Abstract
Background/aim
Recently, an increase in the number of asymptomatic rare benign liver tumors (BLTs) has been reported during health check-ups. It is difficult to determine the nature of partial rare BLTs and not easy to distinguish from malignant liver tumors. This study aimed to analysis clinical features, diagnosis and treatment of rare BLTs to reduce misdiagnosis and provide reference for clinical practice.
Methods
From January 2012 to January 2021, we treated 112 rare BLTs by hepatectomy, including 54 focal nodular hyperplasias, 14 hepatocellular adenomas, 28 hepatic angiomyolipomas, 3 hepatic granulomas, 2 inflammatory pseudotumors of the liver, 2 nodular regenerative hyperplasia, 2 hepatic lipomas, 1 solitary fibrous tumor of the liver, 1 hepatic schwannoma and 1 hepatic myelolipoma.
Results
The majority of patients were middle-aged female and asymptomatic. Single tumors were dominant. The diagnostic accuracies of computed tomography (CT) and magnetic resonance imaging (MRI) were 32.5% and 44.2%, respectively. The majority of tumors were likely to be misdiagnosed as hepatocellular carcinoma (HCC) or difficult to distinguish from HCC. All patients underwent surgical treatment. Postoperative pathological and immunohistochemical examination can confirm the diagnosis. No patients without tumor recurrence or metastasis during follow-up period.
Conclusion
Altogether, the clinical symptoms of rare BLTs lack specificity, and their preoperative diagnosis largely depends on imaging examination, with a low diagnostic accuracy rate and high chances of misdiagnosis as HCC. Diagnosis is confirmed by pathological and immunohistochemical examination. Surgical resection for rare BLT is safe and effective, regular postoperative follow-up is necessary.
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Original data are available per request.
References
Belghiti J, Cauchy F, Paradis V, Vilgrain V (2014) Diagnosis and management of solid benign liver lesions. Nat Rev Gastroenterol Hepatol 11:737–749. https://doi.org/10.1038/nrgastro.2014.151
Bioulac-Sage P et al (2007) Pathological diagnosis of liver cell adenoma and focal nodular hyperplasia: Bordeaux update. J Hepatol 46:521–527. https://doi.org/10.1016/j.jhep.2006.12.007
Bioulac-Sage P et al (2009) Hepatocellular adenoma management and phenotypic classification: the Bordeaux experience. Hepatology 50:481–489. https://doi.org/10.1002/hep.22995
Chen N, Slater K (2017) Solitary fibrous tumour of the liver-report on metastasis and local recurrence of a malignant case and review of literature. World J Surg Oncol 15:27. https://doi.org/10.1186/s12957-017-1102-y
Chen W, Liu Y, Zhuang Y, Peng J, Huang F, Zhang S (2017) Hepatic perivascular epithelioid cell neoplasm: A clinical and pathological experience in diagnosis and treatment. Mol Clin Oncol 6:487–493. https://doi.org/10.3892/mco.2017.1168
Chiche L, Adam JP (2013) Diagnosis and management of benign liver tumors. Semin Liver Dis 33:236–247. https://doi.org/10.1055/s-0033-1351779
Cho HD et al (2016) Changes in the types of liver diseases requiring hepatic resection: a single-institution experience of 9016 cases over a 10-year period. Korean J Hepatobiliary Pancreat Surg 20:49–52. https://doi.org/10.14701/kjhbps.2016.20.2.49
Costa AF, Thipphavong S, Arnason T, Stueck AE, Clarke SE (2018) Fat-containing liver lesions on imaging: detection and differential diagnosis. AJR Am J Roentgenol 210:68–77. https://doi.org/10.2214/AJR.17.18136
European Association for the Study of the L (2016) EASL Clinical Practice Guidelines on the management of benign liver tumours. J Hepatol 65:386–398. https://doi.org/10.1016/j.jhep.2016.04.001
Garoufalia Z, Machairas N, Kostakis ID, Liakea A, Tsaparas P, Liapis G, Sotiropoulos GC (2018) Malignant potential of epithelioid angiomyolipomas of the liver: a case report and comprehensive review of the literature. Mol Clin Oncol 9:226–230. https://doi.org/10.3892/mco.2018.1659
Giannitrapani L, Soresi M, La Spada E, Cervello M, D’Alessandro N, Montalto G (2006) Sex hormones and risk of liver tumor. Ann N Y Acad Sci 1089:228–236. https://doi.org/10.1196/annals.1386.044
Grazioli L et al (2012) Hepatocellular adenoma and focal nodular hyperplasia: value of gadoxetic acid-enhanced MR imaging in differential diagnosis. Radiology 262:520–529
Hoffmann K et al (2015) Outcome after a liver resection of benign lesions. HPB (oxford) 17:994–1000. https://doi.org/10.1111/hpb.12496
