Beign Liver Tumors

Question 1

How are benign liver tumors classified?

Answer 1

Mesenchymal: Hemangioma and Hamartomas

Epithelial: FNH, Adenoma

Other: teratoma, inflammatory pseudo tumor.

Question 2

Classification of Liver hemangioma?

Answer 2

Focal, multifocal and diffuse

Question 3

Presentation of Liver hemiangiomas?

Answer 3

• Usually asymptomatic mass
• Bleeding
• Thrombocytopenia
• CHF
• Hypothyroidism

Question 4

Diagnostic tests for liver hemangioma?

Answer 4

AFP - should be normal

U/S - usually diagnostic

CT- peripheral enhancement with filling in on delays

Question 5

Treatment for liver Hemangioma?

Answer 5

Solitary hemangioma typically mimic the history of RICH skin lesions

Symptomatic multifocal or diffuse lesions may respond to propranolol or vincrisitne as second line

Angioembolization or hepatic artery ligation may considered for large symptomatic lesions.

Last resort is liver transplant for diffuse with CHF.

Question 6

Mesenchymal Hamartoma presentation, assessment and treatment?

Answer 6

• Usually asymptomatic mass - 75% in right lobe
• May present with large cyst

On imaging will have large and or multiple cysts

Symptomatic lesions should be resected, cystectomy alone is OK for large lesions.

Small lesions may be observed.

No risk of malignancy

Question 7

FNH presentation, assessment and treatment?

Answer 7

Incidental finding most common

Will have central scar on imaging

Observe if asymptomatic

Question 8

Hepatic Adenoma presentation, assessment, and treatment?

Answer 8

Associated with glycogen storage disease, steroid use and hormone therapy.

Presents as incidental finding, may also present with rupture and bleeding.

CT- isodense to liver with fast venous washout.

Treatment - control any contributing factors (stop hormones/steroids, control glycogen disease) - often resolve.

Lesions > 5cm or those without predisposing factors should be resected.