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In practice, patients with benign liver tumors typically present in three broad clinical scenarios: (1) a liver tumor incidentally discovered in an asymptomatic patient, (2) a liver tumor identified during surveillance in a patient with a history of malignancy or chronic liver disease, and (3) a liver tumor discovered during evaluation of upper abdominal symptoms. Advances in cross-sectional imaging coupled with increased utilization have led to an increase in the incidental identification and diagnosis of benign liver tumors. The vast majority of incidentally discovered liver tumors are benign, do not cause symptoms, and do not require resection. When symptoms are present, typically they are vague, ill-defined complaints presumably related to stretching of Glisson's capsule or associated with a mass effect from compression of adjacent structures. Hence, since the majority of these benign liver masses are asymptomatic and some patients have unrelated, vague upper abdominal symptoms, the onus is on the clinician to ascertain causality as precisely as possible to determine the need for surveillance or a treatment strategy and to avoid unnecessary treatment. In this chapter, the clinical features and treatment options for the three most common benign solid liver tumors are discussed: hepatic hemangioma, focal nodular hyperplasia, and hepatocellular adenoma (HA). Other rare, unusual benign liver tumors are reviewed in brief. Cystic tumors are discussed elsewhere. Table 136-1 illustrates the broad differential diagnosis of benign liver tumors. With the exception of HA, the majority of benign liver tumors are not associated with malignancy and do not require resection if the diagnosis can be established without an operation. Minimally invasive operative techniques should not expand the indication for resection of benign liver tumors.

TABLE 136-1:

Differential Diagnosis of Benign Liver Tumors



Hemangiomata are the most common benign liver tumor with overall prevalence between 2% and 20% in the general population.1 Most hepatic hemangiomata are discovered in middle-aged patients with a 5:1 predominance in women. Approximately one-third of the patients have multiple hemangiomata. The majority of hemangiomata are less than 5 cm; however, these lesions can become quite large. “Giant hemangioma” is a term used to describe size greater than 4 cm, although many centers emphasize the appropriateness of nonoperative therapy even for significantly larger lesions.2,3 As no clear correlation exists between hemangioma size, symptoms, and the need for therapeutic intervention, the term “giant” is of limited clinical utility.

The pathogenesis of hemangiomata ...

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