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Liver mass

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Synonyms and keywords: Hepatic mass; Solid liver lesion; Liver lesions; Cystic liver lesions

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Patient Information


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Jinhui Wu, M.D.

Overview

The liver is the largest internal organ which lies under the right side of your ribcage just beneath your right lung. It is a very important organ for digestion and metabolism. Primary liver cancer starts in the liver. Metastatic liver cancer starts somewhere else and spreads to your liver. It is hard to detect hepatocellular carcinoma in its early stages. Frequent symptoms include pain and lump in the right abdomen, yellowing of the eyes and skin, marasmus and fatigue. Possible treatments include surgery, radiation therapy and chemotherapy. Prognosis is poor for most hepatocellular carcinoma patients.

What are the symptoms of hepatocellular carcinoma?

In its earliest stages, hepatocellular carcinoma does not cause any symptoms. When the tumors grow larger, people may notice one or more of the following symptoms:

  • Abdominal pain and vague abdominal fullness: At first the location of the abdominal pain you are experiencing may be isolated on the upper-right part of your abdomen. It is usually relatively mild pain or no pain at all that is present with this life-threatening condition. With the development of cancer, abdominal pain is usually persistent.
  • Abdominal lump: People cannot find any lump at the beginning of the disease. When the tumor begins to enlarge, the lump may be obvious in the abdominal region.
  • Jaundice and itching: This is caused by hepatocellular necrosis and obstruction of bile in the bile ducts.
  • Nausea and vomiting: Hepatocellular carcinoma disturbs the normal functions of digestion.
  • Vomiting blood: This symptom is attributed to many factors such as dysfunction of the liver and spleen.
  • Loss of appetite
  • General decline in health
  • Weakness or fatigue
  • Fever

Infections or other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell the doctor so that problems can be diagnosed and treated as early as possible.

Who is at risk for hepatocellular carcinoma?

There are some factors that may increase your risk of developing hepatocellular carcinoma. These risk factors include:

Diagnosis

It is hard to diagnose hepatocellular carcinoma in its early stages. Other problems can also cause the same symptoms such as stomach discomfort, gallbladder diseases, and pancreatic diseases. So, if you have those symptoms, you had better go to see your doctor to do some tests. They include lab tests and image tests.

  • Alpha fetoprotein test: This is a blood test. AFP(alpha-fetoprotein) can be found in the blood of unborn babies, but it disappears shortly after birth. When the level of AFP is higher than normal, it suggests that the patient may have hepatocellular carcinoma. Detecting AFP can be used to look for early tumors in people with a high risk for hepatocellular carcinoma.
  • Ultrasound: This test is used to find tumors in the liver by ultrasound. Tumor tissue may produce a different echo from normal tissue. So different echo patterns can help tell whether there is a tumor present and some details such as the size, boundary and so on.
  • Computed tomography (CT) scan and biopsy: CT scans are often used to diagnose hepatocellular carcinoma. It can confirm the location of cancer and show the organs near the tumor, as well as lymph nodes and distant organs where cancer might have spread. This is helpful in staging cancer and in determining whether surgery is a good treatment option. CT scans can also be used to guide a biopsy in which a biopsy sample is removed and looked at under a microscope by a pathologist.
  • Magnetic resonance imaging (MRI): An MRI uses magnetic fields, which is a different imaging type from computed tomography (CT) to produce detailed images of the body. MRI scans are very helpful when diagnosing hepatocellular carcinoma. Sometimes they can be used to distinguish a benign tumor from a cancerous one. Like computed tomography (CT), a contrast agent may be injected into a patient’s vein to create a better picture. MRI scans take a longer time than a CT scan to complete.
  • Laparoscopy and biopsy: During this test, a thin, lighted scope is put in through a small cut in the abdomen to look at the liver and other organs. The test can help the doctor in diagnosis or treatment plans. Also through this tube, the doctor can use small probes to take out tissue samples to be checked under the microscope by pathologists.

When to seek urgent medical care?

Call your health care provider if symptoms of hepatocellular carcinoma develop. If one or more of the following symptoms emerge, seek medical care as soon as possible:

  • Sudden severe abdominal pain and a decrease in blood pressure: The reason a person with hepatocellular carcinoma has sudden severe abdominal pain is sometimes due to a ruptured carcinoma. This is the result of cancer developing very fast. Sometimes if the carcinoma invades the main vessel it results in a hemorrhage into the peritoneal cavity and the patients may feel sudden abdominal pain.
  • Vomiting a lot of blood: This is the result of complications such as dysfunction of the liver or synthetic blood coagulation factors and esophagogastric fundus vein rupture. An abundant amount of blood loss due to vomiting may lead to shock and even death.

Treatment options

Patients with hepatocellular carcinoma have many treatment options. The type of treatment depends on the stage of the tumor. The options are surgery, radiation therapy, chemotherapy, or a combination of methods and palliative treatment.

Surgery

  • Surgical Resection (Partial Hepatectomy): The surgeon can judge whether the patient is able to handle this surgery.
  • Liver transplant: If available, a liver transplant may be the best option for patients with small liver tumors (either 1 tumor smaller than 5 cm or 1 to 3 tumors no larger than 3 cm).
  • Tumor ablation or embolization: Ablation refers to local methods that destroy the tumor without removing it, such as Radiofrequency ablation (RFA), Ethanol (alcohol) ablation, Cryosurgery (cryotherapy), Hepatic artery embolization, Chemoembolization, and Radioembolization.

Radiation therapy: This is a cancer treatment that kills cancer cells or keeps them from growing by using high-energy x-rays or other types of radiation.

  • External beam radiation therapy
  • Radioembolization

Targeted therapy: This new therapy uses a drug named Sorafenib (Nexavar) to lengthen the lifetime of patients with hepatocellular carcinoma. Sorafenib is a targeted drug which can slow the progression of advanced hepatocellular carcinoma by blocking both angiogenesis (new blood vessel growth in tumors) and growth-stimulating molecules in cancer cells. At present, Sorafenib has been studied in hepatocellular carcinoma patients with relatively normal liver function.

Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effect may not be the same for each person, and they may change from one treatment session to the next.

Diseases with similar symptoms

Other health problems may also cause similar symptoms. Go to see your doctor to verify your diseases as early as possible. Diseases with similar symptoms are listed below:

Where to find medical care for hepatocellular carcinoma?

Directions to Hospitals Treating hepatocellular carcinoma

Prevention of hepatocellular carcinoma

Epidemiological data shows the following may be helpful to reduce the risk of hepatocellular carcinoma:

  • Avoiding alcohol abuse: Alcohol abuse is the most common cause in western countries.
  • Prevention of infection with hepatitis B or C: Hepatitis B or C are the main cause in Asian countries. Childhood vaccination against hepatitis B may reduce the risk of liver cancer in the future.
  • Hemochromatosis screening: Certain autoimmune diseases of the liver may be related to the development of hepatocellular carcinoma. Early screening may be helpful.

What to expect (Outlook/Prognosis)?

The prognosis of hepatocellular carcinoma is poor and it depends on the following:

  • Whether or not the tumor can be removed by surgery
  • The stage of cancer: the size of the tumor, whether cancer has spread outside the liver
  • The patient’s general health
  • Whether cancer has just been diagnosed or has recurred

Resources

Overview

Overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

Liver mass (also known as “hepatic mass”) is generally defined as the neoplastic growth of tissue in the liver. Abnormal growths found in the liver can be benign or malignant. Liver mass may be classified according to imaging features (hyperechoic vs. hypoechoic), histopathological origin (benign vs. malignant), and distribution (single/focal/solitary vs. multiple). The most common cause of a liver mass is liver cancer. Common causes of benign liver mass, include: hepatic hemangioma, focal nodular hyperplasia, hepatic adenoma, idiopathic noncirrhotic portal hypertension (including nodular regenerative hyperplasia, regenerative nodules. Conversely, common causes of malignant liver mass, include: hepatocellular carcinoma, cholangiocarcinoma, metastatic disease. “Primary liver tumors”, which originate in the liver or from hepatic-derived cells and tissues, and “secondary tumors” which originate in other sites and metastasize to the liver. Liver masses are common. The annual incidence rate of malignant liver mass is approximately 6 per 100,000 individuals in the United States. The incidence rate of liver mass increases with age; The median age at diagnosis varies widely between 5 to 60 years. Females are more commonly affected with benign liver masses than males. The female to male ratio is approximately 2.3 to 1. However, males are more commonly affected with malignant liver masses than females. The male to female ratio is approximately 3 to 1. The incidence of malignant liver mass varies widely according to the ethnicity and geographic location. A hallmark feature in the evaluation of liver mass is the malignancy assessment. The evaluation approach of liver mass will mainly depend in the initial morphological evaluation of the mass (size, margins, contours, imaging pattern, and growth). Other characteristics, such as: location, clinical features, and distribution may be helpful for the therapeutical management, surveillance, and follow-up of liver mass. Liver mass can be divided into 2 categories: benign liver mass and malignant liver mass. Based upon these categories, complementary diagnostic studies and management, include: PET/CT scan, MRI, and surgical resection. In the majority of cases, liver masses are asymptomatic and are usually found incidentally. However, in some cases, patients may develop non-specific symptoms, such as: right upper quadrant abdominal pain, pruritus, and unintentional weight loss. A positive history of chronic hepatitis, cirrhosis, nonalcoholic fatty liver disease, prolonged contraceptive use, and alcohol abuse may be suggestive of a liver mass. Symptoms related with liver mass will vary depending on the size and location of the tumor. For instance, compression symptoms from left lobe lesions, such as early satiety. Other symptoms of liver mass may also include: loss of appetite, fatigue, nausea, and vomiting.

