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Evaluation of nonmalignant liver masses

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Abstract

Nonmalignant liver masses are increasingly being recognized with the widespread use of imaging modalities such as ultrasonography, computed tomography, and magnetic resonance imaging. The majority of these lesions are detected incidentally in asymptomatic patients. Based on the radiologic appearance, benign lesions can be categorized as solid or cystic, single or multiple, hypervascular or hypovascular. Based on histologic characteristics, they are classified as of hepatocellular, biliary, or mesenchymal origin. In the majority of patients, a proper diagnosis can be made based on these characteristics on imaging modalities alone. An invasive approach is seldom required. This review discusses the various characteristics of the most common benign liver lesions and recommends a practical approach.

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References and Recommended Reading

  1. Choi BY, Nguyen MH: The diagnosis and management of benign hepatic tumors. J Clin Gastroenterol 2005, 39:401–412.

    Article  PubMed  Google Scholar 

  2. Mortele KJ, Ros PR: Benign liver neoplasms. Clin Liver Dis 2002, 6:119–145. A comprehensive review of benign hepatic mass lesions.

    Article  PubMed  Google Scholar 

  3. de Rave S, Hussain SM: A liver tumour as an incidental finding: differential diagnosis and treatment. Scand J Gastroenterol Suppl 2002:81–86.

  4. Trotter JF, Everson GT: Benign focal lesions of the liver. Clin Liver Dis 2001, 5:17–42, v. A practical review on benign hepatic mass lesions.

    Article  PubMed  CAS  Google Scholar 

  5. Semelka RC, Sofka CM: Hepatic hemangiomas. Magn Reson Imaging Clin N Am 1997, 5(2):241–53.

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  7. Harvey CJ, Albrecht T: Ultrasound of focal liver lesions. Eur Radiol 2001, 11:1578–1593.

    Article  PubMed  CAS  Google Scholar 

  8. Mergo PJ, Ros PR: Benign lesions of the liver. Radiol Clin North Am 1998, 36:319–331.

    Article  PubMed  CAS  Google Scholar 

  9. Karnam U, Reddy K: Approach to the patient with a liver mass. In Textbook of Gastroenterology, edn 4. Edited by Yamada T. Philadelphia: Lippincott Williams & Wilkins, 2003:973–982.

    Google Scholar 

  10. Adam YG, Huvos AG, Fortner JG: Giant hemangiomas of the liver. Ann Surg 1970, 172:239–245.

    Article  PubMed  CAS  Google Scholar 

  11. Vilgrain V, Boulos L, Vullierme MP, et al.: Imaging of atypical hemangiomas of the liver with pathologic correlation. Radiographics 2000, 20:379–397.

    PubMed  CAS  Google Scholar 

  12. Hosten N, Puls R, Bechstein WO, Felix R: Focal liver lesions: Doppler ultrasound. Eur Radiol 1999, 9:428–435.

    Article  PubMed  CAS  Google Scholar 

  13. Quaia E, Calliada F, Bertolotto M, et al.: Characterization of focal liver lesions with contrast-specific US modes and a sulfur hexafluoride-filled microbubble contrast agent: diagnostic performance and confidence. Radiology 2004, 232:420–430.

    Article  PubMed  Google Scholar 

  14. Quaia E, Bertolotto M, Dalla Palma L: Characterization of liver hemangiomas with pulse inversion harmonic imaging. Eur Radiol 2002, 12:537–544.

    PubMed  Google Scholar 

  15. Bartolotta TV, Midiri M, Quaia E, et al.: Benign focal liver lesions: spectrum of findings on SonoVue-enhanced pulse-inversion ultrasonography. Eur Radiol 2005, 15:1643–1649.

    Article  PubMed  Google Scholar 

  16. Hanafusa K, Ohashi I, Himeno Y, et al.: Hepatic hemangioma: findings with two-phase CT. Radiology 1995, 196:465–469.

    PubMed  CAS  Google Scholar 

  17. Leslie DF, Johnson CD, MacCarty RL, et al.: Single-pass CT of hepatic tumors: value of globular enhancement in distinguishing hemangiomas from hypervascular metastases. AJR Am J Roentgenol 1995, 165:1403–1406.

    PubMed  CAS  Google Scholar 

  18. Leslie DF, Johnson CD, Johnson CM, et al.: Distinction between cavernous hemangiomas of the liver and hepatic metastases on CT: value of contrast enhancement patterns. AJR Am J Roentgenol 1995, 164:625–629.

    PubMed  CAS  Google Scholar 

  19. Nino-Murcia M, Olcott EW, Jeffrey RB, Jr, et al.: Focal liver lesions: pattern-based classification scheme for enhancement at arterial phase CT. Radiology 2000, 215:746–751.

