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liver mass

Etiology: - hepatocellular adenoma - hepatocellular carcinoma - focal nodular hyperplasia - hepatic hemangioma Epidemiology: - most are incidentalomas discovered on abdominal imaging [1] Clinical manifestations: - symptoms uncommon [1] Laboratory: 1) liver function tests 2) hepatitis B serology, HBsAg 3) hepatitis C serology 4) alpha-fetoprotein Special laboratory: - percutaneous fine-needle biopsy if abnormal laboratory tests* * MRI takes precedence Radiology: 1) hepatobiliary ultrasonography 2) computed tomography (CT) or magnetic resonance imaging (MRI) - diagnosis of hepatocellular carcinoma* if - patient with cirrhosis - liver mass > 1 cm - contrast enhancement in the arterial phase - washout of contrast in the venous phase [1] 3) Tc-99-tagged erythrocyte scan for diagnosis of hepatic hemangiomas > 3 cm in size (NOT useful for smaller lesions) * liver biopsy not needed [1] Management: 1) lesions < 5 cm suspected to be hepatocellular adenoma a) discontinue oral contraceptives - observe for regression of lesion b) resection if not taking oral contraceptives 2) lesions > 5 cm in size -> resection 3) frozen section evaluation of biopsies a) hepatocellular adenoma -> resect b) focal nodular hyperplasia a) no malignant potential b) resection is optional 4) liver transplantation if cirrhosis & meets Milan criteria [1]

Related

hepatobiliary ultrasonography liver (function) tests (LFT, liver panel, hepatic function panel)

General

mass lesion liver disease

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 17, 18. American College of Physicians, Philadelphia 1998, 2015, 2018
  2. Shaked O, Siegelman ES, Olthoff K, Reddy KR Biologic and clinical features of benign solid and cystic lesions of the liver. Clin Gastroenterol Hepatol. 2011 Jul;9(7):547-62.e1-4 PMID: 21397723
  3. Bonder A, Afdhal N. Evaluation of liver lesions. Clin Liver Dis. 2012 May;16(2):271-83. Review. PMID: 22541698
  4. Marrero JA, Ahn J, Rajender Reddy K. Am Coll Gastroenterology ACG clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol. 2014 Sep;109(9):1328-47; PMID: 25135008