Liver mass natural history, complications and prognosis

In the majority of cases of liver mass, patients are asymptomatic. Benign liver lesions generally remain stable throughout without undergoing any changes. However, without treatment, patient with malignant lesions will develop symptoms of jaundice, ascites, cachexia, right upper quadrant abdominal pain, nausea, and vomiting, which will eventually lead to death. Common complications of liver mass include extrinsic compression of adjacent structures, hemorrhage, and liver failure. Due to the late presentation, the prognosis of malignant lesions is poor even with treatment. However, prognosis of benign liver mass is generally good with appropriate treatment.

Benign liver lesions generally do not change over time in size. They do remain stable throughout although occasionally they become smaller. However, in the setting of OCPs and during pregnancy enlargement of lesions have been reported. Malignant transformation of benign lesions is very rare except for hepatic adenoma which has 8-15% potential.^[1]

Common complications of liver mass include:^[2][3][4][5]

• Transformation into malignant lesion
• Extrinsic compression of adjacent structures:
  • Compression of bile ducts and nearby arteries and veins
  • Gastric compression
• Hemorrhage
  • Hemoperitoneum
  • Intratumoral bleeding
• Liver failure

• Due to the late presentation, the prognosis of malignant lesions is poor even with treatment.^[6]
• Without treatment, malignant lesions will result in early death.
• The survival rate of malignant lesions is less than 50 percent.
• The prognosis depends on the following:
  • Operable vs inoperable cancer
  • Cancer staging: size and metastasis play a major role in prognosis
  • Patient’s general health
  • Time of cancer diagnosis

• Prognosis is generally good with appropriate treatment.
• Resolution of the lesion even with treatment is uncertain.
• The risk of malignant transformation as high as 8-13%.

• Prognosis of focal nodular hyperplasia is generally excellent as mostly lesions stay stable.
• There is no evidence for the malignant transformation of FNH.

• Prognosis of hemangioma is generally excellent.
• There is no evidence for malignant transformation of associated with hemangioma.