    PubMed  CAS  Google Scholar 

  20. Yun EJ, Choi BI, Han JK, et al.: Hepatic hemangioma: contrast-enhancement pattern during the arterial and portal venous phases of spiral CT. Abdom Imaging 1999, 24:262–266.

    Article  PubMed  CAS  Google Scholar 

  21. Kim T, Federle MP, Baron RL, et al.: Discrimination of small hepatic hemangiomas from hypervascular malignant tumors smaller than 3 cm with three-phase helical CT. Radiology 2001, 219:699–706.

    PubMed  CAS  Google Scholar 

  22. Brunt EM: Benign tumors of the liver. Clin Liver Dis 2001, 5:1–15, v.

    Article  PubMed  CAS  Google Scholar 

  23. Op de Beeck B, Luypaert R, Dujardin M, Osteaux M:Benign liver lesions: differentiation by magnetic resonance. Eur J Radiol 1999, 32:52–60.

    Article  PubMed  CAS  Google Scholar 

  24. Numminen K, Halavaara J, Tervahartiala P, et al.: Liver tumour MRI: what do we need for lesion characterization? Scand J Gastroenterol 2004, 39:67–73.

    Article  PubMed  CAS  Google Scholar 

  25. Buscarini E, Danesino C, Plauchu H, et al.: High prevalence of hepatic focal nodular hyperplasia in subjects with hereditary hemorrhagic telangiectasia. Ultrasound Med Biol 2004, 30:1089–1097.

    Article  PubMed  Google Scholar 

  26. Nguyen BN, Flejou JF, Terris B, et al.: Focal nodular hyperplasia of the liver: a comprehensive pathologic study of 305 lesions and recognition of new histologic forms. Am J Surg Pathol 1999, 23:1441–1454.

    Article  PubMed  CAS  Google Scholar 

  27. Luciani A, Kobeiter H, Maison P, et al.: Focal nodular hyperplasia of the liver in men: is presentation the same in men and women? Gut 2002, 50:877–880.

    Article  PubMed  CAS  Google Scholar 

  28. Wanless IR, Mawdsley C, Adams R: On the pathogenesis of focal nodular hyperplasia of the liver. Hepatology 1985, 5:1194–1200.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  30. Scalori A, Tavani A, Gallus S, et al.: Oral contraceptives and the risk of focal nodular hyperplasia of the liver: a case-control study. Am J Obstet Gynecol 2002, 186:195–197.

    Article  PubMed  Google Scholar 

  31. Leconte I, Van Beers BE, Lacrosse M, et al.: Focal nodular hyperplasia: natural course observed with CT and MRI. J Comput Assist Tomogr 2000, 24:61–66.

    Article  PubMed  CAS  Google Scholar 

  32. Ishak KG, Rabin L: Benign tumors of the liver. Med Clin North Am 1975, 59:995–1013.

    PubMed  CAS  Google Scholar 

  33. Terminology of nodular hepatocellular lesions. International Working Party. Hepatology 1995, 22:983–993.

  34. Hussain SM, Terkivatan T, Zondervan PE, et al.: Focal nodular hyperplasia: findings at state-of-the-art MR imaging, US, CT, and pathologic analysis. Radiographics 2004, 24:3-17, discussion 8–9.

    Article  Google Scholar 

  35. Kehagias D, Moulopoulos L, Antoniou A, et al.: Focal nodular hyperplasia: imaging findings. Eur Radiol 2001, 11:202–212.

    Article  PubMed  CAS  Google Scholar 

  36. Uggowitzer MM, Kugler C, Mischinger HJ, et al.: Echoenhanced Doppler sonography of focal nodular hyperplasia of the liver. J Ultrasound Med 1999, 18:445–451, quiz 53–54.

    PubMed  CAS  Google Scholar 

  37. Brancatelli G, Federle MP, Grazioli L, et al.: Focal nodular hyperplasia: CT findings with emphasis on multiphasic helical CT in 78 patients. Radiology 2001, 219:61–68.

    PubMed  CAS  Google Scholar 

  38. Choi CS, Freeny PC: Triphasic helical CT of hepatic focal nodular hyperplasia: incidence of atypical findings. AJR Am J Roentgenol 1998, 170:391–395.

    PubMed  CAS  Google Scholar 

  39. Carlson SK, Johnson CD, Bender CE, Welch TJ: CT of focal nodular hyperplasia of the liver. AJR Am J Roentgenol 2000, 174:705–712.

    PubMed  CAS  Google Scholar 

  40. Edmondson HA, Henderson B, Benton B: Liver-cell adenomas associated with use of oral contraceptives. N Engl J Med 1976, 294:470–472.

    Article  PubMed  CAS  Google Scholar 

  41. Mattison GR, Glazer GM, Quint LE, et al.: MR imaging of hepatic focal nodular hyperplasia: characterization and distinction from primary malignant hepatic tumors. AJR Am J Roentgenol 1987, 148:711–715.