Historical Perspective

Liver mass as a separate entity was first described in detail by Hippocrates. He was also the first to differentiate liver abscess from other liver masses. In 1843, Dr. Robert Liston, a British surgeon, was the first to describe hemangioma. In 1911, Yamagiwa suggested a new classification system based on the cell of origin and divided hepatobiliary cancers into hepatocellular cancer and cholangiocellular cancer, with the proposed terminology of hepatoma and cholangioma. In 1958, I Bartok discovered hepatoblastoma for the first time.

Classification

A liver mass may be grouped into several subtypes based on the number of nodules (solitary or multiple), type of histopathology (benign or malignant), and consistency (solid or cystic).

Causes

The most common cause of a liver mass is hepatocellular carcinoma. Common causes of benign liver mass, include: hepatic hemangioma, focal nodular hyperplasia, hepatic adenoma, idiopathic non-cirrhotic portal hypertension, nodular regenerative hyperplasia, regenerative nodules. Common causes malignant liver masses, include: hepatocellular carcinoma, cholangiocarcinoma, metastatic disease

Differentiating Liver Mass from Other Diseases

Liver mass may be differentiated according to clinical features, laboratory findings, imaging features, histological features, and genetic studies, from other diseases that cause abdominal pain, pruritus, low-grade fever, and ascites. Common differential diagnosis includes: liver abscess, simple liver cyst, and fungal infections.

Epidemiology and Demographics

Liver masses are common. The annual incidence rate of malignant liver mass is approximately 6 per 100,000 individuals in the United States. The incidence rate of liver mass increases with age; The median age at diagnosis varies widely between 5 to 60 years. Females are more commonly affected with benign liver masses than males. The female to male ratio is approximately 2.3 to 1. However, males are more commonly affected with malignant liver masses than females. The male to female ratio is approximately 3 to 1. The incidence of malignant liver mass varies widely according to the ethnicity and geographic location.

Screening

According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for liver mass.

Diagnosis

Evaluation of Liver Mass

A hallmark feature in the evaluation of liver mass is the malignancy assessment. The evaluation approach of liver mass will mainly depend in the initial morphological evaluation of the mass (size, margins, contours, imaging pattern, and growth). Other characteristics, such as: location, clinical features, and distribution may be helpful for the therapeutical management, surveillance, and follow-up of liver mass. Liver mass can be divided into 2 categories benign liver mass and malignant liver mass. Based upon these categories, recommended complementary diagnostic studies include PET/CT scan, MRI, and surgical resection.

Staging

According to the American Joint Committee on Cancer (AJCC) staging system, there are 4 stages of malignant liver mass, based on 3 factors: tumor size, lymph node invasion, and metastasis. Each stage is assigned a letter and a number that designate T for tumor size, N for node invasion, and M for metastasis.

History and Symptoms

In the majority of cases, liver masses are asymptomatic and are usually found incidentally. However, in some cases, patients may develop non-specific symptoms, such as: right upper quadrant abdominal pain, pruritus, and unintentional weight loss. A positive history of chronic hepatitis, cirrhosis, nonalcoholic fatty liver disease, prolonged contraceptive use, and alcohol abuse may be suggestive of a liver mass. Symptoms related with liver mass will vary depending on the size and location of the tumor. For instance, compression symptoms from left lobe lesions, such as early satiety. Other symptoms of liver mass may also include: loss of appetite, fatigue, nausea, and vomiting.[1][2]

Physical Examination

Physical examination findings of liver mass will depend on location and size of the tumor. Usually large liver tumors may cause pain and tenderness in palpation of the abdomen due to stretching of the liver capsule. On the other hand, liver masses with smaller size can present with no remarkable findings. Common physical examination of patients with liver mass, may include: janudice, hepatomegaly, abdominal tenderness, splenomegaly, abdominal wall vascular collaterals, and weight loss.

Laboratory Findings

Laboratory findings consistent with the diagnosis of liver mass include: elevated serum alpha-fetoprotein level, positive serologic testing for hepatitis B/C surface antigen, and abnormal liver function tests.Routinary laboratory findings associated with liver mass, include: complete blood count, electrolytes, calcium, alkaline phosphatase, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, creatinine, albumin, and lactate dehydrogenase.

Imaging

Ultrasound is the initial method of choice for the evaluation of liver mass. The evaluation of liver mass will depend on several characteristics, such as: vascular pattern, margins, location, distribution, and attenuation. Further evaluation of liver mass, should include other diagnostic studies, such as: triphasic CT scan with complementary tumoral markers,or MRI. Other imaging study useful for the malignancy evaluation of liver mass is PET scanning, which may be helpful for the detection of occult disease and malignancy assessment.

X Ray

On conventional radiography there are no characteristic findings of liver mass.

CT

Computed tomography may be useful for the evaluation and diagnosis of liver masses. The evaluation of liver mass should be performed with a triphasic CT, this modality includes 3 phases: non-contrast, arterial phase, and portal venous phase. On CT, characteristic findings of liver mass, may include: solitary or multiple lesion, solid or cystic consistency, and normally a rounded lesion. The evaluation of liver mass will depend on several characteristics, such as: vascular pattern, size, location, size, distribution, margins, attenuation, and contrast enhancement.[2]

MRI

On MRI, characteristic features for the diagnosis of liver mass, include: higher soft tissue contrast, lack of radiation exposure, lesion characterization by evaluation of signal intensities, improving detection of hypervascular lesions, and characterization of the dynamics of contrast uptake.[2]

Other Diagnostic Studies

Biopsy

Biopsy for liver mass may be classified into 2 categories: non-surgical biopsy and surgical biopsy. Biopsy findings associated with liver mass will depend on tumor histology. Common types of liver tissue biopsy for liver mass, include: channels lined by benign endothelium, fibromuscular hyperplasia, and loss of reticulin scaffold. Common indications for biopsy in liver mass, include: suspected hepatocellular carcinoma, and unspecific imaging findings. The most important contraindication for biopsy in liver mass is suspected liver hemangioma.[3][4]

Treatment

Medical Therapy

The majority of cases of liver masses (benign liver tumors) are asymptomatic and require only supportive care. Medical therapy is indicated only in cases of infectious cystic lesions. Surgery is the main stay of treatment for solid lesions.

Surgery

In the majority of cases of benign hepatic tumors, patients are asymptomatic, and no treatment is indicated. The main indication for treatment is the presence of significant clinical symptoms or suspicion of malignancy or fear of malignant transformation. Surgery is the mainstay of treatment for symptomatic benign liver lesions.

Primary Prevention

Effective measures for the primary prevention of liver lesions include limited use of OCP’s, vaccination for hepatitis, alcohol cessation, especially in cirrhotic patients, avoidance of hepatotoxic drugs, physical exercise, smoking cessation, adequate caloric intake, prevention of obesity, screening of blood donors for Hepatitis B, Hepatitis C.

Secondary Prevention

Secondary preventive measures of liver mass are similar to primary preventive measures.

References

  1. ↑ Roche SP, Kobos R (2004). “Jaundice in the adult patient”. Am Fam Physician. 69 (2): 299–304. PMID 14765767.
  2. ↑ 2.0 2.1 2.2 Bonder A, Afdhal N (2012). “Evaluation of liver lesions”. Clin Liver Dis. 16 (2): 271–83. doi:10.1016/j.cld.2012.03.001. PMID 22541698.
  3. ↑ Hepatocellular carcinoma. Libre Pathology.https://librepathology.org/wiki/Hepatocellular_carcinoma Accessed on March 28, 2016
  4. ↑ Borzio M, Borzio F, Macchi R, Croce AM, Bruno S, Ferrari A, Servida E (1994). “The evaluation of fine-needle procedures for the diagnosis of focal liver lesions in cirrhosis”. J. Hepatol. 20 (1): 117–21. PMID 8201212.
Historical Perspective

Historical Perspective

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Liver mass as a separate entity was first described in detail by Hippocrates. He was also the first to differentiate liver abscess from other liver masses. In 1843, Dr. Robert Liston, a British surgeon, was the first to describe hemangioma. In 1911, Yamagiwa suggested a new classification system based on the cell of origin and divided hepatobiliary cancers into hepatocellular cancer and cholangiocellular cancer, with the proposed terminology of hepatoma and cholangioma. In 1958, I Bartok discovered hepatoblastoma for the first time.

