Liver tumor

Last updated
Liver tumor
Other namesHepatic tumors
Specialty Oncology, Gastroenterology, Hepatology
Diagnostic method medical imaging, liver biopsy
Treatmentvaries based on type

Liver tumors (also known as hepatic tumors) are abnormal growth of liver cells on or in the liver. Several distinct types of tumors can develop in the liver because the liver is made up of various cell types. [1] Liver tumors can be classified as benign (non-cancerous) or malignant (cancerous) growths. They may be discovered on medical imaging (even for a different reason than the cancer itself), and the diagnosis is often confirmed with liver biopsy. [2] Signs and symptoms of liver masses vary from being asymptomatic to patients presenting with an abdominal mass, hepatomegaly, abdominal pain, jaundice, or some other liver dysfunction. Treatment varies and is highly specific to the type of liver tumor. [3]

Contents

Classification

Liver tumor types by relative incidence in adults in the United States. Liver tumor types in adults by relative incidence.png
Liver tumor types by relative incidence in adults in the United States.

Liver tumors can be broadly classified as benign or malignant:

Benign

There are several types of benign liver tumors. They are caused by either abnormal growth of neoplastic cells or in response to liver injury, known as regenerative nodules. [2] One way to categorize benign liver tumors is by their anatomic source, such as hepatocellular, biliary, or stromal. [2] : 693–704 

Hemangiomas

Cavernous hemangiomas (also called hepatic hemangioma or liver hemangioma) are the most common type of benign liver tumor, found in

Liver hemangiomas do not usually cause symptoms. [2] [5] They are usually small, with sizes up to 10 centimeters. [5] Their size tends to remain stable overtime. [5] However, if the hemangioma is large it can cause abdominal pain, a sense of fullness in right upper abdominal area, heart problems, and coagulation dysfunction. [2] [5] Cavernous hemangiomas are diagnosed with medical imaging (do not usually need biopsy to confirm diagnosis). [2]

Given their benign course and often asymptomatic nature, cavernous hemangiomas are typically diagnosed incidentally (e.g. when medical imaging is obtained for another reason). [5] In terms of management, they are usually monitored with periodic imaging as well as more closely if the person becomes pregnant. [5] If the cavernous hemangioma grows quickly or the patient is symptomatic, further medical intervention is warranted. [5] Therapies include open or laparoscopic surgical resection, arterial embolization, or radio-frequency ablation. [5] In terms of complications of hepatic hemangiomas, it is very rare for a hepatic hemangioma to rupture or bleed. [6]

Focal nodular hyperplasia

Focal nodular hyperplasia (FNH) is the second most common benign tumor of the liver. [2] FNH is found in

These tumors usually do not have any symptoms. If large, they may present with abdominal pain. [2] It is common for patients to have multiple distinct liver lesions; however, they do not tend to grow over time and they do not typically convert to malignant tumors. [2] Diagnosis is made mainly with medical imaging, such as ultrasound or MRI with contrast. [2] The majority of FNH have a characteristic "central scar" on contrast-enhanced imaging, which helps to solidify the diagnosis. [2] However, if a central scar is not present on imaging, it is hard to tell the difference between FNH, hepatic adenoma, and hepatocellular carcinoma, in which cases biopsy is the next step to aid in the diagnosis process. [2]

Given the benign nature of FNH and the fact that they rarely progress in size or undergo malignant transformation, FNH tumors are usually managed with clinical monitoring. [2] Surgical indications or arterial embolization for FNH include if the FNH lesion is large, symptomatic, or there is uncertainty surrounding the correct diagnosis. [2]

Hepatic adenoma

Hepatocellular adenomas (also called hepatocellular adenoma) are rare benign liver tumors made up of hepatocytes, [2] with estimates indicating hepatocellular adenomas make up 2% of liver tumors. [7] They are most common in women using contraceptives or hormone replacement therapies containing estrogen, women who are pregnant, or people mis-using steroids. [7] They are also associated with glycogen storage diseases (subtypes I and III), and newer studies are suggesting that diabetes, obesity, high blood pressure, and dyslipidemia are risk factors for hepatic adenomas. [7]