    PubMed  CAS  Google Scholar 

  42. Mathieu D, Rahmouni A, Anglade MC, et al.: Focal nodular hyperplasia of the liver: assessment with contrast-enhanced TurboFLASH MR imaging. Radiology 1991, 180:25–30.

    PubMed  CAS  Google Scholar 

  43. Baum JK, Bookstein JJ, Holtz F, Klein EW: Possible association between benign hepatomas and oral contraceptives. Lancet 1973, 2:926–929.

    Article  PubMed  CAS  Google Scholar 

  44. Rooks JB, Ory HW, Ishak KG, et al.: Epidemiology of hepatocellular adenoma. The role of oral contraceptive use. JAMA 1979, 242:644–648.

    Article  PubMed  CAS  Google Scholar 

  45. Labrune P, Trioche P, Duvaltier I, et al.: Hepatocellular adenomas in glycogen storage disease type I and III: a series of 43 patients and review of the literature. J Pediatr Gastroenterol Nutr 1997, 24:276–279.

    Article  PubMed  CAS  Google Scholar 

  46. Carrasco D, Prieto M, Pallardo L, et al.: Multiple hepatic adenomas after long-term therapy with testosterone enanthate. Review of the literature. J Hepatol 1985, 1:573–578.

    Article  PubMed  CAS  Google Scholar 

  47. Kerlin P, Davis GL, McGill DB, et al.: Hepatic adenoma and focal nodular hyperplasia: clinical, pathologic, and radiologic features. Gastroenterology 1983, 84:994–1002.

    PubMed  CAS  Google Scholar 

  48. Foster JH, Berman MM: The malignant transformation of liver cell adenomas. Arch Surg 1994, 129:712–717.

    PubMed  CAS  Google Scholar 

  49. De Carlis L, Pirotta V, Rondinara GF, et al.: Hepatic adenoma and focal nodular hyperplasia: diagnosis and criteria for treatment. Liver Transpl Surg 1997, 3:160–165.

    Article  PubMed  Google Scholar 

  50. Terkivatan T, de Wilt JH, de Man RA, et al.: Indications and long-term outcome of treatment for benign hepatic tumors: a critical appraisal. Arch Surg 2001, 136:1033–1038.

    Article  PubMed  CAS  Google Scholar 

  51. 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, 67:173–178. An original paper on the presentation and the natural course of benign and solid tumors of the liver.

    PubMed  CAS  Google Scholar 

  52. Charny CK, Jarnagin WR, Schwartz LH, et al.: Management of 155 patients with benign liver tumours. Br J Surg 2001, 88:808–813.

    Article  PubMed  CAS  Google Scholar 

  53. Hung CH, Changchien CS, Lu SN, et al.: Sonographic features of hepatic adenomas with pathologic correlation. Abdom Imaging 2001, 26:500–506.

    Article  PubMed  CAS  Google Scholar 

  54. Ichikawa T, Federle MP, Grazioli L, Nalesnik M: Hepatocellular adenoma: multiphasic CT and histopathologic findings in 25 patients. Radiology 2000, 214:861–868.

    PubMed  CAS  Google Scholar 

  55. Grazioli L, Federle MP, Brancatelli G, et al.: Hepatic adenomas: imaging and pathologic findings. Radiographics 2001, 21:877-892, discussion 92–94.

    Google Scholar 

  56. Flejou JF, Barge J, Menu Y, et al.: Liver adenomatosis. An entity distinct from liver adenoma? Gastroenterology 1985, 89:1132–1138.

    PubMed  CAS  Google Scholar 

  57. Grazioli L, Federle MP, Ichikawa T, et al.: Liver adenomatosis: clinical, histopathologic, and imaging findings in 15 patients. Radiology 2000, 216:395–402.

    PubMed  CAS  Google Scholar 

  58. Buchel O, Roskams T, Van Damme B, itet al.: Nodular regenerative hyperplasia, portal vein thrombosis, and avascular hip necrosis due to hyperhomocysteinaemia. Gut 2005, 54:1021–1023.

    Article  PubMed  CAS  Google Scholar 

  59. Naber AH, Van Haelst U, Yap SH: Nodular regenerative hyperplasia of the liver: an important cause of portal hypertension in non-cirrhotic patients. J Hepatol 1991, 12:94–99.

    Article  PubMed  CAS  Google Scholar 

  60. Nakanuma Y: Nodular regenerative hyperplasia of the liver: retrospective survey in autopsy series. J Clin Gastroenterol 1990, 12:460–465.

