Internal Medicine

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

234 Benign Tumors of the Liver

specific therapy

Treatment Options

■Cavernous hemangiomas: small, asymptomatic lesions generally

observed; large, symptomatic lesions resected if anatomically fea-

sible & operative risk reasonable

■FNH: if confirmed or strongly suspected by clinical, radiologic or

biopsy features, generally observed

■Hepatocellular adenoma: surgical resection generally recom-

mended whenever possible, particularly if tumor >4–6 cm in diam-

eter, which is associated w/ risk of intraperitoneal hemorrhage;

whether or not resected, oral contraceptives should be discontin-

ued, which may be associated w/ spontaneous tumor regression

follow-up

■Tumors suspected to be cavernous hemangioma or FNH: repeat

imaging, typically US, in 6 mo & then annually for 1 or 2 y to confirm

stability & lack of progression

■LFTs q 6–12 m

complications and prognosis

Complications

■Cavernous hemangioma may be associated w/ episodes of severe,

acute abdominal pain from bleeding or thrombosis of tumor; rupture

w/ hemoperitoneum rare

■FNH only rarely associated w/ intralesional bleeding, necrosis or

hemoperitoneum, typically w/ use of oral contraceptives

■Hepatocellular adenoma may be associated w/ tumor rupture in

hemoperitoneum in 25–40% of cases

Prognosis

■Cavernous hemangioma: good, w/ no complications resulting from

smaller lesions; lesions >4–6 cm have some risk of thrombosis or

bleeding, but only few spontaneous ruptures reported; no reports of

malignant transformation

■FNH: good, w/ only rare complications of rupture & no reports of

malignant degeneration

■Hepatocellular adenoma: depends on size, w/ lesions >4–6 cm hav-

ing substantial risk of rupture w/ intraperitoneal bleeding; few

reports of malignant transformation