benign liver tumors

What are the most common benign liver tumors?

Hepatic hemangiomas, focal nodular hyperplasia (FNH), and hepatocellular adenoma Benign liver tumors 1

Which benign liver tumor is most common overall?

Hepatic hemangioma Benign liver tumors 2

Which benign liver tumors are more common in women?

Hepatic hemangioma, FNH, and hepatocellular adenoma Benign liver tumors 3

What factors are associated with an increased risk of hepatocellular adenoma?

Use of oral contraceptives, especially those containing estrogen, and pregnancy Benign liver tumors 4

What are the most common types of hepatic cysts?

Solitary and hydatid (echinococcal) cysts Benign liver tumors 5

What are the usual clinical features of benign liver tumors and cysts?

Mainly asymptomatic; often incidental findings Benign liver tumors 6

When might symptomatic manifestations occur with benign liver tumors and cysts?

In cases of large lesions; upper abdominal pain and postprandial fullness Benign liver tumors 7

What is the best initial test for diagnosing benign liver tumors and cysts?

Ultrasonography Benign liver tumors 8

When is a biopsy needed in the diagnosis of benign liver tumors and cysts?

In unclear cases where imaging is inconclusive Benign liver tumors 9

What is the treatment approach for benign liver tumors and cysts?

Generally conservative; surgery reserved for specific lesion types, symptomatic or complicated cases Benign liver tumors 10

What is the typical female to male ratio for hepatic hemangioma?

5:1 Benign liver tumors 11

What is the typical female to male ratio for FNH?

8:1 Benign liver tumors 12

What is the typical female to male ratio for hepatocellular adenoma?

9:1 Benign liver tumors 13

What is the peak incidence age for hepatic hemangiomas?

30-50 Benign liver tumors 14

What age group is most affected by FNH?

Young women in the third or fourth decade of life (though can occur at any age); men get diagnosed later in life. Benign liver tumors 15

What age group is most affected by hepatocellular adenomas?

Childbearing age (mostly at age 15-45) Benign liver tumors 16

What hormonal component is associated with hepatic hemangiomas?

Estrogen therapy associated with increased growth Benign liver tumors 17

What is the suggested etiology of FNH?

Localized hyperplastic reaction by hepatocytes to an underlying arteriovenous malformation Benign liver tumors 18

What factors are associated with hepatocellular adenoma?

Oral contraceptives and anabolic steroids Benign liver tumors 19

What are the complications associated with hepatocellular adenoma?

Risk of malignant transformation, rupture, and bleeding causing hemorrhagic shock Benign liver tumors 20

What is the typical clinical picture of a hepatocellular adenoma?

Young woman with history of oral contraceptive or anabolic steroid use, upper right abdominal pain Benign liver tumors 21

What are the typical ultrasound findings in hepatic hemangiomas?

Usually well-demarcated, homogeneous, hyperechoic (pale) Benign liver tumors 22

What are the typical ultrasound findings in FNH?

Homogeneous, hypoechoic to isoechoic, round/oval, sharply defined, central stellate scar (~50% of cases) Benign liver tumors 23

What are the typical ultrasound findings in hepatocellular adenomas?

Mainly isoechoic, no characteristic vascularization, inhomogeneous due to bleeding, more frequent in the right lobe Benign liver tumors 24

What are the contrast-enhanced sonography findings of a hepatic hemangioma?

Early arterial phase peripheral nodular enhancement with complete centripetal filling in the portal venous and late phases (iris diaphragm phenomenon) Benign liver tumors 25

What are the contrast-enhanced sonography findings of FNH?

From the central artery, radial arrangement of peripheral arteries with typical spoke-like pattern, fast centripetal or mixed filling in arterial phase, sustained enhancement or weak washout in delayed phase Benign liver tumors 26

What are the contrast-enhanced sonography findings of hepatocellular adenoma?

Hypervascularity compared to adjacent liver parenchyma, sustained enhancement or weak washout in the delayed phase Benign liver tumors 27

What are the typical CT findings of a hepatic hemangioma?

Well-demarcated, early arterial phase discontinuous, nodular, or peripheral enhancement, subsequent gradual centripetal enhancement (iris diaphragm phenomenon), delayed-phase hyperintensity Benign liver tumors 28

What are the typical CT findings of FNH?