    Article  PubMed  CAS  Google Scholar 

  61. Casillas C, Marti-Bonmati L, Galant J: Pseudotumoral presentation of nodular regenerative hyperplasia of the liver: imaging in five patients including MR imaging. Eur Radiol 1997, 7:654–658.

    PubMed  CAS  Google Scholar 

  62. Rha SE, Lee MG, Lee YS, itet al.: Nodular regenerative hyperplasia of the liver in Budd-Chiari syndrome: CT and MR features. Abdom Imaging 2000, 25:255–258.

    Article  PubMed  CAS  Google Scholar 

  63. Taylor BR, Langer B: Current surgical management of hepatic cyst disease. Adv Surg 1997, 31:127–148.

    PubMed  CAS  Google Scholar 

  64. Cowles RA, Mulholland MW: Solitary hepatic cysts. J Am Coll Surg 2000, 191:311–321.

    Article  PubMed  CAS  Google Scholar 

  65. Federle MP, Brancatelli G: Imaging of benign hepatic masses. Semin Liver Dis 2001, 21:237–249.

    Article  PubMed  CAS  Google Scholar 

  66. Gaines PA, Sampson MA: The prevalence and characterization of simple hepatic cysts by ultrasound examination. Br J Radiol 1989, 62:335–337.

    Article  PubMed  CAS  Google Scholar 

  67. Caremani M, Vincenti A, Benci A, itet al.: Ecographic epidemiology of non-parasitic hepatic cysts. J Clin Ultrasound 1993, 21:115–118.

    Article  PubMed  CAS  Google Scholar 

  68. Regev A, Reddy KR, Berho M, itet al.: Large cystic lesions of the liver in adults: a 15-year experience in a tertiary center. J Am Coll Surg 2001, 193:36–45.

    Article  PubMed  CAS  Google Scholar 

  69. vanSonnenberg E, Wroblicka JT, D'Agostino HB, itet al.:Symptomatic hepatic cysts: percutaneous drainage and sclerosis. Radiology 1994, 190:387–392.

    PubMed  CAS  Google Scholar 

  70. Tchelepi H, Ralls PW: Ultrasound of focal liver masses. Ultrasound Q 2004, 20:155–169.

    Article  PubMed  Google Scholar 

  71. Nisenbaum HL, Rowling SE: Ultrasound of focal hepatic lesions. Semin Roentgenol 1995, 30:324–346.

    Article  PubMed  CAS  Google Scholar 

  72. Fulcher AS, Sterling RK: Hepatic neoplasms: computed tomography and magnetic resonance features. J Clin Gastroenterol 2002, 34:463–471.

    Article  PubMed  Google Scholar 

  73. Mortele KJ, Ros PR: Cystic focal liver lesions in the adult: differential CT and MR imaging features. Radiographics 2001, 21:895–910.

    PubMed  CAS  Google Scholar 

  74. Alobaidi M, Shirkhoda A: Benign focal liver lesions: discrimination from malignant mimickers. Curr Probl Diagn Radiol 2004, 33:239–253.

    Article  PubMed  Google Scholar 

  75. Horton KM, Bluemke DA, Hruban RH, itet al.: CT and MR imaging of benign hepatic and biliary tumors. Radiographics 1999, 19:431–451.

    PubMed  CAS  Google Scholar 

  76. Karnam U, Reddy KR: Approach to the patient with a liver mass. In Atlas of Gastroenterology, edn 3. Edited by Yamada T. Philadelphia: Lippincott Williams & Wilkins, 2003:111–117.

    Google Scholar 

  77. Desmet VJ: Congenital diseases of intrahepatic bile ducts: variations on the theme "ductal plate malformation". Hepatology 1992, 16:1069–1083.

    Article  PubMed  CAS  Google Scholar 

  78. Levy AD, Rohrmann CA, Jr, Murakata LA, Lonergan GJ:Caroli's disease: radiologic spectrum with pathologic correlation. AJR Am J Roentgenol 2002, 179:1053–1057.

    PubMed  Google Scholar 

  79. Choi BI, Yeon KM, Kim SH, Han MC: Caroli disease: central dot sign in CT. Radiology 1990, 174:161–163.

    PubMed  CAS  Google Scholar 

  80. Pavone P, Laghi A, Catalano C, itet al.: Caroli's disease: evaluation with MR cholangiopancreatography (MRCP). Abdom Imaging 1996, 21:117–119.

    Article  PubMed  CAS  Google Scholar 

  81. Torzilli G, Minagawa M, Takayama T, itet al.: Accurate preoperative evaluation of liver mass lesions without fine-needle biopsy. Hepatology 1999, 30:889–893.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to K. Rajender Reddy MD.

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Blonski, W., Reddy, K.R. Evaluation of nonmalignant liver masses. Curr Gastroenterol Rep 8, 38–45 (2006). https://doi.org/10.1007/s11894-006-0062-0

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