Benign Liver Tumors
Cameron Schlegel
PGY-1
Outline
Benign Liver Tumors are, in general….
•
Asymptomatic
•
Diagnosed: imaging
•
Treatment: Do no harm
–
Unless…
•
Malignant potential
•
Causing symptoms
Differential
Benign
•
Cavernous Hemangioma
•
Focal Nodular Hyperplasia
•
Hepatocellular Adenoma
•
Cystic Tumors
•
Paraganglioma
•
Inflammatory Pseudotumor
•
Peliosis Hepatis
•
Angiomyolipoma/Lipoma
•
Biliary Papillomatosis
•
Caroli Disease
•
Peribiliary Cysts
•
Von Meyenburg Complexes
•
Biliary cystadenomas
Malignant
•
Hepatocellular Carcinoma
•
Intrahepatic
Cholangiocarcinoma
•
Metastases
Differential
Benign
•
Cavernous Hemangioma
•
Focal Nodular Hyperplasia
•
Hepatocellular Adenoma
•
Cystic Tumors
•
Paraganglioma
•
Inflammatory Pseudotumor
•
Peliosis Hepatis
•
Angiomyolipoma/Lipoma
•
Biliary Papillomatosis
•
Caroli Disease
•
Peribiliary Cysts
•
Von Meyenburg Complexes
•
Biliary cystadenomas
Malignant
•
Hepatocellular Carcinoma
•
Intrahepatic
Cholangiocarcinoma
•
Metastases
Cavernous Hemangioma
•
Presentation
:
–
Most common benign liver tumor
–
Female, 40, usually <5cm and
solitary
–
Asymptomatic
–
Syndromes: Kasabach-Merritt,
Osler-Rendu-Weber, VHL
–
Symptomatic in children, 70%
mortality
•
Pathogenesis
:
–
Endothelial lining of blood vessels
•
Diagnosis
: Imaging
–
CT: peripheral
centripital
–
MRI: T1 hypointensity;
Focal Nodular Hyperplasia
• Presentation
– Second most common benign liver
tumor
– Females, 40s, solitary lesions – Not stimulated by hormones – Asymptomatic
• Pathogenesis:
– Hepatocellular hyperplasia 2/2 vascular
malformation
– High concentration Kupffer cells – Well circumscribed, unencapsulated,
central fibrous scar
– Benign hepatocytes in nodules,
separated by fibrous septa that originate from central scar
• Diagnosis: Imaging
– CT: hypoattenuating on early phase images – MRI: arterial enhancement
Hepatocellular Adenoma
• Presentation
– Females (90%), 20-40s, solitary (80%) – OCP/Androgen use
– Iron overload B-thalassemia, type 1 or
3 glycogen storage, diabetes mellitus
– Asymptomatic
– Intraperitoneal hemorrhage (30-50%) – Malignant transformation 10%
• Pathogenesis
– Well differentiated hepatocytes lacking bile ducts/portal triads
• Diagnosis: Imaging
– CT: hypo- to isoattenuating
Imaging Characteristics of Benign Liver
Tumors
Imaging Characteristics of Benign Liver
Tumors
Imaging Characteristics of Benign Liver
Tumors
Compare/Contrast
Tumors
Malignant? CT
MRI
T1
T2
Treatment
Cavernous Hemangio ma No Peripheral central, hyperintense on delayed Nothing If symptoms: enucleation or resection FNH No rapid enhancementduring arterial phase - Hypointense central
scar
- Sulfur Colloid Scan
Nothing
If symptoms: resection
HC
Compare/Contrast
Tumors
Malignant? CT
MRI
T1
T2
Treatment
Cavernous Hemangio ma No Peripheral central, hyperintense on delayed Nothing If symptoms: enucleation or resection FNH No rapid enhancementduring arterial phase - Hypointense central
scar
- Sulfur Colloid Scan
Nothing
If symptoms: resection
HC
