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  • Review Article
  • Published:

Diagnosis and management of solid benign liver lesions

Nature Reviews Gastroenterology & Hepatology volume 11, pages 737–749 (2014)Cite this article

Subjects

Key Points

  • Haemangioma and focal nodular hyperplasia are the two most frequent benign liver lesions and only exceptionally require treatment, specific advice or follow-up

  • Hepatocellular adenoma, which now frequently occurs in obese females, is a heterogeneous liver lesion at risk of bleeding and malignant transformation according to the patients' gender and the pathological subtype and size of the tumour

  • In women, the low risk of complications associated with hepatocellular adenomas of <5 cm allows conservative management with regular follow-up

  • The accuracy of MRI now limits the use of biopsy for the diagnosis of hepatocellular adenoma, focal nodular hyperplasia or haemangioma

  • The uncertainty of imaging diagnosis for inflammatory pseudotumours of the liver, angiomyolipomas or in a setting of abnormal underlying liver parenchyma still justifies the routine use of liver biopsy

Abstract

More and more asymptomatic benign liver tumours are discovered incidentally and can be divided into regenerative lesions and true neoplastic lesions. The most common regenerative lesions include hemangioma, focal nodular hyperplasia and inflammatory pseudotumours of the liver. Neoplastic lesions include hepatocellular adenomas and angiomyolipomas. Regenerative lesions rarely increase in volume, do not yield a higher risk of complications and usually do not require treatment. By contrast, hepatocellular adenomas and angiomyolipomas can increase in volume and are associated with a risk of complications. Large hepatocellular adenomas (>5 cm in diameter) are undoubtedly associated with a risk of bleeding and malignant transformation, particularly the inflammatory (also known as telangiectatic) and β-catenin mutated subtypes. Accurate diagnosis needs to be obtained to select patients eligible for surgical resection. MRI has markedly improved diagnosis and can identify the major hepatocellular adenomas subtypes. The use of biopsy results to inform the indication for resection remains questionable. However, when diagnosis remains uncertain after imaging, percutaneous biopsy could help improve diagnostic accuracy.

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Figure 1: A typical haemangioma on ultrasound.
Figure 2: Typical FNH on MRI.
Figure 3: Steatotic hepatocellular adenoma on MRI.
Figure 4: Inflammatory (telangiectatic) hepatocellular adenoma on MRI.
Figure 5: An inflammatory pseudotumour of the liver with solitary necrotic tumour appearance.
Figure 6: Diagnostic management of suspect benign liver lesions.
Figure 7: Stereotypical simplified MRI features of benign liver lesions.

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Authors and Affiliations

  1. Department of Hepatobiliary Surgery and Liver Transplantation, Beaujon Hospital, University Paris-Diderot, 100 Boulevard du General Leclerc, Clichy, 92110, France

    Jacques Belghiti & François Cauchy

  2. Department of Pathology, Beaujon Hospital, University Paris-Diderot, 100 Boulevard du General Leclerc, Clichy, 92110, France

    Valérie Paradis

  3. Department of Radiology, Beaujon Hospital, University Paris-Diderot, 100 Boulevard du General Leclerc, Clichy, 92110, France

    Valérie Vilgrain

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  1. Jacques Belghiti
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  2. François Cauchy
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  4. Valérie Vilgrain
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J.B. and V.V. made a substantial contribution to discussion of content and writing the article. F.C. contributed substantially to writing the article and reviewing and/or editing the article before submission. V.P. substantially contributed to the discussion of content and reviewing and/or editing the article before submission.

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Belghiti, J., Cauchy, F., Paradis, V. et al. Diagnosis and management of solid benign liver lesions. Nat Rev Gastroenterol Hepatol 11, 737–749 (2014). https://doi.org/10.1038/nrgastro.2014.151

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