Liver tumor

Source: Wikipedia, the free encyclopedia.
Liver tumor
Other namesHepatic tumors
SpecialtyOncology, Gastroenterology, Hepatology
Diagnostic methodmedical imaging, liver biopsy
Treatmentvaries based on type

Liver tumors (also known as hepatic tumors) are abnormal growth of liver cells on or in the

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]

Classification

Liver tumor types by relative incidence in adults in the United States.[4]

Liver tumors can be broadly classified as

malignant
:

Benign

There are several types of benign liver tumors. They are caused by either abnormal growth of

biliary, or stromal.[2]
: 693–704 

Hemangiomas

hepatic artery and its branches.[5] These tumors are most common in women.[5] The cause of liver hemangiomas remains unknown; however, it may have congenital and genetic components.[5] They are not known to become malignant based on the available existing literature.[5]

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

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 0.2%–0.3% of adults worldwide.[2] FNH is more common in females (10:1 female to male ratio) except in Japan and China, in which there is a more equal prevalence of cases between females and males.[2] FNH is associated with women of childbearing years and has been associated with women taking hormonal oral contraceptives.[2] This tumor is the result of a congenital arteriovenous malformation hepatocyte response. This process is one in which all normal constituents of the liver are present, but the pattern by which they are presented is abnormal.[citation needed]

These tumors usually do not have any symptoms. If large, they may present with abdominal pain.

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.

arterial embolization for FNH include if the FNH lesion is large, symptomatic, or there is uncertainty surrounding the correct diagnosis.[2]

Hepatic adenoma

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

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.

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.

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.

hepatic fibrosis, pockets of fatty liver changes, and inflammatory pseudotumor.[2]

Cancerous

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.
Main article: Liver cancer

Diagnosis

Further information: Hepatocellular_carcinoma § 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

computed tomography (CT) and magnetic resonance imaging
(MRI).

CA125). These tumour markers are found in primary liver cancers, as well as in other cancers and certain other disorders.[14][15]

Ultrasound

Main article: Ultrasonography of liver tumors

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.[citation needed]

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
]

References

  1. ^ "Liver Tumors". Johns Hopkins Medicine. Retrieved 4 July 2021.
  2. ^
    OL 29371356M – via Google Books
    .
  3. ^ "Benign Liver Tumors". The Lecturio Medical Concept Library. Retrieved 4 July 2021.
  4. OL 28261767M
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  5. ^
    PMID 26361504
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  6. S2CID 31253509
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  7. ^
    PMID 26557953
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  8. PMID 20887318
    .
  9. PMID 23320183
    .
  10. PMID 22748109
    .
  11. ^
    PMID 26011213
    .
  12. ^ Prevention, CDC-Centers for Disease Control and (2019-07-16). "CDC - Echinococcosis - Biology". www.cdc.gov. Retrieved 2021-02-15.
  13. PMID 31439937
    .
  14. PMID 23396291
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  15. PMID 24649215
    .

External links
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