Historical Perspective

References

  1. ↑ Liston R (1843). “Case of erectile tumour in the popliteal space.-Removal”. Med Chir Trans. 26: 120–32. PMC 2116921. PMID 20895766.
  2. ↑ Yamagiwa K. Zum Kenntniss des prim%ren parenchymatosen Leberkarzinoms (“Hepatoma”). Virchows Arch Path Anat 1911;203:75-131.
  3. ↑ Okuda K (2002). “Hepatocellular carcinoma–history, current status and perspectives”. Dig Liver Dis. 34 (9): 613–6. PMID 12405244.
  4. ↑ Madabhavi, Irappa; Patel, Apurva; Choudhary, Mukesh; Aagre, Suhas; Revannasiddaiah, Swaroop; Modi, Gaurang; Anand, Asha; Panchal, Harsha; Parikh, Sonia; Raut, Shreeniwas (2014). “Paraneoplastic Recurrent Hypoglycaemic Seizures: An Initial Presentation of Hepatoblastoma in an Adolescent Male—A Rare Entity”. Case Reports in Pediatrics. 2014: 1–5. doi:10.1155/2014/104543. ISSN 2090-6803.
  5. ↑ Barthelmes L, Tait IS (2005). “Liver cell adenoma and liver cell adenomatosis”. HPB (Oxford). 7 (3): 186–96. doi:10.1080/13651820510028954. PMC 2023950. PMID 18333188.
  6. ↑ Baum JK, Bookstein JJ, Holtz F, Klein EW (1973). “Possible association between benign hepatomas and oral contraceptives”. Lancet. 2 (7835): 926–9. PMID 4126557.
Classification

Classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2] Aditya Ganti M.B.B.S. [3]

Overview

A liver mass may be grouped into several subtypes based on the number of nodules (solitary or multiple), type of histopathology (benign or malignant), and consistency (solid or cystic).

Classification

A liver mass may be classified into several sub-types based on number of nodules, type of histo-pathology, and consistency.[1][2][3][4][5][6][7][8][9][10][11]

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Liver mass
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Based on number of nodules
 
 
 
 
 
 
 
 
Type of histopathology
 
 
 
 
 
 
 
 
Imaging/consistency
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Solitary
 
 
 
 
 
Multiple
 
Benign
 
 
 
Malignant
 
Solid
 
 
 
 
 
Cystic
 

CLassification based on the number of nodules

  • Liver mass based on the number of nodules on imaging can be classified into 2 types:
    • Solitary nodule
    • Multiple nodules
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Solid liver mass
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No history of liver disease
 
 
 
 
 
 
 
 
 
 
 
 
 
History of liver disease
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Asymptomatic
 
 
 
 
 
 
 
 
Symptomatic
 
 
 
Arterial enchancement with washout
 
Only arterial enchancement
 
Persistant arterial enhancement
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Weight loss
 
 
 
HCC
 
Dyspatic nodule
 
Cholangiocarcinoma
 
 
 
 
 
 
 
 
 
 
 
Adenoma
 
FNH*
 
Hemangioma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Metastasis
H/O of cancer
 
 
 
Fibrolammellar HCC
No H/O of cancer
 

Abbreviations:

  • FNH: Focal nodular hyperplasia

Classification based on histopathology

  • Based on the type of histopathology, liver mass can be classified into 2 types:
    • Benign
    • Malignant
WHO Classification of Liver Tumors
Benign Tumors Malignant Tumors
Epithelial Hepatocytes
Biliary cells
  • Intrahepatic bileduct adenoma
  • Intrahepatic bileduct cystadenoma
  • Biliary papillomatosis
Non-Epithelial Mesenchymal

Classification based on consistency

  • Based on the consitency of the mass, liver mass can be classified into 2 types:
    • Solid
    • Cystic
      • Complex cysts
      • Solid cysts
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Liver mass
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cystic
 
 
 
 
 
 
 
Solid
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Thin walled
 
 
 
 
 
 
 
 
 
 
Thick walled Septations
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Single
 
 
 
Multiple
 
Cystadenoma
 
 
 
Cyst adenocarcinoma
 
 
 
Choledochal cyst
 
 
 
 
 
 
 
 
 
 
 
 
Simple Hepatic cyst
 
 
 
Polycystic Liver Disease
 

References

  1. ↑ Mergo PJ, Ros PR. Benign Lesions of the Liver. In: The Radiologic Clinics of North America, 2, W.B. Saunders, Philadelphia 1998. Vol 36, p.319.
  2. ↑ Kim TK, Lee E, Jang HJ (2015). “Imaging findings of mimickers of hepatocellular carcinoma”. Clin Mol Hepatol. 21 (4): 326–43. doi:10.3350/cmh.2015.21.4.326. PMC 4712159. PMID 26770920.
  3. ↑ Ferrell, Linda (2000). “Liver Pathology: Cirrhosis, Hepatitis and Primary Liver Tumors. Update and Diagnostic Problems”. Modern Pathology. 13 (6): 679–704. doi:10.1038/modpathol.3880119. ISSN 0893-3952.
  4. ↑ Kim, Tae Kyoung; Lee, Eunchae; Jang, Hyun-Jung (2015). “Imaging findings of mimickers of hepatocellular carcinoma”. Clinical and Molecular Hepatology. 21 (4): 326. doi:10.3350/cmh.2015.21.4.326. ISSN 2287-2728.
  5. ↑ Doo, Kyung Won; Lee, Chang Hee; Choi, Jae Woong; Lee, Jongmee; Kim, Kyeong Ah; Park, Cheol Min (2009). ““Pseudo Washout” Sign in High-Flow Hepatic Hemangioma on Gadoxetic Acid Contrast-Enhanced MRI Mimicking Hypervascular Tumor”. American Journal of Roentgenology. 193 (6): W490–W496. doi:10.2214/AJR.08.1732. ISSN 0361-803X.
  6. ↑ Zech CJ, Herrmann KA, Reiser MF, Schoenberg SO (2007). “MR imaging in patients with suspected liver metastases: value of liver-specific contrast agent Gd-EOB-DTPA”. Magn Reson Med Sci. 6 (1): 43–52. PMID 17510541.
  7. ↑ Cheng, H C; Tsai, S H; Chiang, J H; Chang, C Y (1995). “Hyalinized liver hemangioma mimicking malignant tumor at MR imaging”. American Journal of Roentgenology. 165 (4): 1016–1017. doi:10.2214/ajr.165.4.7676959. ISSN 0361-803X.
  8. ↑ Haratake J, Horie A, Nagafuchi Y (1992). “Hyalinized hemangioma of the liver”. Am. J. Gastroenterol. 87 (2): 234–6. PMID 1370873.
  9. ↑ Takayasu, K; Moriyama, N; Shima, Y; Muramatsu, Y; Yamada, T; Makuuchi, M; Yamasaki, S; Hirohashi, S (1986). “Atypical radiographic findings in hepatic cavernous hemangioma: correlation with histologic features”. American Journal of Roentgenology. 146 (6): 1149–1153. doi:10.2214/ajr.146.6.1149. ISSN 0361-803X.
  10. ↑ Yamashita Y, Shimada M, Taguchi K, Gion T, Hasegawa H, Utsunomiya T, Hamatsu T, Matsumata T, Sugimachi K (2000). “Hepatic sclerosing hemangioma mimicking a metastatic liver tumor: report of a case”. Surg. Today. 30 (9): 849–52. PMID 11039718.
  11. ↑ Kim, Tae Kyoung; Lee, Eunchae; Jang, Hyun-Jung (2015). “Imaging findings of mimickers of hepatocellular carcinoma”. Clinical and Molecular Hepatology. 21 (4): 326. doi:10.3350/cmh.2015.21.4.326. ISSN 2287-2728.
Pathophysiology

Pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

The exact pathogenesis of a liver mass depends upon the underlying disease. Increased estrogen in hepatic adenoma stimulates hepatocytes via steroid receptors and results vascular ectasia. While in FNH excessive release of growth factors promote growth of small arteries. Some conditions such as hemangioma, hepatic cysts are believed to be as result of genetic abnormality. Precancerous lesions are responsible for HCC, cholangiosarcoma. Hepatic abscess and echinoccosiosis are due to infectious agents.

Pathophysiology

The exact pathogenesis of a liver mass depends upon the underlying disease. The following table summarizes the various causes of liver masses:

Disease Pathogenesis Genetics Associated Conditions Gross Pathology Microscopic Pathology
Hepatocellular adenoma
  • Estrogens cause the transformation of hepatocytes via steroid receptors
  • Results in generalized vascular ectasia
  • Transcription factor 1 gene (TCF1)
  • Interleukin 6 signal transducer gene (IL6ST)
  • β catenin-1 gene (CTNNB1)
  • Well circumscribed
  • Non-lobulated
  • Smooth and soft
  • White to yellow to brown lesions
Focal nodular hyperplasia
  • β-catenin gene (CTNNB1)
  • TP53
  • APC or HNF1α
  • Klippel-Trénaunay-Weber syndrome
  • Well-circumscribed
  • Non-encapsulated
  • Central fibrous scar
  • Hepatic parenchyma arranged in incomplete nodules
  • Fibrous tissue with thick-walled vessels
  • Bile ductular proliferation
  • Cells of chronic inflammation
Hemangioma
  • Congenital disorder
  • Vascular malformations that enlarge by ectasia 
  • Estrogen and progesterone influence over tumor growth
  • More common in females
  • Von Hippel Lindau disease
  • Well-circumscribed
  • Appear red-brown
  • Solitary nodules
  • Less than 5cms
  • Large cystically dilated vessels
  • Thin walls
  • Intravascular thrombosis
  • Calcifications
Hepatic Cyst
  • Von Meyenburg complexes separate from biliary tree and dilate to form cyst
  • Single, unilocular cyst
  • Variable amounts of clear amber fluid (may contain blood, bile, mucus, pus)
  • Lined by flat / cuboidal epithelium
  • Epithelium rests on thin collagenous wall without spindle cell stroma
  • Degenerative changes include epithelial desquamation, multiloculation, calcification
Lymphangioma
  • Lymphangioma is caused by either sequestration of
    • Lymph tissue
    • Abnormal budding of lymph vessels
    • Lack of fusion with the venous system,
    • Obstruction of lymph vessels.
  • Grey-white mass
  • Well circumscribed
  • Edematous appearance
  • Variable size (may be massive)
  • Filled with serous fluid
  • Smooth inner lining
Angiomyolipoma
  • Well circumscribed
  • Uniform yellow mass
Hepatocellular carcinoma
  • Arises from precancerous lesions.[1]:

