Skip to Main Content

  • • Most hepatic masses are benign

    • Major diagnoses:

    • -Adenoma


      -Focal nodular hyperplasia



      -Regenerative nodules

    • Estrogens or anabolic steroids can be associated with adenomas, hemangioma growth, and focal nodular hyperplasia


  • • Adenomas occur primarily in women 20-40 years of age

    • Hemangioma most common benign tumor of liver, affecting 7%

Symptoms and Signs

  • • Most asymptomatic and seen on imaging studies performed for other reasons

    • Pain (right upper quadrant or epigastric)

    • Early satiety

    • Hemorrhage

    • Jaundice

    • Kasabach-Merritt syndrome (consumptive coagulopathy in infantile hemangiomatosis)

Laboratory Findings

  • • Mostly normal

    • Occasionally, elevated transaminases, bilirubin, thrombocytopenia, or coagulopathy

Imaging Findings

  • Ademoma: Homogeneous hyperintense on T1 or T2 MRI or CT, but 10-20% with hemorrhagic areas making appearance heterogenous

    • -PET scan with decreased uptake when compared with hepatocellular carcinoma or metastatic disease

    Hemangioma: Early peripheral enhancement with IV contrast on CT, MRI, or tagged red cell scan followed by centripetal pooling (MRI and CT- lesion hypodense before contrast)

    Focal nodular hyperplasia: CT or MRI showing stellate scar and enhancement with IV contrast, sulfur colloid or superparmagnetic iron oxide uptake (with MRI)

    Cysts: Hypointense or water density on US, CT, or MRI with no septations

  • • History of previous malignant disease

    • History of previous hepatitis or cirrhosis

    • History of other infections (eg, HIV)

Rule Out

  • • Malignant hepatic tumor with resection often being necessary to secure diagnosis

  • • CBC

    • Liver function tests

    • Alpha-fetoprotein (AFP), CA 19-9, CA 125, carcinoembryonic antigen (CEA)

    • History and physical exam

    • US, CT, or MRI depending on overall suspicion of diagnosis

    • Intraoperative US if resection is planned

When to Admit

  • • Tumor with symptomatic hemorrhage


  • • Enucleation if diagnosis is secure

    • Formal anatomic resection if diagnosis is in doubt


  • • Symptomatic lesions or when diagnosis in doubt

    • Adenomas over 5 cm


  • • Medical comorbidity associated with too high a risk for general anesthesia


  • • Discontinue estrogens or androgens for suspected adenomas, focal nodular hyperplasia, or hemangiomas

Treatment Monitoring

  • • Individualized based on recurrence of symptoms following resection

    • Serial CT scans to verify stability of lesion for presumed benign lesions for 2 years or when symptoms change


  • • Liver failure

    • Hemorrhage

    • Biliary injury

    • Perihepatic infection


Bioulac-Sage P et al. Diagnosis of focal nodular hyperplasia: not so easy. Am J Surg Pathol....

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.