Benign Liver Lesions

Haemangioma

  • Most common liver tumour
  • Usually a small single lesion
  • Hypervascular
  • Greater incidence in females

Clinical presentation

  • Usually asymptomatic - incidental

Investigations

  • USS - echogenic spot, well demarcated
  • CT - venous enhancement from periphery to centre
  • MRI - high intensity area

Management

  • None required

Focal nodular hyperplasia

  • Results from a localized hyperplastic hepatocyte response to an underlying congenital arteriovenous malformation
  • Classically a central scar containing a large artery with branches radiating to periphery
  • Contains all the liver ultrastructure - sinusoids, bile ductulus, Kupffer cells
  • More common in young and middle-aged women

Clinical presentation

  • Usually asymptomatic
  • May cause minimal epigastric/RUQ pain

Investigations

  • USS - nodule with varying echogenicity
  • CT - hypervascular mass with central scar
  • MRI - iso or hypo intense lesion
  • FNA - normal hepatocytes and Kupffer cells with central core

Management

  • None required

Hepatic adenoma

  • Benign neoplasm composed of normal hepatocytes
  • No portal vein, central tracts or bile ducts
  • Most are solitary fat containing lesions
  • More common in females
  • Associated with contraceptive hormones and anabolic steroids
  • Multiple adenomas is a rare condition associated with glycogen storage diseases

Clinical presentation

  • Usually asymptomatic
  • May have RUQ pain (size related)
  • May present with rupture, haemorrhage, or malignant transformation
    • Malignant transformation risk higher in males

Investigations

  • USS - filling defect
  • CT - diffuse arterial enhancement
  • MRI - hypo or hyper intense lesion

Management

  • Stop hormones
  • Weight loss
  • Males (irrespective of size) → surgical excision
  • Females - repeat imaging after 6 months
    • If <5cm or reducing in size → annual MRI
    • If >5cm or increase in size → surgical excision