[2][3][4][5][6][7]

    • Genomic alterations
    • Epigenetic modifications
    • Growth factor pathway alterations
  • Nodular or diffusely infiltrative
  • Pale in relation to surrounding liver or green
  • Large polygonal tumours cells
  • Graunular eosinophilic cytoplasm
  • Layered dense collagen bundles
Cholangiocarcinoma
  • The epithelial cell lining the bile ducts are called cholangiocytes.
  • The malignant transformsation of cholangiocytes leads to cholangiocarcinoma.[8]
  • Malignant transformation of cholangiocytes into cholangiocarcinoma include following stages:[9]
  • Hyperplasia
  • Metaplasia
  • Dysplasia
  • Frank carcinoma
  • Progression of malignancy is believed to be due to:[9][10][11]
    • Inflammation
    • Obstruction of bile ducts
    • Biliary intraepithelia neoplasia.
  • ARID1A
  • BAP1
  • BRAF
  • FGFR2
  • IDH1
  • IDH2
  • KMT2C
  • KRAS
  • PBRM1
  • PEG3
  • PTPN3
  • RNF43
  • ROBO2
  • SMAD4
  • TERT
  • TP53
  • Mass-forming
    • Nodular lesion or mass in the hepatic parenchyma
    • Gray to gray-white, firm and solid carcinoma
  • Periductal infiltrating
    • Spreading of the carcinoma along the portal tracts with stricture of the affected bile ducts
    • Dilatation of the peripheral bile ducts
  • Intraductal growth types
    • Polypoid or papillary tumor within the variably dilated bile duct lumen
    • Malignant progression of an intraductal papillary neoplasm of the bile duct
  • Cuboidal or columnar mucin producing cells
  • Dense fibrous(desmoplastic) stroma.
Hepatic abscess
Parasitic cysts:[18][19][20](Echinococcous)
  • Cysts tend to be:
    • Filled with clear fluid
    • White appearance
    • Solitary
    • Unilocular
  • Cyst wall composed of an acellular laminated external layer and a thin, germinal (nucleated) inner layer
  • Brood capsule with protoscoleces inside

References

  1. ↑ Guichard C, Amaddeo G, Imbeaud S, Ladeiro Y, Pelletier L, Maad IB, Calderaro J, Bioulac-Sage P, Letexier M, Degos F, Clément B, Balabaud C, Chevet E, Laurent A, Couchy G, Letouzé E, Calvo F, Zucman-Rossi J (2012). “Integrated analysis of somatic mutations and focal copy-number changes identifies key genes and pathways in hepatocellular carcinoma”. Nat. Genet. 44 (6): 694–8. doi:10.1038/ng.2256. PMC 3819251. PMID 22561517.
  2. ↑ Killela PJ, Reitman ZJ, Jiao Y, Bettegowda C, Agrawal N, Diaz LA, Friedman AH, Friedman H, Gallia GL, Giovanella BC, Grollman AP, He TC, He Y, Hruban RH, Jallo GI, Mandahl N, Meeker AK, Mertens F, Netto GJ, Rasheed BA, Riggins GJ, Rosenquist TA, Schiffman M, Shih I, Theodorescu D, Torbenson MS, Velculescu VE, Wang TL, Wentzensen N, Wood LD, Zhang M, McLendon RE, Bigner DD, Kinzler KW, Vogelstein B, Papadopoulos N, Yan H (2013). “TERT promoter mutations occur frequently in gliomas and a subset of tumors derived from cells with low rates of self-renewal”. Proc. Natl. Acad. Sci. U.S.A. 110 (15): 6021–6. doi:10.1073/pnas.1303607110. PMC 3625331. PMID 23530248. Vancouver style error: initials (help)
  3. ↑ Nault JC, Mallet M, Pilati C, Calderaro J, Bioulac-Sage P, Laurent C, Laurent A, Cherqui D, Balabaud C, Zucman-Rossi J, Zucman Rossi J (2013). “High frequency of telomerase reverse-transcriptase promoter somatic mutations in hepatocellular carcinoma and preneoplastic lesions”. Nat Commun. 4: 2218. doi:10.1038/ncomms3218. PMC 3731665. PMID 23887712.
  4. ↑ Chen YL, Jeng YM, Chang CN, Lee HJ, Hsu HC, Lai PL, Yuan RH (2014). “TERT promoter mutation in resectable hepatocellular carcinomas: a strong association with hepatitis C infection and absence of hepatitis B infection”. Int J Surg. 12 (7): 659–65. doi:10.1016/j.ijsu.2014.05.066. PMID 24866078.
  5. ↑ Schulze K, Imbeaud S, Letouzé E, Alexandrov LB, Calderaro J, Rebouissou S, Couchy G, Meiller C, Shinde J, Soysouvanh F, Calatayud AL, Pinyol R, Pelletier L, Balabaud C, Laurent A, Blanc JF, Mazzaferro V, Calvo F, Villanueva A, Nault JC, Bioulac-Sage P, Stratton MR, Llovet JM, Zucman-Rossi J (2015). “Exome sequencing of hepatocellular carcinomas identifies new mutational signatures and potential therapeutic targets”. Nat. Genet. 47 (5): 505–511. doi:10.1038/ng.3252. PMC 4587544. PMID 25822088.
  6. ↑ Totoki Y, Tatsuno K, Covington KR, Ueda H, Creighton CJ, Kato M, Tsuji S, Donehower LA, Slagle BL, Nakamura H, Yamamoto S, Shinbrot E, Hama N, Lehmkuhl M, Hosoda F, Arai Y, Walker K, Dahdouli M, Gotoh K, Nagae G, Gingras MC, Muzny DM, Ojima H, Shimada K, Midorikawa Y, Goss JA, Cotton R, Hayashi A, Shibahara J, Ishikawa S, Guiteau J, Tanaka M, Urushidate T, Ohashi S, Okada N, Doddapaneni H, Wang M, Zhu Y, Dinh H, Okusaka T, Kokudo N, Kosuge T, Takayama T, Fukayama M, Gibbs RA, Wheeler DA, Aburatani H, Shibata T (2014). “Trans-ancestry mutational landscape of hepatocellular carcinoma genomes”. Nat. Genet. 46 (12): 1267–73. doi:10.1038/ng.3126. PMID 25362482.
  7. ↑ Cleary SP, Jeck WR, Zhao X, Chen K, Selitsky SR, Savich GL, Tan TX, Wu MC, Getz G, Lawrence MS, Parker JS, Li J, Powers S, Kim H, Fischer S, Guindi M, Ghanekar A, Chiang DY (2013). “Identification of driver genes in hepatocellular carcinoma by exome sequencing”. Hepatology. 58 (5): 1693–702. doi:10.1002/hep.26540. PMC 3830584. PMID 23728943.
  8. ↑ Fava, G.; Lorenzini, I. (2012). “Molecular Pathogenesis of Cholangiocarcinoma”. International Journal of Hepatology. 2012: 1–7. doi:10.1155/2012/630543. ISSN 2090-3448.
  9. ↑ 9.0 9.1 Sirica A (2005). “Cholangiocarcinoma: molecular targeting strategies for chemoprevention and therapy”. Hepatology. 41 (1): 5–15. PMID 15690474.
  10. ↑ Holzinger F, Z’graggen K, Büchler M. “Mechanisms of biliary carcinogenesis: a pathogenetic multi-stage cascade towards cholangiocarcinoma”. Ann Oncol. 10 Suppl 4: 122–6. PMID 10436802.
  11. ↑ Gores G (2003). “Cholangiocarcinoma: current concepts and insights”. Hepatology. 37 (5): 961–9. PMID 12717374.
  12. ↑ Stain SC, Yellin AE, Donovan AJ, Brien HW (1991). “Pyogenic liver abscess. Modern treatment”. Arch Surg. 126 (8): 991–6. PMID 1863218.
  13. ↑ Munro JC (1905). “VII. Lymphatic and Hepatic Infections Secondary to Appendicitis”. Ann Surg. 42 (5): 692–734. PMC 1425980. PMID 17861705.
  14. ↑ Huang CJ, Pitt HA, Lipsett PA, Osterman FA, Lillemoe KD, Cameron JL; et al. (1996). “Pyogenic hepatic abscess. Changing trends over 42 years”. Ann Surg. 223 (5): 600–7, discussion 607-9. PMC 1235191. PMID 8651751.
  15. ↑ Rahimian J, Wilson T, Oram V, Holzman RS (2004). “Pyogenic liver abscess: recent trends in etiology and mortality”. Clin Infect Dis. 39 (11): 1654–9. doi:10.1086/425616. PMID 15578367.
  16. ↑ https://librepathology.org/wiki/Liver_pathology Accessed on February 22, 2017
  17. ↑ Lublin M, Bartlett DL, Danforth DN, Kauffman H, Gallin JI, Malech HL; et al. (2002). “Hepatic abscess in patients with chronic granulomatous disease”. Ann Surg. 235 (3): 383–91. PMC 1422444. PMID 11882760.
  18. ↑ Tappe, Dennis, August Stich, and Matthias Frosch. “Emergence of Polycystic Neotropical Echinococcosis.” Emerging Infectious Disease 14.2 (2008): 292-97. Web. 21 February 2010.
  19. ↑ Howorth, MB. “Echinococcosis Of Bone.” Journal of Bone and Joint Surgery 27. (1945): 401-11. Web. 21 February 2010.
  20. ↑ Cox FE (2002). “History of human parasitology”. Clin. Microbiol. Rev. 15 (4): 595–612. PMC 126866. PMID 12364371.
Causes

Causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nawal Muazam M.D.[2]; Suveenkrishna Pothuru, M.B,B.S. [3]; Maria Fernanda Villarreal, M.D. [4]

Overview

The most common cause of a liver mass is hepatocellular carcinoma. Common causes of benign liver mass, include: hepatic hemangioma, focal nodular hyperplasia, hepatic adenoma, idiopathic noncirrhotic portal hypertension (including nodular regenerative hyperplasia and regenerative nodules). Common causes of malignant liver masses, include: hepatocellular carcinoma, cholangiocarcinoma, and metastatic disease.

Causes

Common causes of liver mass incude:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][[#cite_note-NicolauBr�2004-31|[31]]]

Common causes of liver mass Solid Cystic Association with liver disease Malignant potential of transformation
Hepatic cellular carcinoma + – + +
Cholangiocarcinoma + – + +
Hepatic Adenoma + – – +
Focal nodular hyperplasia + – – –
Liver hemangioma + – – –
Angiomyolipoma + – – –
Macroregenerative/dysplastic nodule + – + +
Fibrolemellar hepatocellular carcinoma + – – +
Metastatic cancer + – – +
Focal fatty infiltration and focal fat sparing + – – –
Inflammatory pseudotumor + – – –
Mesenchymal hamartoma + – – –
Hepatic abscess + + – –
Echinococcal cystic disease – + – –
Simple cyst – + – –
Polycystic liver disease – + – –
Cyst adenoma – + – +
Cyst adenocarcinoma – + – +
Choledochal cysts (type IV and V) – + – +

Causes by Organ System

Cardiovascular Hepatic artery aneurysm
Chemical / poisoning No underlying causes
Dermatologic No underlying causes
Drug Side Effect No underlying causes
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic Choledochal cyst
Genetic Klippel-Trenaunay-Weber syndrome, Von Hippel-Lindau disease, Osler-Weber-Rendu syndrome, Autosomal dominant polycystic kidney disease, Caroli disease, Beckwith-Wiedemann syndrome, Familial adenomatous polyposis
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease Amoebic liver abscess, Pyogenic liver abscess, Hydatid cyst, Alveolar hydatid disease, Pericholecystic abscess, Empyema gallbladder, Subhepatic abscess, Subphrenic abscess, Tuberculosis
Musculoskeletal / Ortho Sarcoidosis
Neurologic No underlying causes
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Benign: Cystadenoma, Hepatocellular adenoma, Hepatic hemangioma, Hepatic angiomyolipoma, Hepatoblastoma, Primary hepatic lymphoma, Focal nodular hyperplasia, Nodular regenerative hyperplasia, Teratoma, Autoinfarction hepatocellular adenoma, Hemangioendothelioma, Hepatic hamartoma, Mesenchymal hamartoma of infancy, Cholangioadenoma, Adenolipoma, Angiomyolipoma, Myelolipoma, Fibroma,

Malignant: Cystadenocarcinoma, Hepatocellular carcinoma, Fibrolamellar carcinoma, Cholangiocarcinoma, Primary squamous cell carcinoma, Hepatic angiosarcoma, Carcinoid tumor, Neuroblastoma, Gallbladder cancer, Wilms tumor, Leiomyosarcoma, Fibrosarcoma

Metastatic: Colorectal carcinoma, Pancreatic ductal adenocarcinoma, Oesophageal cancer, gastric carcinoma, gastrointestinal stromal tumor, Carcinoid tumor, Lung cancer, Breast adenocarcinoma, Ovarian cancer, Endometrial cancer, Renal cell carcinoma, Prostate cancer, Non-Hodgkins lymphoma, Hodgkins lymphoma

Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy No underlying causes
Sexual No underlying causes
Trauma Intrahepatic hematoma, Biliary hematoma, Hepatic subcapsular hematoma
Urologic No underlying causes
Miscellaneous No underlying causes

