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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. 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. 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.
Liver hemangiomas do not usually cause symptoms. They are usually small, with sizes up to 10 centimeters. Their size tends to remain stable overtime. 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. Cavernous hemangiomas are diagnosed with medical imaging (do not usually need biopsy to confirm diagnosis).
Given their benign course and often asymptomatic nature, cavernous hemangiomas are typically diagnosed incidentally (e.g. when medical imaging is obtained for another reason). In terms of management, they are usually monitored with periodic imaging as well as more closely if the person becomes pregnant. If the cavernous hemangioma grows quickly or the patient is symptomatic, further medical intervention is warranted. Therapies include open or laparoscopic surgical resection, arterial embolization, or radio-frequency ablation. In terms of complications of hepatic hemangiomas, it is very rare for a hepatic hemangioma to rupture or bleed.
These tumors usually do not have any symptoms. If large, they may present with abdominal pain. 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. Diagnosis is made mainly with medical imaging, such as ultrasound or MRI with contrast. The majority of FNH have a characteristic "central scar" on contrast-enhanced imaging, which helps to solidify the diagnosis. 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.
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. Surgical indications or arterial embolization for FNH include if the FNH lesion is large, symptomatic, or there is uncertainty surrounding the correct diagnosis.
Hepatocellular adenomas are most often asymptomatic and often found incidentally on imaging. However, if signs and symptoms are present they include non-specific abdominal pain, Jaundice, and higher than normal gamma glutamyl transferase and alkaline phosphatase laboratory values. They are, in most cases, located in the right hepatic lobe and are frequently seen as a single lesion. Their size ranges from 1 to 30 cm. They can be difficult to diagnosis with Medical imaging alone, because it can be hard to tell the difference between hepatocellular adenoma, focal nodular hyperplasia, and hepatocellular carcinoma. Molecular categorization via biopsy and pathological analysis aids in both diagnosis and understanding prognosis, particularly because hepatocellular adenomas have the potential to become malignant. It is important to note, percutaneous biopsy should be avoided, because this method can lead to bleeding or rupture of the adenoma. The best way to biopsy suspected hepatic adenoma is via open or laparoscopic excisional biopsy.
Because hepatocellular adenomas are so rare, there are no clear guidelines for the best course of treatment. The complications, which include malignant transformation, spontaneous hemorrhage, and rupture, are considered when determining the treatment approach Estimates indicate approximately 20-40% of hepatocellular adenomas will undergo spontaneous hemorrhage. 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. Transformation to hepatocellular carcinoma is more common in men. 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. 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. 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).
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. 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.
Pseudotumors:
Pseudotumors differ from liver tumors in that they are not a proliferation of abnormal cells but are "local variations" of tissue type. Notably, liver pseudotumors can be confused for a liver tumor on initial imaging studies when diagnostically working up a liver mass. Examples of pseudotumors include: distinct areas of hepatic fibrosis, pockets of fatty liver changes, and inflammatory pseudotumor.
, 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.
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