Internal Medicine

0521779407-B01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

Benign Tumors of the Liver 233

complete filling in on CT; & low signal density on T1-weighted images

& very high signal density (light bulb) on T2-weighted images; cotton

wool pooling of isotope on technetium-labeled RBC scan

■FNH hypoechoic; hyperechoic or mixed on US; central scar in some

but not all cases by CT; central scar more often detected by MR than

CT; 50% of lesions take up isotope or fill in on routine technetium

sulfur colloid liver scan

■Hepatocellular adenoma diagnosed on basis of clinical awareness in

association w/ use of oral contraceptives & imaging studies not char-

acteristic of other benign or malignant lesions; can also be diagnosed

by hepatic arteriography, although not often used

Biopsy

■Liver biopsy not performed for cavernous hemangioma because of

ease of diagnosis by imaging & risk of bleeding

■Percutaenous liver biopsy often not diagnostic for FNH or hepato-

cellular adenoma, but can exclude malignant lesion

differential diagnosis

■Hepatocellular carcinoma: usually associated w/ chronic underlying

chronic liver disease, (incr.) LFTs, (incr.) AFP

■Hepatic metastasis: usually associated w/ multiple rather than 1

lesion, (incr.) LFTs & known primary

■Other epithelial tumors: bile duct adenoma, hepatobiliary cystade-

noma

■Other mesenchymal tumors: infantile hemangioendothelioma,

liomyoma

■Other misc tumors: carcinoid, teratoma

management

What to Do First

■Assess likelihood that tumor benign based on presence of single

lesion, normal LFTs, & no underlying liver disease

General Measures

■Use history, physical exam, LFTs, & imaging to exclude underlying

chronic liver disease, & CEA & AFP to exclude malignant tumor

■Assess size, presence of symptoms and potential need for resection

based on symptoms or clarification of diagnosis