References

  1. ↑ Kim TK, Lee E, Jang HJ (2015). “Imaging findings of mimickers of hepatocellular carcinoma”. Clin Mol Hepatol. 21 (4): 326–43. doi:10.3350/cmh.2015.21.4.326. PMC 4712159. PMID 26770920.
  2. ↑ Ferrell, Linda (2000). “Liver Pathology: Cirrhosis, Hepatitis and Primary Liver Tumors. Update and Diagnostic Problems”. Modern Pathology. 13 (6): 679–704. doi:10.1038/modpathol.3880119. ISSN 0893-3952.
  3. ↑ Kim, Tae Kyoung; Lee, Eunchae; Jang, Hyun-Jung (2015). “Imaging findings of mimickers of hepatocellular carcinoma”. Clinical and Molecular Hepatology. 21 (4): 326. doi:10.3350/cmh.2015.21.4.326. ISSN 2287-2728.
  4. ↑ Doo, Kyung Won; Lee, Chang Hee; Choi, Jae Woong; Lee, Jongmee; Kim, Kyeong Ah; Park, Cheol Min (2009). ““Pseudo Washout” Sign in High-Flow Hepatic Hemangioma on Gadoxetic Acid Contrast-Enhanced MRI Mimicking Hypervascular Tumor”. American Journal of Roentgenology. 193 (6): W490–W496. doi:10.2214/AJR.08.1732. ISSN 0361-803X.
  5. ↑ Zech CJ, Herrmann KA, Reiser MF, Schoenberg SO (2007). “MR imaging in patients with suspected liver metastases: value of liver-specific contrast agent Gd-EOB-DTPA”. Magn Reson Med Sci. 6 (1): 43–52. PMID 17510541.
  6. ↑ Cheng, H C; Tsai, S H; Chiang, J H; Chang, C Y (1995). “Hyalinized liver hemangioma mimicking malignant tumor at MR imaging”. American Journal of Roentgenology. 165 (4): 1016–1017. doi:10.2214/ajr.165.4.7676959. ISSN 0361-803X.
  7. ↑ Haratake J, Horie A, Nagafuchi Y (1992). “Hyalinized hemangioma of the liver”. Am. J. Gastroenterol. 87 (2): 234–6. PMID 1370873.
  8. ↑ Takayasu, K; Moriyama, N; Shima, Y; Muramatsu, Y; Yamada, T; Makuuchi, M; Yamasaki, S; Hirohashi, S (1986). “Atypical radiographic findings in hepatic cavernous hemangioma: correlation with histologic features”. American Journal of Roentgenology. 146 (6): 1149–1153. doi:10.2214/ajr.146.6.1149. ISSN 0361-803X.
  9. ↑ Yamashita Y, Shimada M, Taguchi K, Gion T, Hasegawa H, Utsunomiya T, Hamatsu T, Matsumata T, Sugimachi K (2000). “Hepatic sclerosing hemangioma mimicking a metastatic liver tumor: report of a case”. Surg. Today. 30 (9): 849–52. PMID 11039718.
  10. ↑ Kim, Tae Kyoung; Lee, Eunchae; Jang, Hyun-Jung (2015). “Imaging findings of mimickers of hepatocellular carcinoma”. Clinical and Molecular Hepatology. 21 (4): 326. doi:10.3350/cmh.2015.21.4.326. ISSN 2287-2728.
  11. ↑ Lee, So Jung; Kim, So Yeon; Kim, Kyoung Won; Shin, Yong Moon; Kim, Hyoung Jung; Lee, Jong Seok; Kim, Sun A (2012). “Hepatic angiomyolipoma with minimal fat, mimicking hepatocellular carcinoma”. Clinical and Molecular Hepatology. 18 (3): 330. doi:10.3350/cmh.2012.18.3.330. ISSN 2287-2728.
  12. ↑ Kim R, Lee JM, Joo I, Lee DH, Woo S, Han JK, Choi BI (2015). “Differentiation of lipid poor angiomyolipoma from hepatocellular carcinoma on gadoxetic acid-enhanced liver MR imaging”. Abdom Imaging. 40 (3): 531–41. doi:10.1007/s00261-014-0244-4. PMID 25231411.
  13. ↑ Jeon TY, Kim SH, Lim HK, Lee WJ (2010). “Assessment of triple-phase CT findings for the differentiation of fat-deficient hepatic angiomyolipoma from hepatocellular carcinoma in non-cirrhotic liver”. Eur J Radiol. 73 (3): 601–6. doi:10.1016/j.ejrad.2009.01.010. PMID 19200676.
  14. ↑ Kim, T K; Choi, B I; Han, J K; Jang, H J; Cho, S G; Han, M C (1997). “Peripheral cholangiocarcinoma of the liver: two-phase spiral CT findings”. Radiology. 204 (2): 539–543. doi:10.1148/radiology.204.2.9240550. ISSN 0033-8419.
  15. ↑ Choi BI, Kim TK, Han JK (1998). “MRI of clonorchiasis and cholangiocarcinoma”. J Magn Reson Imaging. 8 (2): 359–66. PMID 9562062.
  16. ↑ Guo, Le-Hang; Xu, Hui-Xiong (2015). “Contrast-Enhanced Ultrasound in the Diagnosis of Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma: Controversy over the ASSLD Guideline”. BioMed Research International. 2015: 1–5. doi:10.1155/2015/349172. ISSN 2314-6133.
  17. ↑ Wilson, Stephanie R.; Kim, Tae Kyoung; Jang, Hyun-Jung; Burns, Peter N. (2007). “Enhancement Patterns of Focal Liver Masses: Discordance Between Contrast-Enhanced Sonography and Contrast-Enhanced CT and MRI”. American Journal of Roentgenology. 189 (1): W7–W12. doi:10.2214/AJR.06.1060. ISSN 0361-803X.
  18. ↑ Ohtomo K, Baron RL, Dodd GD, Federle MP, Miller WJ, Campbell WL, Confer SR, Weber KM (1993). “Confluent hepatic fibrosis in advanced cirrhosis: appearance at CT”. Radiology. 188 (1): 31–5. doi:10.1148/radiology.188.1.8511316. PMID 8511316.
  19. ↑ Hussain, Hero K.; Syed, Ibrahim; Nghiem, Hanh V.; Johnson, Timothy D.; Carlos, Ruth C.; Weadock, William J.; Francis, Isaac R. (2004). “T2-weighted MR Imaging in the Assessment of Cirrhotic Liver”. Radiology. 230 (3): 637–644. doi:10.1148/radiol.2303020921. ISSN 0033-8419.
  20. ↑ Ohtomo K, Baron RL, Dodd GD, Federle MP, Ohtomo Y, Confer SR (1993). “Confluent hepatic fibrosis in advanced cirrhosis: evaluation with MR imaging”. Radiology. 189 (3): 871–4. doi:10.1148/radiology.189.3.8234718. PMID 8234718.
  21. ↑ Brancatelli G, Baron RL, Federle MP, Sparacia G, Pealer K (2009). “Focal confluent fibrosis in cirrhotic liver: natural history studied with serial CT”. AJR Am J Roentgenol. 192 (5): 1341–7. doi:10.2214/AJR.07.2782. PMID 19380559.
  22. ↑ Kelekis NL, Makri E, Vassiou A, Patsiaoura K, Spiridakis M, Dalekos GN (2004). “Confluent hepatic fibrosis as the presenting imaging sign in nonadvanced alcoholic cirrhosis”. Clin Imaging. 28 (2): 124–7. doi:10.1016/S0899-7071(03)00243-2. PMID 15050225.
  23. ↑ Ooi CG, Chan KL, Peh WC, Saing H, Ngan H (1999). “Confluent hepatic fibrosis in monozygotic twins”. Pediatr Radiol. 29 (1): 53–5. doi:10.1007/s002470050534. PMID 9880618.
  24. ↑ Park YS, Lee CH, Kim BH, Lee J, Choi JW, Kim KA, Ahn JH, Park CM (2013). “Using Gd-EOB-DTPA-enhanced 3-T MRI for the differentiation of infiltrative hepatocellular carcinoma and focal confluent fibrosis in liver cirrhosis”. Magn Reson Imaging. 31 (7): 1137–42. doi:10.1016/j.mri.2013.01.011. PMID 23688409.
  25. ↑ Brancatelli G, Federle MP, Grazioli L, Golfieri R, Lencioni R (2002). “Large regenerative nodules in Budd-Chiari syndrome and other vascular disorders of the liver: CT and MR imaging findings with clinicopathologic correlation”. AJR Am J Roentgenol. 178 (4): 877–83. doi:10.2214/ajr.178.4.1780877. PMID 11906867.
  26. ↑ Brancatelli G, Federle MP, Grazioli L, Golfieri R, Lencioni R (2002). “Benign regenerative nodules in Budd-Chiari syndrome and other vascular disorders of the liver: radiologic-pathologic and clinical correlation”. Radiographics. 22 (4): 847–62. doi:10.1148/radiographics.22.4.g02jl17847. PMID 12110714.
  27. ↑ Newerla, Caroline; Schaeffer, Fabienne; Terracciano, Luigi; Hohmann, Joachim (2012). “Multiple FNH-Like Lesions in a Patient with Chronic Budd-Chiari Syndrome: Gd-EOB-Enhanced MRI and BR1 CEUS Findings”. Case Reports in Radiology. 2012: 1–5. doi:10.1155/2012/685486. ISSN 2090-6862.
  28. ↑ Yoneda N, Matsui O, Kitao A, Kita R, Kozaka K, Koda W, Kobayashi S, Gabata T, Ikeda H, Sato Y, Nakanuma Y (2012). “Hepatocyte transporter expression in FNH and FNH-like nodule: correlation with signal intensity on gadoxetic acid enhanced magnetic resonance images”. Jpn J Radiol. 30 (6): 499–508. doi:10.1007/s11604-012-0085-4. PMID 22618456.
  29. ↑ Matsui, O; Kadoya, M; Takahashi, S; Yoshikawa, J; Gabata, T; Takashima, T; Kitagawa, K (1995). “Focal sparing of segment IV in fatty livers shown by sonography and CT: correlation with aberrant gastric venous drainage”. American Journal of Roentgenology. 164 (5): 1137–1140. doi:10.2214/ajr.164.5.7717220. ISSN 0361-803X.
  30. ↑ Itai Y, Matsui O (1999). “‘Nonportal’ splanchnic venous supply to the liver: abnormal findings on CT, US and MRI”. Eur Radiol. 9 (2): 237–43. doi:10.1007/s003300050661. PMID 10101644.
  31. [[#cite_ref-NicolauBr�2004_31-0|↑]] Nicolau, C.; Br�, C. (2004). “Focal liver lesions: evaluation with contrast-enhanced ultrasonography”. Abdominal Imaging. 29 (3). doi:10.1007/s00261-003-0117-8. ISSN 0942-8925. replacement character in |last2= at position 3 (help)
Differential Diagnosis

Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]; Dildar Hussain, MBBS [3]; Aditya Ganti M.B.B.S. [4]

Overview

Liver mass must be differentiated from the diseases that cause abdominal pain, pruritus, low-grade fever, and ascities such as angiomyolipoma, adenoma, borderline (high-grade dysplastic) nodule, cholangiocarcinoma, confluent fibrosis, focal nodular hyperplasia, focal fat sparing and deposit on liver, gallbladder cancer, hereditary hemorrhagic telangiectasia, inflammatory pseudotumors, liver hemangioma, hepatoblastoma in children, pyogenic liver abscesses, pancreatic cancer, Stomach cancer.

Common Differential Diagnosis

Liver mass must be differentiated from the following diseases that cause abdominal pain, pruritus, low-grade fever, and ascities such as:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][16][17][18][19][20][21][22][13][23][24][25][26][27]

Abbreviations: RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram

Disease Clinical manifestations Diagnosis Comments
Symptoms Signs
Abdominal Pain Fever Rigors and chills Nausea or vomiting Jaundice Constipation Diarrhea Weight loss GI bleeding Hypo-

tension

Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging
Hepatocellular carcinoma/Metastasis RUQ + − + + + + + + + − +
  • Normal
  • Hyperactive if obstruction present

Other symptoms:

Cholangiocarcinoma RUQ + − + + − − + − − − + Normal
  • Predisposes to pancreatic cancer
Pancreatic carcinoma MidEpigastric − − + + + − + − − − + Normal

Skin manifestations may include:

Focal nodular hyperplasia Diffuse ± − − ± − − + + − − − Normal
  • Open biopsy if diagnosis can not be established
Disease Abdominal Pain Fever Rigors and chills Nausea or vomiting Jaundice Constipation Diarrhea Weight loss GI bleeding Hypo-

tension

Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging Comments
Gallbladder cancer Midepigastric − − + + − + + − − − − Normal
Liver hemangioma Intermittent RUQ − − + + − − − − − − − Normal
  • Abnormal LFTs
Liver abscess RUQ + − + + − − + − − − − Normal
  • US
  • CT
Cirrhosis RUQ+Bloating + − + + − − + − − − − Normal US
  • Stigmata of liver disease
  • Cruveilhier- Baumgarten murmur
Inflammatory lesions RUQ ± − + + − − − − − − − Normal US
  • Nodular,shrunken or coarse liver
  • Stigmata of liver disease

