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Liver Diseases pp 319-340 | Cite as

Benign Liver Tumours

  • Emilio De RaffeleEmail author
Chapter

Abstract

Benign liver tumours are a heterogeneous group of solid or cystic focal liver lesions (FLL) deriving from different cell types. Solid benign liver tumours may have hepatocellular, biliary, vascular and mesenchymal origin, respectively. The most frequent are the hepatic hemangioma (HH), the focal nodular hyperplasia (FNH), and the hepatocellular adenoma (HA). Cystic lesions of the liver (CLL) represent a miscellaneous group of disorders, with heterogeneous etiology, prevalence, and clinical manifestations. The most common are the simple hepatic cysts (SHC), the polycystic liver disease (PLD), the biliary cystic tumours (BCT), comprising biliary cystadenoma (BCA) and cystadenocarcinoma (BCAC).

FLLs are increasingly being discovered, in otherwise asymptomatic patients in most cases, because of the extensive use of medical imaging in clinical practice. Their accurate evaluation is essential to identify primary and metastatic liver malignancies at an early, potentially curable stage. An appropriate diagnostic approach to FLLs requires a detailed clinical history and consideration of risk factors, physical examination, laboratory test findings, different imaging modalities, and histopathology in selected cases. Radiological evaluation is the most important aspect and includes ultrasonography (US), and contrast-enhanced imaging techniques, i.e. computed tomography (CT), magnetic resonance imaging (MRI), contrast-enhanced US (CEUS), and positron emission tomography (PET) in selected cases. Standardization of the technical specifications for CT and MRI should be applied to the evaluation of FLLs. An appropriate contrast-enhanced imaging technique should include a late arterial phase, a portal venous phase, and a delayed venous phase.

If the diagnosis remains uncertain after extensive radiographic imaging, a liver biopsy or even a surgical resection for histopathological examination should be performed.

The management of benign hepatic tumors ranges from conservative to aggressive, depending on the nature of the lesions. Asymptomatic benign tumours usually do not require any specific treatment. However, some benign tumours have malignant potential and should be resected. Symptomatic lesions may require a wide variety of treatments, including liver surgery in selected cases. We review the biological and clinical features of the most common benign hepatic lesions, to guide diagnosis and management strategies.

Keywords

Benign liver tumour Focal liver lesion Focal nodular hyperplasia Hepatocellular adenoma Cystic liver lesion Simple hepatic cyst Polycystic liver disease Biliary cystic tumour Mucinous cystic neoplasm Biliary cystadenoma Biliary cystadenocarcinoma 

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Authors and Affiliations

  1. 1.Unità Operativa di Chirurgia Generale, Dipartimento dell’Apparato Digerente, Azienda Ospedaliero-Universitaria di BolognaPoliclinico S. Orsola-MalpighiBolognaItaly

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