Klompenhouwer AJ et al (2020) Hepatic angiomyolipoma: an international multicenter analysis on diagnosis, management and outcome. HPB (oxford) 22:622–629. https://doi.org/10.1016/j.hpb.2019.09.004
Margonis GA, Ejaz A, Spolverato G, Rastegar N, Anders R, Kamel IR, Pawlik TM (2015) Benign solid tumors of the liver: management in the modern era. J Gastrointest Surg 19:1157–1168. https://doi.org/10.1007/s11605-014-2723-x
Marrero JA, Ahn J, Rajender Reddy K, Americal College of G (2014) ACG clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol 109:1328–1347. https://doi.org/10.1038/ajg.2014.213 (quiz 1348)
McInnes MD, Hibbert RM, Inácio JR, Schieda N (2015) Focal nodular hyperplasia and hepatocellular adenoma: accuracy of gadoxetic acid-enhanced MR imaging–a systematic review. Radiology 277:413–423
Mezhir JJ et al (2013) Changes in the management of benign liver tumours: an analysis of 285 patients. HPB (oxford) 15:156–163. https://doi.org/10.1111/j.1477-2574.2012.00556.x
Motosugi U, Ichikawa T, Sou H, Sano K, Tominaga L, Muhi A, Tsutomu A (2010) Distinguishing hypervascular pseudolesions of the liver from hypervascular hepatocellular carcinomas with gadoxetic acid-enhanced MR imaging. Radiology 256:151–158
Nault JC, Bioulac-Sage P, Zucman-Rossi J (2013) Hepatocellular benign tumors-from molecular classification to personalized clinical care. Gastroenterology 144:888–902. https://doi.org/10.1053/j.gastro.2013.02.032
Nguyen TB, Roncalli M, Di Tommaso L, Kakar S (2016) Combined use of heat-shock protein 70 and glutamine synthetase is useful in the distinction of typical hepatocellular adenoma from atypical hepatocellular neoplasms and well-differentiated hepatocellular carcinoma. Mod Pathol 29:283–292
Oldhafer KJ, Habbel V, Horling K, Makridis G, Wagner KC (2020) Benign Liver Tumors. Visc Med 36:292–303. https://doi.org/10.1159/000509145
Perrakis A, Vassos N, Grutzmann R, Croner RS (2017) What is changing in indications and treatment of focal nodular hyperplasia of the liver. Is there any place for surgery? Ann Hepatol 16:333–341. https://doi.org/10.5604/16652681.1235475
Picchia S, Terlizzo M, Bali MA (2019) Hepatic schwannoma: CT and histologic features. Curr Probl Cancer 43:511–513. https://doi.org/10.1016/j.currproblcancer.2018.10.002
Radhi J (2010) Hepatic myelolipoma. J Gastrointestin Liver Dis 19:106–107
Suh CH, Kim KW, Kim GY, Shin YM, Kim PN, Park SH (2015) The diagnostic value of Gd-EOB-DTPA-MRI for the diagnosis of focal nodular hyperplasia: a systematic review and meta-analysis. Eur Radiol 25:950–960. https://doi.org/10.1007/s00330-014-3499-9
Thevathasan T, Colbatzky T, Schmelzle M, Pratschke J, Krenzien F (2021) Risk factors for malignant transformation of hepatocellular adenoma to hepatocellular carcinoma: protocol for systematic review and meta-analysis. BMJ Open 11:e045733. https://doi.org/10.1136/bmjopen-2020-045733
Wan DL, Zhai ZL, Ren KW, Yang YC, Lin SZ, Zheng SS (2016) Hepatic schwannoma: a case report and an updated 40-year review of the literature yielding 30 cases. Mol Clin Oncol 4:959–964. https://doi.org/10.3892/mco.2016.850
Yang X, Zhu J, Biskup E, Cai F, Li A (2015) Inflammatory pseudotumors of the liver: experience of 114 cases. Tumour Biol 36:5143–5148. https://doi.org/10.1007/s13277-015-3167-y
Zimmermann A (2001) Terminology of nodular hepatocellular lesions. J Hepatol 34:781–782
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Key R&D Program of Jiangxi Provincial Department of Science and Technology, Grant Number: 20202BBGL73092.
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All authors contributed to the study conception and design. LHL and TW: wrote the main manuscript text. XG: prepared pathological figures, MTC and TW: prepared imaging figures. MTC, GQZ, YQX: collected data. WD and JX: followed up patients. Critical revision of the manuscript: LHL, TW, MTC and RFS. All authors have read and approved the final manuscript.
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This retrospective study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board of the First Affiliated Hospital of Nanchang University, and the requirement for informed consent was waived.
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Luo, L., Wang, T., Cheng, M. et al. Rare benign liver tumors that require differentiation from hepatocellular carcinoma: focus on diagnosis and treatment. J Cancer Res Clin Oncol 149, 2843–2854 (2023). https://doi.org/10.1007/s00432-022-04169-w
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DOI: https://doi.org/10.1007/s00432-022-04169-w