References

  1. ↑ Choi BI, Kim TK, Han JK (1998). “MRI of clonorchiasis and cholangiocarcinoma”. J Magn Reson Imaging. 8 (2): 359–66. PMID 9562062.
  2. ↑ Guo, Le-Hang; Xu, Hui-Xiong (2015). “Contrast-Enhanced Ultrasound in the Diagnosis of Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma: Controversy over the ASSLD Guideline”. BioMed Research International. 2015: 1–5. doi:10.1155/2015/349172. ISSN 2314-6133.
  3. ↑ Wilson, Stephanie R.; Kim, Tae Kyoung; Jang, Hyun-Jung; Burns, Peter N. (2007). “Enhancement Patterns of Focal Liver Masses: Discordance Between Contrast-Enhanced Sonography and Contrast-Enhanced CT and MRI”. American Journal of Roentgenology. 189 (1): W7–W12. doi:10.2214/AJR.06.1060. ISSN 0361-803X.
  4. ↑ Ohtomo K, Baron RL, Dodd GD, Federle MP, Miller WJ, Campbell WL, Confer SR, Weber KM (1993). “Confluent hepatic fibrosis in advanced cirrhosis: appearance at CT”. Radiology. 188 (1): 31–5. doi:10.1148/radiology.188.1.8511316. PMID 8511316.
  5. ↑ Wu, Jim S.; Saluja, Sanjay; Garcia-Tsao, Guadalupe; Chong, Alice; Henderson, Katherine J.; White, Robert I. (2006). “Liver Involvement in Hereditary Hemorrhagic Telangiectasia: CT and Clinical Findings Do Not Correlate in Symptomatic Patients”. American Journal of Roentgenology. 187 (4): W399–W405. doi:10.2214/AJR.05.1068. ISSN 0361-803X.
  6. ↑ Itai, Y; Matsui, O (1997). “Blood flow and liver imaging”. Radiology. 202 (2): 306–314. doi:10.1148/radiology.202.2.9015047. ISSN 0033-8419.
  7. ↑ {{cite
  8. ↑ Mathieu D, Vasile N, Dibie C, Grenier P (1985). “Portal cavernoma: dynamic CT features and transient differences in hepatic attenuation”. Radiology. 154 (3): 743–8. doi:10.1148/radiology.154.3.3881794. PMID 3881794.
  9. ↑ Itai Y, Murata S, Saida Y, Minami M. Central zone and peripheral zone of the liver based on portal and hepatic arterial blood supply: imaging approach to deformity of cirrhotic liver. Jpn J Clin Radiol. 1994;39:1553–1559
  10. ↑ Kim, Tae Kyoung; Lee, Kyoung Ho; Jang, Hyun–Jung; Haider, Masoom A.; Jacks, Lindsay M.; Menezes, Ravi J.; Park, Seong Ho; Yazdi, Leyla; Sherman, Morris; Khalili, Korosh (2011). “Analysis of Gadobenate Dimeglumine–enhanced MR Findings for Characterizing Small (1–2-cm) Hepatic Nodules in Patients at High Risk for Hepatocellular Carcinoma”. Radiology. 259 (3): 730–738. doi:10.1148/radiol.11101549. ISSN 0033-8419.
  11. ↑ Kim JH, Kim TK, Kim BS, Eun HW, Kim PN, Lee MG, Ha HK (2002). “Enhancement of hepatic hemangiomas with levovist on coded harmonic angiographic ultrasonography”. J Ultrasound Med. 21 (2): 141–8. PMID 11833870.
  12. ↑ Brannigan, Margot; Burns, Peter N.; Wilson, Stephanie R. (2004). “Blood Flow Patterns in Focal Liver Lesions at Microbubble-enhanced US”. RadioGraphics. 24 (4): 921–935. doi:10.1148/rg.244035158. ISSN 0271-5333.
  13. ↑ 13.0 13.1 Kim TK, Jang HJ, Wilson SR (2006). “Benign liver masses: imaging with microbubble contrast agents”. Ultrasound Q. 22 (1): 31–9. PMID 16641791.
  14. ↑ Jang, Hyun-Jung; Kim, Tae Kyoung; Lim, Hyo Keun; Park, Sang Jae; Sim, Jung Suk; Kim, Hyae Young; Lee, Joo-Hyuk (2003). “Hepatic Hemangioma: Atypical Appearances on CT, MR Imaging, and Sonography”. American Journal of Roentgenology. 180 (1): 135–141. doi:10.2214/ajr.180.1.1800135. ISSN 0361-803X.
  15. ↑ . doi:10.1102/1470-7330.2009.0015. Missing or empty |title= (help)
  16. ↑ 16.0 16.1 Jang, Hyun-Jung; Yu, Hojun; Kim, Tae Kyoung (2009). “Imaging of Focal Liver Lesions”. Seminars in Roentgenology. 44 (4): 266–282. doi:10.1053/j.ro.2009.05.008. ISSN 0037-198X.
  17. ↑ Bhayana, Deepak; Kim, Tae Kyoung; Jang, Hyun-Jung; Burns, Peter N.; Wilson, Stephanie R. (2010). “Hypervascular Liver Masses on Contrast-Enhanced Ultrasound: The Importance of Washout”. American Journal of Roentgenology. 194 (4): 977–983. doi:10.2214/AJR.09.3375. ISSN 0361-803X.
  18. ↑ Tamada T, Ito K, Yamamoto A, Sone T, Kanki A, Tanaka F, Higashi H (2011). “Hepatic hemangiomas: evaluation of enhancement patterns at dynamic MRI with gadoxetate disodium”. AJR Am J Roentgenol. 196 (4): 824–30. doi:10.2214/AJR.10.5113. PMID 21427331.
  19. ↑ Heiken, Jay P. (2007). “Distinguishing benign from malignant liver tumours”. Cancer Imaging. 7 (Special Issue A): S1–S14. doi:10.1102/1470-7330.2007.9084. ISSN 1470-7330.
  20. ↑ Alturkistany, Samira; Jang, Hyun-Jung; Yu, Hojun; Lee, Kyoung Ho; Kim, Tae Kyoung (2011). “Fading hepatic hemangiomas on multiphasic CT”. Abdominal Radiology. 37 (5): 775–780. doi:10.1007/s00261-011-9826-6. ISSN 2366-004X.
  21. ↑ Liu GJ, Lu MD, Xie XY, Xu HX, Xu ZF, Zheng YL, Liang JY, Wang W (2008). “Real-time contrast-enhanced ultrasound imaging of infected focal liver lesions”. J Ultrasound Med. 27 (4): 657–66. PMID 18359914.
  22. ↑ Kim, Kyoung Won; Choi, Byung Ihn; Park, Seong Ho; Kim, Ah Young; Koh, Young Hwan; Lee, Hyun Ju; Han, Joon Koo (2004). “Pyogenic hepatic abscesses: distinctive features from hypovascular hepatic malignancies on contrast-enhanced ultrasound with SH U 508A; early experience”. Ultrasound in Medicine & Biology. 30 (6): 725–733. doi:10.1016/j.ultrasmedbio.2004.03.006. ISSN 0301-5629.
  23. ↑ Syed MA, Kim TK, Jang HJ (2007). “Portal and hepatic vein thrombosis in liver abscess: CT findings”. Eur J Radiol. 61 (3): 513–9. doi:10.1016/j.ejrad.2006.11.022. PMID 17161932.
  24. ↑ Menias, Christine O.; Surabhi, Venkateswar R.; Prasad, Srinivasa R.; Wang, Hanlin L.; Narra, Vamsi R.; Chintapalli, Kedar N. (2008). “Mimics of Cholangiocarcinoma: Spectrum of Disease”. RadioGraphics. 28 (4): 1115–1129. doi:10.1148/rg.284075148. ISSN 0271-5333.
  25. ↑ Gollapudi P, Chejfec G, Zarling EJ (1992). “Spontaneous regression of hepatic pseudotumor”. Am. J. Gastroenterol. 87 (2): 214–7. PMID 1734701.
  26. ↑ Yoon KH, Ha HK, Lee JS, Suh JH, Kim MH, Kim PN, Lee MG, Yun KJ, Choi SC, Nah YH, Kim CG, Won JJ, Auh YH (1999). “Inflammatory pseudotumor of the liver in patients with recurrent pyogenic cholangitis: CT-histopathologic correlation”. Radiology. 211 (2): 373–9. doi:10.1148/radiology.211.2.r99ma36373. PMID 10228516.
  27. ↑ CHEDID, Marcio F.; KRUEL, Cleber R. P.; PINTO, Marcelo A.; GREZZANA-FILHO, Tomaz J. M.; LEIPNITZ, Ian; KRUEL, Cleber D. P.; SCAFFARO, Leandro A.; CHEDID, Aljamir D. (2017). “HEPATOCELLULAR CARCINOMA: DIAGNOSIS AND OPERATIVE MANAGEMENT”. ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo). 30 (4): 272–278. doi:10.1590/0102-6720201700040011. ISSN 2317-6326.
Epidemiology and Demographics

Epidemiology and Demographics

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

The annual incidence rate of malignant liver mass is approximately 6 per 100,000 individuals in the United States. The incidence rate of liver mass increases with age; the median age at diagnosis varies widely between 5 to 60 years. Females are more commonly affected with benign liver masses than males. The female to male ratio is approximately 2.3 to 1. However, males are more commonly affected with malignant liver masses than females. The male to female ratio of malignant liver mass is approximately 3 to 1. The incidence of malignant liver mass varies widely according to geographic location and ethnicity.

