Benign liver tumors in adults: Diagnosis and management

Benign tumors of the liver are a heterogeneous group of lesions whose detection has greatly increased because of the widespread use of imaging techniques. Only a few types, such as cavernous hemangiomas, focal nodular hyperplasia (FNH), hepatic adenoma (HA), and cysts, are frequent enough to be of clinical importance. Although often asymptomatic, these tumors are sometimes associated with pain or digestive symptoms. In some of them, hormonal manipulation has a role in both the development and the course. Complications, such as spontaneous rupture or sudden increase in size, have been reported. Only in hepatic adenoma is malignant transformation considered possible. The clinical importance of these tumors lies mainly in making a correct diagnosis of the type of lesion, and in ruling out primary or metastatic tumors. Although most cases can now be identified through imaging techniques, in some, diagnosis remains uncertain even after percutaneous biopsy, making surgical exploration necessary. We here consider 104 patients with benign lesions: 60 underwent resection; the remaining 44 had follow up only. Of the former group, 35 had hemangiomas, 16 “cellular” tumors (either FNH or HA), and 9 cystic lesions. Forty-four were resected due to the presence of symptoms and 16 because of uncertain diagnosis. It is concluded that cavernous hemangioma, FNH, and most of the cysts have a favorable clinical evolution and, when the diagnosis is certain, resection is not indicated. Surgery can be considered for symptomatic or complicated cases and those in which the diagnosis remains uncertain with imaging work-up techniques. HA and cystic adenoma require surgical treatment even in asymptomatic patients.