Benign liver lesions (hepatocellular adenoma, FNH, hemangioma)
Hemangioma, focal nodular hyperplasia, and hepatocellular adenoma are the three solid benign liver lesions, usually found incidentally and diagnosed by their pattern on multiphasic contrast CT or MRI in a noncirrhotic liver. Hemangioma and FNH need no treatment or follow-up, whereas adenoma carries risks of hemorrhage and malignant transformation that drive estrogen withdrawal, 6-month imaging, and resection for lesions over 5 cm, in men, or after rupture.
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What this article covers
- Overview
Definition: three solid, noncancerous liver lesions that arise in an otherwise normal (noncirrhotic) liver: cavernous hemangioma (a vascular malformation), focal nodular hyperplasia (FNH, a…
- Epidemiology
Hemangioma is the most common benign liver tumor: it accounts for up to 73% of benign liver tumors, is diagnosed most often in women aged 30 to 50 years, and has a female-to-male ratio of up to 5:1.
- Risk factors
Estrogen-containing oral contraceptives (adenoma): the dominant association; hepatocellular adenoma is a recognized serious adverse effect of estrogen.
- Pathophysiology
Hemangioma, a venous malformation: congenital vascular lesions dilate (ectasia) over time into a collection of cavernous vascular channels; slow blood pooling explains the progressive centripetal contrast fill-in on imaging.
- Clinical features
Incidental, asymptomatic mass (all three): the usual presentation, with no associated laboratory abnormalities in adenoma.
- Differential diagnosis
Hepatocellular carcinoma: arises in cirrhosis or chronic hepatitis B and shows arterial-phase hyperenhancement followed by washout on portal venous or delayed phases (hepatocellular carcinoma).
- Diagnosis
The diagnosis is established by the characteristic enhancement pattern on multiphasic contrast CT or MRI in a noncirrhotic liver; there are no formal criteria, and risk is then graded by lesion type…
- Management
First, treat suspected adenoma rupture as an emergency: in a patient with sudden abdominal pain and hypotension, resuscitate with blood transfusion and proceed to surgical resection of the ruptured adenoma.
- Complications
Adenoma rupture with intraperitoneal hemorrhage: the most serious and life-threatening complication, presenting as hemorrhagic shock; risk rises with size over 5 cm.
- Prognosis
Hemangioma and FNH are benign for life: neither has malignant potential, spontaneous bleeding is rare, and neither requires surveillance once the imaging diagnosis is secure.
- Prevention
Avoid estrogens after an adenoma diagnosis: stop estrogen-containing oral contraceptives at diagnosis and choose a non-estrogen contraceptive method thereafter (contraception).
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