Hepatocellular adenomas are most often asymptomatic and often found incidentally on imaging. [7] However, if signs and symptoms are present they include non-specific abdominal pain, yellowing of skin, and higher than normal gamma glutamyl transferase and alkaline phosphatase laboratory values. [7] They are, in most cases, located in the right hepatic lobe and are frequently seen as a single lesion. [7] Their size ranges from 1 to 30 cm. [7] They can be difficult to diagnosis with imaging studies alone, because it can be hard to tell the difference between hepatocellular adenoma, focal nodular hyperplasia, and hepatocellular carcinoma. [7] Molecular categorization via biopsy and pathological analysis aids in both diagnosis and understanding prognosis, particularly because hepatocellular adenomas have the potential to become malignant. [2] [7] It is important to note, percutaneous biopsy should be avoided, because this method can lead to bleeding or rupture of the adenoma. [7] The best way to biopsy suspected hepatic adenoma is via open or laparoscopic excisional biopsy. [7]

Because hepatocellular adenomas are so rare, there are no clear guidelines for the best course of treatment. [7] The complications, which include malignant transformation, spontaneous hemorrhage, and rupture, are considered when determining the treatment approach [7] Estimates indicate approximately 20-40% of hepatocellular adenomas will undergo spontaneous hemorrhage. [7] [2] The evidence is not well elucidated, but the best available data suggests that the risk of hepatocellular adenoma becoming hepatocellular carcinoma, which is malignant liver tumor, is 4.2% of all cases. [8] Transformation to hepatocellular carcinoma is more common in men. [2] Currently, if the hepatic adenoma is >5 cm, increasing in size, symptomatic lesions, has molecular markers associated with HCC transformation, rising level of liver tumor markers such as alpha fetoprotein, the patient is a male, or has a glycogen storage disorder, the adenoma is recommended to be surgically removed. [7] Like most liver tumors, the anatomy and location of the adenoma determines whether the tumor can removed laparoscopically or if it requires an open surgical procedure. [7] Hepatocellular adenomas are also known to decrease in size when there is decreased estrogen or steroids (e.g. when estrogen-containing contraceptives, steroids are stopped, or post-partum). [7]

Women of childbearing age with hepatic adenomas were previously recommended to avoid becoming pregnant altogether; however, currently a more individualized approach is recommended that takes into account the size of the adenoma and whether surgical resection is possible prior to becoming pregnant. [9] [7] Currently, there is a clinical trial called the Pregnancy and Liver Adenoma Management (PALM) study that is investigating management of hepatic adenomas during pregnancy; however, the results of this trial have not been published as of February 2021. [10]

Liver Cell Adenomatosis

Liver cell adenomatosis (also called hepatic adenomatosis) is a related but distinct diagnosis from hepatocellular adenoma. [11] [7] On medical imaging and histopathological biopsy results they are the same as hepatic adenomas. [7] Liver cell adenomatosis differs from hepatic adenomas by its definition of more than 10 hepatic adenomas that are in both liver lobes in a person who does not have a glycogen storage disease and is not taking exogenous hormones. [7] Liver cell adenomatosis is not associated with steroid use (e.g. their size does not change when taking or not taking oral contraceptives containing estrogen or anabolic steroids), which is another distinction from hepatic adenomas. [11] Liver cell adenomatosis is associated with liver dysfunction and higher rates of bleeding than hepatic adenomas alone. [7] Available evidence suggests that bleeding occurs in approximately 63% of patients with liver cell adenomatosis. [11] Liver cell adenomatosis is also associated with becoming hepatocellular carcinoma. [11] Like hepatic adenomas, they are diagnosed with imaging and biopsies as needed. Treatment of liver cell adenomatosis is difficult due to the multiple, widespread lesions. Liver imaging should be reviewed to see if it is possible to surgically remove the tumors. [7] Liver transplantation is a treatment option for some patients. [7]

Simple Liver Cysts

Liver cysts are common. They are fluid-filled contained structures within the liver. Simple liver cysts are seen most commonly in women and kids. [2] In terms of pathophysiology, they are formed in response to developmental events and in response to trauma and inflammation. [2] In addition, liver cysts can be seen with polycystic kidney disease and echinococcosis infection (hydatid disease). [2] [12]

