Management of Benign Liver Tumors

provided all typical features are present on contrast-enhanced MRI or CT. Giant hemangiomas ( 1 5 cm) are frequently associated with abdominal pain or discomfort and may give rise to specific complications necessitating resection. The correct interpretation of cystic lesions mainly relies on ultrasound and MRI. Their diagnosis is also fairly straightforward except in those patients whose simple cysts have become atypical as a result of intracystic bleeding. Other cystic lesions include congenital bile duct cysts and cystadenoma that have in common an inherent risk of malignant transformation. Probably the most confusing benign liver tumors are focal nodular hyperplasia and hepatocellular adenoma (HCA). Whereas their management is entirely different, it can be very difficult to differentiate one for the other on imaging studies alone. Although new imaging techniques are currently under investigation to increase diagnostic accuracy, histological confirmation may still be required. Differentiating HCA from well-differentiated hepatocellular carcinoma is even more difficult, radiologically as well as on microscopical examination. Whereas focal nodular hyperplasia rarely gives rise to complications, HCA carries a risk of spontaneous intratumoral bleeding and malignant degeneration. Spontaneous bleeding in HCA with rupture into the abdominal cavity is a life-threatening complication of HCA. Its management has changed radically and the recommended first-line treatment nowadays is selective arterial emThis special issue of Digestive Surgery is dedicated to benign hepatobiliary lesions and summarizes the international expert discussions that focused on this topic during a one-day symposium held in Amsterdam on April 23, 2009. The rationale of this meeting was that these tumors are increasingly recognized as a result of recent technical advances in abdominal imaging modalities as well as their widespread use. In addition, management of benign hepatobiliary lesions has evolved sufficiently over the past decade to warrant an update. Many benign liver lesions are an incidental finding in patients with no specific symptoms and it is in the first place crucial to establish the correct diagnosis as the natural history of these tumors varies widely. However, in patients who are evaluated because of upper abdominal complaints, another difficulty is to make sure that the benign liver tumor and not an associated condition is indeed responsible for the symptoms. This is particularly true for biliary cysts and liver hemangiomas which are the most frequent and the least symptomatic of these tumors. Overall, there is a bad correlation between a liver tumor and complaints and any benign tumor ! 3–5 cm is unlikely to be symptomatic. Although the list of possible benign lesions in the liver is long, only those lesions that currently generate discussion are dealt with in this issue. The most common benign liver lesions are hemangiomas and simple cysts. The diagnosis of hemangiomas is fairly straightforward Published online: April 1, 2010