Early arterial phase enhancement, hypointense to isointense and poorly visualized in the portal venous phase, central scar ("nest of vessels") Benign liver tumors 29

What are the typical CT findings of a hepatocellular adenoma?

Well-demarcated, heterogenous density due to the presence of fat/glycogen/hemorrhagic products, early arterial phase peripheral enhancement, subsequent centripetal enhancement, no retention of contrast on delayed-phase Benign liver tumors 30

What are the typical pathological findings of a hepatic hemangioma?

Possibly pedunculated, cystic lesions with a dark color; cavernous vascular spaces of variable size, lined by flat endothelial cells Benign liver tumors 31

What are the typical pathological findings of FNH?

Light yellow color compared with the surrounding liver tissue; localized hepatocyte nodules, with large malformed arterial branches and centralized fibrous tissue (central stellate scar); normal hepatic lobular architecture absent Benign liver tumors 32

What are the typical pathological findings of hepatocellular adenoma?

Enlarged hepatocytes, with small and regular nuclei, cytoplasmic glycogen and lipid deposits; arranged in sheets or 2-cell thick cords Benign liver tumors 33

What is the recommended treatment for a hepatic hemangioma?

Conservative treatment is often sufficient; surgical treatment if symptomatic/complications arise Benign liver tumors 34

What is the recommended treatment for FNH?

Conservative treatment is often sufficient; surgical treatment if symptomatic/complications arise Benign liver tumors 35

What is the recommended treatment for a hepatocellular adenoma?

Discontinue oral contraceptives; surgical resection if symptomatic or tumor > 5 cm in women, or surgical resection for all men Benign liver tumors 36

What is the recommended follow-up for a hepatic hemangioma?

Regular follow-up Benign liver tumors 37

What is the recommended follow-up for FNH?

Ultrasonography every six months for the first three years after diagnosis Benign liver tumors 38

What is the recommended follow-up for hepatocellular adenoma?

CT or MRI at 6- to 12-month intervals Benign liver tumors 39

What is the etiology of simple hepatic cysts?

Congenital Hepatic cysts 40

What is the peak incidence of simple hepatic cysts?

> 50 years Hepatic cysts 41

What is the sex predilection for simple hepatic cysts?

Slightly higher in females (1.5:1 female:male ratio) Hepatic cysts 42

What are the clinical features of simple hepatic cysts?

Usually asymptomatic; large cysts may present with dull abdominal pain, bloating, and early satiety Hepatic cysts 43

What are the ultrasound findings in simple hepatic cysts?

Anechoic, round lesion with dorsal acoustic enhancement Hepatic cysts 44

What are the CT findings in simple hepatic cysts?

Well-delimited lesion; shows no contrast enhancement Hepatic cysts 45

How are symptomatic simple hepatic cysts managed?

Laparoscopic resection Hepatic cysts 46

What is the definition of a biloma?

Collection of bile in the form of a cyst (biliary cyst) Differential diagnoses 47

What are common etiologies of a biloma?

Common complication of hemihepatectomy or liver transplantation, trauma, spontaneous; due to insufficient closure of bile ducts Differential diagnoses 48

What are the clinical features of a biloma?

Nonspecific; fever, and signs of inflammation; potential jaundice, abdominal pain Differential diagnoses 49

What are the diagnostics findings of a biloma?

Ultrasound (hypoechoic to anechoic), CT (hypodense, possible peripheral contrast enhancement), labs (elevated transaminases and bilirubin, and leukocytosis) Differential diagnoses 50

What is the treatment for a biloma?

Drainage and antibiotic treatment in patients with inflammation; spontaneous healing is possible, surgical repair may be necessary Differential diagnoses 51

What are some differential diagnoses to consider when evaluating liver masses?

Malignant liver tumors (HCC, intrahepatic cholangiocellular carcinoma, liver metastases), liver abscess, localized non-space occupying lesions of the liver, regenerative nodules in liver cirrhosis, portal vein thrombosis, accessory lobes of liver, round ligament of liver, hepatic inflammatory pseudotumor Differential diagnoses 52