Pseudotumors:

Pseudotumors differ from liver tumors in that they are not a proliferation of abnormal cells but are "local variations" of tissue type. [2] Notably, liver pseudotumors can be confused for a liver tumor on initial imaging studies when diagnostically working up a liver mass. [2] Examples of pseudotumors include: distinct areas of hepatic fibrosis, pockets of fatty liver changes, and inflammatory pseudotumor. [2]

Cancerous

Large HCC filling almost entire of right lobe Ultrasound Scan ND 1230124453 1300210.png
Large HCC filling almost entire of right lobe
Cross section of a human liver, showing multiple large pale tumor deposits. The tumor is an adenocarcinoma derived from a primary lesion in the body of the pancreas. Secondary tumor deposits in the liver from a primary cancer of the pancreas.jpg
Cross section of a human liver, showing multiple large pale tumor deposits. The tumor is an adenocarcinoma derived from a primary lesion in the body of the pancreas.

Diagnosis

Upon discovery of a liver tumor, the main issue in the workup is to determine whether the tumor is benign or malignant. Many imaging modalities are used to aid in the diagnosis of malignant liver tumors. These include sonography (ultrasound), computed tomography (CT) and magnetic resonance imaging (MRI).

Tumor markers, chemicals sometimes found in the blood of people with cancer, can be helpful in diagnosing and monitoring the course of liver cancers. High levels of alpha-fetoprotein (AFP) in the blood can be found in many cases of HCC and intrahepatic cholangiocarcinoma. Cholangiocarcinoma can be detected with these commonly used tumor markers: carbohydrate antigen 19-9 (CA 19–9), carcinoembryonic antigen (CEA) and cancer antigen 125 (CA125). These tumour markers are found in primary liver cancers, as well as in other cancers and certain other disorders. [14] [15]

Ultrasound

Ultrasonography of liver tumors involves two stages: detection and characterization.[ citation needed ] Tumor detection is based on the performance of the method and should include morphometric information (three axes dimensions, volume) and topographic information (number, location specifying liver segment and lobe/lobes). The specification of these data is important for staging liver tumors and prognosis.[ citation needed ] Tumor characterization is a complex process based on a sum of criteria leading towards tumor nature definition. Often, other diagnostic procedures, especially interventional ones are no longer necessary. Tumor characterization using the ultrasound method will be based on the following elements: consistency (solid, liquid, mixed), echogenicity, structure appearance (homogeneous or heterogeneous), delineation from adjacent liver parenchyma (capsular, imprecise), elasticity, posterior acoustic enhancement effect, the relation with neighboring organs or structures (displacement, invasion), vasculature (presence and characteristics on Doppler ultrasonography and contrast-enhanced ultrasound (CEUS).[ citation needed ]

Computed tomography

Selected images from a biphasic CT of Focal Nodular Hyperplasia in the left hepatic lobe (arrow). These masses have characteristic early arterial enhancement (6a) with contrast wash out on the portal venous phase images (6b) from the mass making these lesions difficult to identify on portal venous phase images alone. Late arterial and portal venous phase CT of focal nodular hyperplasia.jpg
Selected images from a biphasic CT of Focal Nodular Hyperplasia in the left hepatic lobe (arrow). These masses have characteristic early arterial enhancement (6a) with contrast wash out on the portal venous phase images (6b) from the mass making these lesions difficult to identify on portal venous phase images alone.

When evaluating hepatic masses by abdominal computed tomography (CT), it can be advantageous to have both late arterial and portal venous phase images since some tumors enhance briskly during the arterial phase (hepatocellular carcinoma, hepatic adenoma, follicular nodular hyperplasia (FNH), and hypervascular metastasis), but maybe occult or difficult to characterize on portal venous phase imaging alone. However, it should be stressed that the addition of late arterial phase images is only indicated if one of these tumors is suspected, or if there is a need for further characterization of a hepatic mass, since the large majority of patients will not benefit from the addition of this phase. In addition, if there is a need to definitively characterize a hepatic mass, MRI is generally more sensitive and specific, with no associated radiation dose.[ citation needed ]

Related Research Articles

<span class="mw-page-title-main">Hepatocellular carcinoma</span> Medical condition

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer in adults and is currently the most common cause of death in people with cirrhosis. HCC is the third leading cause of cancer-related deaths worldwide.

