

IHC:

immunohistochemistry

IL-6:

interleukin 6

LFABP:

liver fatty acid binding protein

MRI:

magnetic resonance imaging

NRH:

nodular regenerative hyperplasia

OCs:

oral contraceptives

PET:

positron emission tomography

RES:

reticuloendothelial system

RFA:

radio frequency ablation

SAA:

serum amyloid A

SPECT:

single-photon emission CT

TAE:

transcatheter arterial embolization

US:

ultrasound

VEGF:

vascular endothelial growth factor

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Authors and Affiliations

  1. Drexel University College of Medicine, Philadelphia, PA, USA

    Eyob Feyssa & Santiago J. Munoz

  2. Virtua Center for Liver Disease, Cherry Hill, NJ, USA

    Santiago J. Munoz

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  1. Eyob Feyssa
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  2. Santiago J. Munoz
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Correspondence to Santiago J. Munoz .

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Editors and Affiliations

  1. Medical Director, Capital Health Medical Center Hopewell, Pennington, NJ, USA

    Cataldo Doria

  2. Capital Health Center for Digestive Health, Pennington, NJ, USA

    Jason N. Rogart

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Feyssa, E., Munoz, S.J. (2021). Approach to the Patient with a Solid Liver Mass. In: Doria, C., Rogart, J.N. (eds) Hepato-Pancreato-Biliary Malignancies. Springer, Cham. https://doi.org/10.1007/978-3-030-37482-2_1-1

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  • DOI: https://doi.org/10.1007/978-3-030-37482-2_1-1

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