Benign masses in the liver | Gastrointestinal pathology | Pathology

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; associated with OC pills, sex hormone therapy, and 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): HCC is more common in people with 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 risk. Food additives have been shown to increase risk in animal experiments.

It is often asymptomatic in early stages. Later, it may present with signs of hepatic failure, such as ascites, portal hypertension, jaundice, bleeding tendencies, encephalopathy, coma, right quadrant pain, anorexia, and weight loss. The tumor may also rupture, causing bleeding into the peritoneum.

Diagnosis is by CT, MRI, and rising alpha fetoprotein levels in serum. If possible, liver biopsy should be avoided in HCC because there is an increased risk of bleeding and a 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.

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; associated with OC pills, sex hormone therapy, and 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): HCC is more common in people with 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 risk. Food additives have been shown to increase risk in animal experiments.