<span class="mw-page-title-main">Adenoma</span> Type of benign tumor

An adenoma is a benign tumor of epithelial tissue with glandular origin, glandular characteristics, or both. Adenomas can grow from many glandular organs, including the adrenal glands, pituitary gland, thyroid, prostate, and others. Some adenomas grow from epithelial tissue in nonglandular areas but express glandular tissue structure. Although adenomas are benign, they should be treated as pre-cancerous. Over time adenomas may transform to become malignant, at which point they are called adenocarcinomas. Most adenomas do not transform. However, even though benign, they have the potential to cause serious health complications by compressing other structures and by producing large amounts of hormones in an unregulated, non-feedback-dependent manner. Some adenomas are too small to be seen macroscopically but can still cause clinical symptoms.

<span class="mw-page-title-main">Cholangiocarcinoma</span> Bile duct adenocarcinoma

Cholangiocarcinoma, also known as bile duct cancer, is a type of cancer that forms in the bile ducts. Symptoms of cholangiocarcinoma may include abdominal pain, yellowish skin, weight loss, generalized itching, and fever. Light colored stool or dark urine may also occur. Other biliary tract cancers include gallbladder cancer and cancer of the ampulla of Vater.

<span class="mw-page-title-main">Adrenocortical carcinoma</span> Medical condition

Adrenocortical carcinoma (ACC) is an aggressive cancer originating in the cortex of the adrenal gland.

<span class="mw-page-title-main">Benign tumor</span> Mass of cells which cannot spread throughout the body

A benign tumor is a mass of cells (tumor) that does not invade neighboring tissue or metastasize. Compared to malignant (cancerous) tumors, benign tumors generally have a slower growth rate. Benign tumors have relatively well differentiated cells. They are often surrounded by an outer surface or stay contained within the epithelium. Common examples of benign tumors include moles and uterine fibroids.

The International Classification of Diseases for Oncology (ICD-O) is a domain-specific extension of the International Statistical Classification of Diseases and Related Health Problems for tumor diseases. This classification is widely used by cancer registries.

<span class="mw-page-title-main">Hemangioendothelioma</span> Medical condition

Hemangioendotheliomas are a family of vascular neoplasms of intermediate malignancy.

<span class="mw-page-title-main">Pleomorphic adenoma</span> Medical condition

Pleomorphic adenoma is a common benign salivary gland neoplasm characterised by neoplastic proliferation of epithelial (ductal) cells along with myoepithelial components, having a malignant potentiality. It is the most common type of salivary gland tumor and the most common tumor of the parotid gland. It derives its name from the architectural Pleomorphism seen by light microscopy. It is also known as "Mixed tumor, salivary gland type", which refers to its dual origin from epithelial and myoepithelial elements as opposed to its pleomorphic appearance.

Hepatectomy is the surgical resection of the liver. While the term is often employed for the removal of the liver from a liver transplant donor, this article will focus on partial resections of hepatic tissue and hepatoportoenterostomy.

<span class="mw-page-title-main">Focal nodular hyperplasia</span> Medical condition

Focal nodular hyperplasia (FNH) is a benign tumor of the liver, which is the second most prevalent tumor of the liver. It is usually asymptomatic, rarely grows or bleeds, and has no malignant potential. This tumour was once often resected because it was difficult to distinguish from hepatic adenoma, but with modern multiphase imaging is usually now diagnosed by strict imaging criteria and not resected.

<span class="mw-page-title-main">Hepatocellular adenoma</span> Hepatocellular adenoma (HA) is a rare benign tumor of the liver

Hepatocellular adenoma is a rare, benign liver tumor. It most commonly occurs in people with elevated systemic levels of estrogen, classically in women taking estrogen-containing oral contraceptive medication.

<span class="mw-page-title-main">Adrenal tumor</span> Medical condition

An adrenal tumor or adrenal mass is any benign or malignant neoplasms of the adrenal gland, several of which are notable for their tendency to overproduce endocrine hormones. Adrenal cancer is the presence of malignant adrenal tumors, and includes neuroblastoma, adrenocortical carcinoma and some adrenal pheochromocytomas. Most adrenal pheochromocytomas and all adrenocortical adenomas are benign tumors, which do not metastasize or invade nearby tissues, but may cause significant health problems by unbalancing hormones.