Epidemiology and Demographics

Incidence

  • The annual incidence rate of malignant liver mass is approximately 6 per 100,000 individuals in the United States.[1][2]
  • The incidence rate of liver mass increases with age.[1]

Age

  • The median age at diagnosis of liver mass varies widely between 5 to 60 years[1]
  • However, the mean age at diagnosis in malignant liver mass is between 50 and 60 years

Gender

  • Females are more commonly affected with benign liver masses than males. The female to male ratio is approximately 2.3 to 1.[1]
  • However, males are more commonly affected with malignant liver masses than females. The male to female ratio is approximately 3 to 1.

Ethnicity

  • The incidence of malignant liver mass varies widely among different ethnic groups and geographic locations.[1]
  • The incidence of malignant liver mass is higher among Asian population.

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Reddy KR, Kligerman S, Levi J, Livingstone A, Molina E, Franceschi D, Badalamenti S, Jeffers L, Tzakis A, Schiff ER (2001). “Benign and solid tumors of the liver: relationship to sex, age, size of tumors, and outcome”. Am Surg. 67 (2): 173–8. PMID 11243545.
  2. ↑ Munoz N, Bosch X. Epidemiology of hepatocellular carcinoma. In: In: Neoplasms of the Liver, Okuda K, Ishak KG (Eds), Springer, Tokyo 1989. p.3
Risk Factors

Risk Factors

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2]; Aditya Ganti M.B.B.S. [3]

Overview

Common risk factors in the development of liver masses include chronic hepatitis B infection, chronic hepatitis C infection, cirrhosis, inherited metabolic diseases and aflaoxins.

Risk Factors

Common Risk Factors

Common risk factors that may increase the risk of developing liver mass include:[1][2][3][4][5][6][7][8][9][10]

Less Common Risk Factors

Less common risk factors that may increase the risk of developing liver mass include:[11][12][13][14]

References

  1. ↑ National Cancer Institute. Physician Data Query Database 2015.http://www.cancer.gov/types/liver/hp/adult-liver-treatment-pdq
  2. ↑ Trichopoulos D, Bamia C, Lagiou P, Fedirko V, Trepo E, Jenab M, Pischon T, Nöthlings U, Overved K, Tjønneland A, Outzen M, Clavel-Chapelon F, Kaaks R, Lukanova A, Boeing H, Aleksandrova K, Benetou V, Zylis D, Palli D, Pala V, Panico S, Tumino R, Sacerdote C, Bueno-De-Mesquita HB, Van Kranen HJ, Peeters PH, Lund E, Quirós JR, González CA, Sanchez Perez MJ, Navarro C, Dorronsoro M, Barricarte A, Lindkvist B, Regnér S, Werner M, Hallmans G, Khaw KT, Wareham N, Key T, Romieu I, Chuang SC, Murphy N, Boffetta P, Trichopoulou A, Riboli E (2011). “Hepatocellular carcinoma risk factors and disease burden in a European cohort: a nested case-control study”. J. Natl. Cancer Inst. 103 (22): 1686–95. doi:10.1093/jnci/djr395. PMC 3216968. PMID 22021666.
  3. ↑ Cecil, Russell L., James B. Wyngaarden, and Lloyd H. Smith. Textbook of . Philadelphia: Saunders, 1988. Print.
  4. ↑ “Redirecting”.
  5. ↑ CHEDID, Marcio F.; KRUEL, Cleber R. P.; PINTO, Marcelo A.; GREZZANA-FILHO, Tomaz J. M.; LEIPNITZ, Ian; KRUEL, Cleber D. P.; SCAFFARO, Leandro A.; CHEDID, Aljamir D. (2017). “HEPATOCELLULAR CARCINOMA: DIAGNOSIS AND OPERATIVE MANAGEMENT”. ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo). 30 (4): 272–278. doi:10.1590/0102-6720201700040011. ISSN 2317-6326.
  6. ↑ Fujiwara N, Friedman SL, Goossens N, Hoshida Y (2017). “Risk factors and prevention of hepatocellular carcinoma in the era of precision medicine”. J. Hepatol. doi:10.1016/j.jhep.2017.09.016. PMID 28989095.
  7. ↑ Trad, Dorra; Bibani, Norsaf; Sabbah, Meriam; Elloumi, Hela; Gargouri, Dalila; Ouakaa, Asma; Kharrat, Jamel (2017). “Known, new and emerging risk factors of hepatocellular carcinoma (review)”. La Presse Médicale. 46 (11): 1000–1007. doi:10.1016/j.lpm.2017.09.025. ISSN 0755-4982.
  8. ↑ Budny A, Kozłowski P, Kamińska M, Jankiewicz M, Kolak A, Budny B, Budny W, Niemunis-Sawicka J, Szczypiór G, Kurniawka B, Burdan F (2017). “[Epidemiology and risk factors of hepatocellular carcinoma]”. Pol. Merkur. Lekarski (in Polish). 43 (255): 133–139. PMID 28987047.
  9. ↑ Parkin, Donald Maxwell (2006). “The global health burden of infection-associated cancers in the year 2002”. International Journal of Cancer. 118 (12): 3030–3044. doi:10.1002/ijc.21731. ISSN 0020-7136.
  10. ↑ Shi, J; Zhu, L; Liu, S; Xie, W-f (2005). “A meta-analysis of case–control studies on the combined effect of hepatitis B and C virus infections in causing hepatocellular carcinoma in China”. British Journal of Cancer. 92 (3): 607–612. doi:10.1038/sj.bjc.6602333. ISSN 0007-0920.
  11. ↑ Trad, Dorra; Bibani, Norsaf; Sabbah, Meriam; Elloumi, Hela; Gargouri, Dalila; Ouakaa, Asma; Kharrat, Jamel (2017). “Known, new and emerging risk factors of hepatocellular carcinoma (review)”. La Presse Médicale. 46 (11): 1000–1007. doi:10.1016/j.lpm.2017.09.025. ISSN 0755-4982.
  12. ↑ Clavière C, Bronowicki JP, Hudziak H, Bigard MA, Gaucher P (1998). “[Role of sex steroids and their receptors in the pathophysiology of hepatocellular carcinoma]”. Gastroenterol. Clin. Biol. (in French). 22 (1): 73–86. PMID 9762169.
  13. ↑ “Studies of Cancer in Humans – Tobacco Smoke and Involuntary Smoking – NCBI Bookshelf”.
  14. ↑ “Tobacco smoke and involuntary smoking”. IARC Monogr Eval Carcinog Risks Hum. 83: 1–1438. 2004. PMC 4781536. PMID 15285078.
Screening

Screening

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for benign liver mass. However, routine screening is recommended for individuals with chronic hepatitis B virus infection or cirrhosis from any cause who are at risk for development of HCC by ultrasound every 6 months.

Screening

According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for benign liver mass. However, routine screening is recommended for individuals with chronic hepatitis B virus infection or cirrhosis from any cause who are at risk for development of HCC by ultrasound every 6 months. [1]

References

  1. ↑ Recommendations. US preventive services task force(2015) http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=liver+mass Accessed on March, 24th 2016
Natural History, Complications and Prognosis

Natural History, Complications and Prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

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.

Natural History

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]

Complications

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

Prognosis

Prognosis of malignant lesions

  • 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:

Prognosis of benign lesions

Hepatic adenoma

  • 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%.

Focal nodular hyperplasia

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

Hemangioma

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

References

  1. ↑ Weimann A, Ringe B, Klempnauer J, Lamesch P, Gratz KF, Prokop M, Maschek H, Tusch G, Pichlmayr R (1997). “Benign liver tumors: differential diagnosis and indications for surgery”. World J Surg. 21 (9): 983–90, discussion 990–1. PMID 9361515.
  2. ↑ Tu J, Jia Z, Ying X, Zhang D, Li S, Tian F, Jiang G (2016). “The incidence and outcome of major complication following conventional TAE/TACE for hepatocellular carcinoma”. Medicine (Baltimore). 95 (49): e5606. doi:10.1097/MD.0000000000005606. PMC 5266057. PMID 27930585.
  3. ↑ Jia Z, Tian F, Jiang G (2013). “Ruptured hepatic carcinoma after transcatheter arterial chemoembolization”. Curr Ther Res Clin Exp. 74: 41–3. doi:10.1016/j.curtheres.2012.12.006. PMC 3862201. PMID 24384870.
  4. ↑ Chung JW, Park JH, Im JG, Han JK, Han MC (1993). “Pulmonary oil embolism after transcatheter oily chemoembolization of hepatocellular carcinoma”. Radiology. 187 (3): 689–93. doi:10.1148/radiology.187.3.8388567. PMID 8388567.
  5. ↑ Chung JW, Park JH, Han JK, Choi BI, Han MC, Lee HS, Kim CY (1996). “Hepatic tumors: predisposing factors for complications of transcatheter oily chemoembolization”. Radiology. 198 (1): 33–40. doi:10.1148/radiology.198.1.8539401. PMID 8539401.
  6. ↑ Rhim H (2005). “Complications of radiofrequency ablation in hepatocellular carcinoma”. Abdom Imaging. 30 (4): 409–18. doi:10.1007/s00261-004-0255-7. PMID 15688113.
Diagnosis

Diagnosis

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Treatment

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