Abstract and Introduction
Abstract
The widespread use of imaging modalities and the continuous improvement in their sensitivity have lead to an increasing number of incidental findings of focal liver masses, either solitary or multiple. Most of these so-called incidentalomas are benign and are discovered in healthy, asymptomatic patients. The main issue is to ensure the proper diagnosis, so that clear management recommendations can be provided. Surgery is rarely indicated in these circumstances. Infrequently, benign liver tumors are diagnosed because of symptoms or complications, and require urgent management including surgery as a major role in the cure. Due to better understanding of the clinical and pathological features of benign liver tumors, the increased accuracy of imaging tools, and improvement in surgical techniques (including laparoscopy), the management of these lesions has evolved. Here the clinical and biological features of the most common solid and cystic benign liver tumors are reviewed, and the key points of management focusing on the role of surgery, preventive or diagnostic, are addressed.
Introduction
Benign liver tumors (BLT) are extremely frequent, varied, and mostly asymptomatic. Each cellular component of the liver (e.g., hepatocyte, biliary, endothelial, or other mesenchymal cells) can undergo benign proliferation, but only four lesions have common clinical relevance: hemangioma, focal nodular hyperplasia, hepatocellular adenoma, and hepatic cysts. The affected population usually consists of young women. Clinical management should take into account the symptoms, history, hormonal status (present and future), nature of the tumor, and psychological aspects.
The widespread use of highly sensitive imaging has led to an increasing incidence of focal liver masses, either solitary or multiple. In these so-called incidentalomas, the patient is healthy and asymptomatic; therefore, the major goal is to ensure the diagnosis so that clear management recommendations, including rare and strictly justified surgical options, may be provided. Infrequently, BLTs are diagnosed because of symptoms or complications, and surgery may play a major role in cure under these circumstances.
Nonetheless, for practitioners treating BLT, the initial step is to establish an accurate diagnosis. The next step is to decide on the proper management of the patient, based first on the symptoms, and second, on the nature of the tumor. To reach these goals, it is mandatory to (1) know the natural history of the various tumors and be familiar with their radiological behavior, and (2) consider the surgery guidelines for the particular indication. The operative procedures must be justified, be safe (with no mortality and minimal morbidity), involve no blood transfusions, be as minimally invasive as possible, and have no long-term aftereffects. Some useful considerations to keep in mind with regard to diagnosis and management of BLT are given in Table 1 .
Semin Liver Dis. 2013;33(3):236-247. © 2013 Thieme Medical Publishers
