liver mass
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Etiology
Epidemiology
- most are incidentalomas discovered on abdominal imaging[1]
Clinical manifestations
- symptoms uncommon[1]
Laboratory
Diagnostic procedures
* MRI takes precedence
Radiology
- hepatobiliary ultrasonography
- 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]
- diagnosis of hepatocellular carcinoma* if
- 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
- lesions < 5 cm suspected to be hepatocellular adenoma
- discontinue oral contraceptives - observe for regression of lesion
- resection if not taking oral contraceptives
- lesions > 5 cm in size -> resection
- frozen section evaluation of biopsies
- hepatocellular adenoma -> resect
- focal nodular hyperplasia
- no malignant potential
- resection is optional
- liver transplantation if cirrhosis & meets Milan criteria[1]
More general terms
Additional terms
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Medical Knowledge Self Assessment Program (MKSAP) 11, 17, 18. American College of Physicians, Philadelphia 1998, 2015, 2018
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/21397723
- ↑ Bonder A, Afdhal N. Evaluation of liver lesions. Clin Liver Dis. 2012 May;16(2):271-83. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22541698
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/25135008