Benign masses in the liver

Condition	Features
Cysts	Polycystic kidney disease, simple hepatic cyst, hydatid cyst
Focal nodular hyperplasia	Seen in women on OC pills, single or multiple nodules, asymptomatic, most do not need treatment
Adenoma	Seen in women of reproductive age, OC pills, sex hormone therapy, pregnancy, most are asymptomatic, may rupture causing intraperitoneal hemorrhage and shock; treat by stopping OC pills and surgical resection if needed
Hemangioma	Most common benign tumor of the liver, more common in women, may rupture causing intraperitoneal hemorrhage; subcapsular, red-purple, spongy, biopsy shows cavernous, blood filled spaces; treat if symptomatic

Hepatocellular carcinoma (HCC): It is more common in individuals suffering from Hep B, Hep C, cirrhosis, non-alcoholic steatosis and steatohepatitis, alcoholic liver disease, exposure to aflatoxins and cigarette smoking. Disorders such as hemochromatosis, Wilson disease, autoimmune hepatitis, alpha 1 antitrypsin deficiency, obesity, diabetes and primary biliary cholangitis also increase the risk. Food additives have been shown to increase risk in animal experiments. It is asymptomatic in early stages, presenting later on with signs of hepatic failure such as ascites, portal hypertension, jaundice, bleeding tendencies, encephalopathy, coma, right quadrant pain, anorexia, weight loss etc. The tumor may rupture with bleeding into the peritoneum. Diagnosis is by CT, MRI, rising alpha fetoprotein levels in serum. If possible, liver biopsy should be avoided in HCC as there is an increased risk of bleeding and the risk of tumor seeding along the needle track. Treatment is by surgical resection, liver transplant, radiofrequency or microwave ablation, chemoembolization, sorafenib (protein kinase inhibitor), Tivantinib (blocks the receptor protein c-MET) and immunotherapy.