<span class="mw-page-title-main">Liver cancer</span> Medical condition

Liver cancer is cancer that starts in the liver. Liver cancer can be primary or secondary. Liver metastasis is more common than that which starts in the liver. Liver cancer is increasing globally.

<span class="mw-page-title-main">Salivary gland tumour</span> Medical condition

Salivary gland tumours, also known as mucous gland adenomas or neoplasms, are tumours that form in the tissues of salivary glands. The salivary glands are classified as major or minor. The major salivary glands consist of the parotid, submandibular, and sublingual glands. The minor salivary glands consist of 800 to 1000 small mucus-secreting glands located throughout the lining of the oral cavity. Patients with these types of tumours may be asymptomatic.

<span class="mw-page-title-main">Computed tomography of the abdomen and pelvis</span>

Computed tomography of the abdomen and pelvis is an application of computed tomography (CT) and is a sensitive method for diagnosis of abdominal diseases. It is used frequently to determine stage of cancer and to follow progress. It is also a useful test to investigate acute abdominal pain. Renal stones, appendicitis, pancreatitis, diverticulitis, abdominal aortic aneurysm, and bowel obstruction are conditions that are readily diagnosed and assessed with CT. CT is also the first line for detecting solid organ injury after trauma.

<span class="mw-page-title-main">Cavernous hemangioma</span> Human disease

Cavernous hemangioma, also called cavernous angioma, venous malformation, or cavernoma, is a type of venous malformation due to endothelial dysmorphogenesis from a lesion which is present at birth. A cavernoma in the brain is called a cerebral cavernous malformation or CCM. Despite its designation as a hemangioma, a cavernous hemangioma is not a tumor as it does not display endothelial hyperplasia. The abnormal tissue causes a slowing of blood flow through the cavities, or "caverns". The blood vessels do not form the necessary junctions with surrounding cells, and the structural support from the smooth muscle is hindered, causing leakage into the surrounding tissue. It is the leakage of blood, referred to as hemorrhage, that causes a variety of symptoms known to be associated with the condition.

<span class="mw-page-title-main">Cavernous liver hemangioma</span> Medical condition

A cavernous liver hemangioma or hepatic hemangioma is a benign tumor of the liver composed of hepatic endothelial cells. It is the most common benign liver tumour, and is usually asymptomatic and diagnosed incidentally on radiological imaging. Liver hemangiomas are thought to be congenital in origin. Several subtypes exist, including the giant hepatic haemangioma, which can cause significant complications.

Interventional oncology is a subspecialty field of interventional radiology that deals with the diagnosis and treatment of cancer and cancer-related problems using targeted minimally invasive procedures performed under image guidance. Interventional oncology has developed to a separate pillar of modern oncology and it employs X-ray, ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) to help guide miniaturized instruments to allow targeted and precise treatment of solid tumours located in various organs of the human body, including but not limited to the liver, kidneys, lungs, and bones. Interventional oncology treatments are routinely carried out by interventional radiologists in appropriate settings and facilities.

Ultrasonography of liver tumors involves two stages: detection and characterization.

