Benign Neoplasms Of Liver Clinical Presentation, Investigations

Enumerate the various benign neoplasms of the liver. The clinical presentation, investigations and principles of management of benign neoplasms of liver.

Other Cystic Diseases

Simple Cystic Disease

• When the cyst is thin-walled, unilocular and regular it is usually a simple cyst.
• The host response is usually not present (unlike hydatid cyst).
• Incidentally discovered by ultrasound examination.
• Clinically, if they are big, the liver will be palpable with a smooth surface and round borders. It is nontender.
• Asymptomatic cysts do not require any treatment.
• Ultrasound-guided aspiration, laparoscopic deroofing and open surgical deroofing are the methods of treating the cyst.
• Differential diagnosis includes hydatid cyst and polycystic disease.

Polycystic Liver Disease

• Congenital abnormality.
• Cysts occur within the liver, pancreas and kidney (principally).
• Cysts are asymptomatic.
• Cysts do not produce liver cell failure (unlike polycystic kidneys).
• Cyst haemorrhage may be the presenting feature with right hypochondriac pain mimicking cholecystitis.
• CT scan and ultrasound are investigations.
• Cyst aspiration (PAIR-like hydatid cyst), and decompression may rarely be required in large painful lesions (laparoscopic).

Observe 7 Cs of polycystic liver.

Benign Tumours Of The Liver

These are not uncommon tumours. They are more frequently diagnosed now with frequent use of ultrasound. The majority of them are asymptomatic and do not require specific treatment.

Their removal should be attempted only by an experienced surgeon. Hepatic adenoma and focal nodular hyperplasia are compared in Table. They have a rare potential for malignant change.

Haemangioma

• Commonest benign tumour of the liver.
• The majority (75%) occur in women.
• Most of them are solitary, subcapsular, and occur in right lobe of liver.
• It may be associated with cavernous haemangioma at some other sites such as the head and neck region. Clinically, it is difficult to diagnose as it presents as hepatomegaly.
• Kupffer cells are not present in hepatic adenomas
• Kasabach-Merritt syndrome: Thrombocytopenia and consumptive coagulopathy.
• Sometimes it may cause cardiovascular failure due to sequestration of blood.
• Ultrasound/CT scan can diagnose their location, number (single or multiple) or presence of any other complications associated with that (thrombosis, infection). MRI is a better investigation.
• Haemangiomas bigger than 8 cm have chance of rupture.

Haemangioma Treatment

1. Transarterial embolisation (TAE)
   • Indicated in large haemangiomas which are unresectable.
   • Large haemangiomas on the inferior surface of the liver are ideally suitable for the treatment
   • Embolic materials
   • Temporary: Gel foam
   • Permanent: Steel coils, polyvinyl alcohol, isobutyl cyanoacrylate.
   • Polyvinyl alcohol particles 300-500 pm in size are used often.
2. They can be resected or can be enucleated.
   • Caution: Before putting a needle into the space occupying lesion in the liver, make sure it is NOT a haemangioma.

Haemangioma Differential Diagnosis: Hepatoma, liver cysts, liver abscess. Other benign tumours are hepatic adenomas and focal nodular hyperplasia.

Primary Liver Cancer Hepatoma Or Hepatocellular Carcinoma

Before discussion on HCC, one has to have knowledge about the segmental anatomy of the liver, which forms the basis of hepatic resection. Even though the details about hepatic resection may not be required for undergraduate students, it is desirable to know about the segmental anatomy to have a better understanding about hepatic resection.