References

  1. ↑ "Liver Tumors". Johns Hopkins Medicine. Retrieved 4 July 2021.
  2. 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 Dooley, James S.; Lok, Anna S. F.; Garcia-Tsao, Guadalupe; Pinzani, Massimo, eds. (6 August 2018). Sherlock's Diseases of the Liver and Biliary System (13th ed.). Wiley-Blackwell. ISBN   978-1-119-23764-8. LCCN   2017059204. OCLC   1187411089. OL   29371356M – via Google Books.
  3. ↑ "Benign Liver Tumors". The Lecturio Medical Concept Library. Retrieved 4 July 2021.
  4. ↑ Mills, Stacy E., ed. (11 February 2015). "Table 37.2". Sternberg's Diagnostic Surgical Pathology (6th ed.). LWW. ISBN   978-1451188752. LCCN   2014036541. OCLC   953861627. OL   28261767M.
  5. 1 2 3 4 5 6 7 8 9 10 11 12 13 Bajenaru, N; Balaban, V; Săvulescu, F; Campeanu, I; Patrascu, T (2015). "Hepatic hemangioma -review-". Journal of Medicine and Life. 8 (Spec Issue): 4–11. ISSN   1844-122X. PMC   4564031 . PMID   26361504.
  6. ↑ Farges, O.; Daradkeh, S.; Bismuth, H. (January 1995). "Cavernous hemangiomas of the liver: are there any indications for resection?". World Journal of Surgery. 19 (1): 19–24. doi:10.1007/BF00316974. ISSN   0364-2313. PMID   7740805. S2CID   31253509.
  7. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Vijay, Adarsh (2015). "Hepatocellular adenoma: An update". World Journal of Hepatology. 7 (25): 2603–9. doi: 10.4254/wjh.v7.i25.2603 . ISSN   1948-5182. PMC   4635146 . PMID   26557953.
  8. ↑ Stoot, Jan H.M.B.; Coelen, Robert J.S.; De Jong, Mechteld C.; Dejong, Cornelis H.C. (October 2010). "Malignant transformation of hepatocellular adenomas into hepatocellular carcinomas: a systematic review including more than 1600 adenoma cases". HPB. 12 (8): 509–522. doi:10.1111/j.1477-2574.2010.00222.x. PMC   2997656 . PMID   20887318.
  9. ↑ Bröker, Mirelle E. E.; Ijzermans, Jan N. M.; van Aalten, Susanna M.; de Man, Robert A.; Terkivatan, Türkan (2012-12-24). "The Management of Pregnancy in Women with Hepatocellular Adenoma: A Plea for an Individualized Approach". International Journal of Hepatology. 2012: 725735. doi: 10.1155/2012/725735 . PMC   3540741 . PMID   23320183.
  10. ↑ van Aalten, Susanna M.; Bröker, Mirelle E. E.; Busschbach, J. J. V.; de Koning, Harry J.; de Man, Robert A.; Steegers, Eric A. P.; Steyerberg, Ewout W.; Terkivatan, Turkan; IJzermans, Jan N. M. (2012-06-29). "Pregnancy and liver adenoma management: PALM-study". BMC Gastroenterology. 12 (1): 82. doi: 10.1186/1471-230X-12-82 . ISSN   1471-230X. PMC   3503786 . PMID   22748109.
  11. 1 2 3 4 Donato, Maren; Jahromi, Alireza Hamidian; Andrade, Ana Ines; Kim, Roger; Chaudhery, Shabnum Ilyas; Sangster, Guillermo (2015-05-01). "Hepatic Adenomatosis: A Rare but Important Liver Disease With Severe Clinical Implications". International Surgery. 100 (5): 903–907. doi:10.9738/INTSURG-D-14-00161.1. ISSN   0020-8868. PMC   4452981 . PMID   26011213.
  12. ↑ Prevention, CDC-Centers for Disease Control and (2019-07-16). "CDC - Echinococcosis - Biology". www.cdc.gov. Retrieved 2021-02-15.
  13. ↑ Yang, Ju Dong; Hainaut, Pierre; Gores, Gregory J.; Amadou, Amina; Plymoth, Amelie; Roberts, Lewis R. (October 2019). "A global view of hepatocellular carcinoma: trends, risk, prevention and management". Nature Reviews Gastroenterology & Hepatology. 16 (10): 589–604. doi:10.1038/s41575-019-0186-y. ISSN   1759-5053. PMC   6813818 . PMID   31439937.
  14. ↑ Malaguarnera, G; Paladina, I; Giordano, M; Malaguarnera, M; Bertino, G; Berretta, M (2013). "Serum markers of intrahepatic cholangiocarcinoma". Disease Markers. 34 (4): 219–28. doi: 10.1155/2013/196412 . PMC   3809974 . PMID   23396291.
  15. ↑ Zhao YJ, Ju Q, Li GC (2013). "Tumor markers for hepatocellular carcinoma". Mol Clin Oncol. 1 (4): 593–598. doi:10.3892/mco.2013.119. PMC   3915636 . PMID   24649215.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.