Benign liver tumors - causes, symptoms, diagnosis, treatment & pathology
Summary
TLDRThis script discusses benign liver tumors, which are non-cancerous and typically harmless. It covers three main types: cavernous hemangiomas, focal nodular hyperplasias, and hepatic adenomas. Cavernous hemangiomas are common vascular masses, while FNH and hepatic adenomas are less common, with the latter often linked to estrogen-based drugs and glycogen storage diseases. Diagnosis involves imaging techniques, and most are left untreated unless symptomatic.
Takeaways
- 🔍 Benign tumors are non-cancerous cell masses that do not invade neighboring tissues or organs.
- 💊 Benign liver tumors are common and typically do not cause serious complications.
- 📈 There are three major types of benign liver tumors: cavernous hemangiomas, focal nodular hyperplasias (FNH), and hepatic adenomas.
- 🏥 Cavernous hemangiomas are the most common, appearing as large vascular spaces lined by endothelial cells within the liver's blood vessels.
- 🔬 Most patients with hemangiomas have small lesions under 1.5 cm and usually remain asymptomatic.
- 🚨 Larger hemangiomas can cause symptoms and, in rare cases, rupture leading to internal bleeding.
- 📊 Diagnosis of hemangiomas can be done through imaging techniques like ultrasound, CT scans, and MRI.
- 🌐 Focal nodular hyperplasias (FNH) are the most common non-blood vessel related benign liver tumors, often found incidentally.
- 🤔 The cause of FNH is unknown but is thought to be a response to vascular injury, with a characteristic central fibrous scar.
- 🚫 Hepatic adenomas are rarer tumors associated with the use of estrogen-based drugs and glycogen storage diseases.
- 👩⚕️ Hepatic adenomas are more likely to rupture and cause internal bleeding, especially during pregnancy.
- 🛑 Management of adenomas may involve adjusting estrogen-based drug use or managing underlying conditions like Von Gierke disease.
Q & A
What are benign tumors and why are they considered non-cancerous?
-Benign tumors are masses of cells that do not invade neighboring tissues or organs, which is why they are typically defined as non-cancerous. They do not have the ability to metastasize or spread to other parts of the body like cancer does.
How common are benign liver tumors and what are their general effects on health?
-Benign liver tumors are quite common and usually do not cause serious complications. They are generally non-cancerous and may not even be noticed unless they grow large enough to cause symptoms or are detected incidentally during other medical examinations.
What are the three major types of benign liver tumors mentioned in the script?
-The three major types of benign liver tumors mentioned are cavernous hemangiomas, focal nodular hyperplasias (FNH), and hepatic adenomas.
What are cavernous hemangiomas and how do they appear on histology?
-Cavernous hemangiomas are masses or swelling of the endothelial cells in the blood vessels of the liver. On histology, they form large vascular spaces that resemble a system of caves, with blood flowing into a large cavern instead of a tube, and endothelial cells scattered throughout.
How are cavernous hemangiomas typically diagnosed?
-Cavernous hemangiomas can be diagnosed through various imaging techniques such as ultrasound, CT scans, and MRI, which allow doctors to visualize the vascular spaces within the liver.
What is focal nodular hyperplasia (FNH) and what makes it different from other benign liver tumors?
-Focal nodular hyperplasia (FNH) is a localized aggregate of rapidly reproducing liver cells. It is the most common non-blood vessel related benign tumor in the liver and is thought to be a response to vascular injury, often featuring an abnormally large blood vessel in the center with smaller branches radiating out.
How is the presence of a fibrous scar in FNH related to the theory of vascular injury?
-The presence of a centralized fibrous scar in FNH supports the vascular injury hypothesis because it suggests that the rapid reproduction of hepatocytes could be a response to an injury that leads to the formation of this scar tissue.
What are hepatic adenomas and what are some factors associated with their development?
-Hepatic adenomas are tumors thought to be made up of liver epithelial cells that often develop in an otherwise healthy liver. They are associated with the use of estrogen-based drugs, such as oral contraceptives, and genetic predisposition or specific genetic mutations.
Why are hepatic adenomas more likely to rupture and cause internal bleeding compared to other benign liver tumors?
-Hepatic adenomas are more likely to rupture and cause internal bleeding due to their composition and structure, which may be more susceptible to such complications, especially during pregnancy or in the presence of certain medical conditions.
How do glycogen storage diseases, particularly von Gierke's disease, relate to the development of hepatic adenomas?
-Glycogen storage diseases, such as von Gierke's disease, are highly associated with hepatic adenomas. Patients with these diseases have liver cells that cannot generate glucose from glycogen, which may somehow predispose them to the development of hepatic adenomas, although the exact mechanism is not clear.
What changes can be observed in hepatic adenomas when patients stop or reduce the dosage of oral contraceptives?
-When patients with hepatic adenomas stop or reduce their dosage of oral contraceptives, the adenomas usually tend to regress, indicating that the hormones in these medications may play a role in their development or maintenance.
Outlines
🏥 Benign Liver Tumors: Types and Characteristics
This paragraph discusses benign liver tumors, which are non-cancerous masses that do not invade surrounding tissues. It explains that these tumors are common and typically asymptomatic. Three main types are highlighted: cavernous hemangiomas, focal nodular hyperplasias (FNH), and hepatic adenomas. Cavernous hemangiomas are the most common, characterized by endothelial cell swellings in liver blood vessels, often appearing as large vascular spaces on histology. FNH, the most common non-blood vessel related benign tumor, is thought to be a response to vascular injury and is typically diagnosed incidentally. Hepatic adenomas, rarer tumors composed of liver epithelial cells, are associated with estrogen-based drugs and glycogen storage diseases, and have a higher risk of rupture and internal bleeding, especially during pregnancy.
🛑 Management and Regression of Hepatic Adenomas
The second paragraph focuses on the management and potential regression of hepatic adenomas. It mentions that changes in medication, particularly the reduction or cessation of estrogen-based oral contraceptives, can lead to the regression of these tumors. Additionally, for patients with Von Gierke disease, managing diet and hormone levels such as glucose, insulin, and glucagon has resulted in improvements and even the resolution of adenomas. The paragraph underscores the importance of understanding and managing these conditions to support the health of affected individuals.
Mindmap
Keywords
💡Benign tumors
💡Cavernous hemangiomas
💡Focal nodular hyperplasias (FNH)
💡Hepatocellular adenomas
💡Endothelial cells
💡Vascular injury
💡Estrogen-based drugs
💡Glycogen storage diseases
💡Imaging techniques
💡Rupture
💡Incidental findings
Highlights
Benign tumors are non-cancerous masses of cells that do not invade neighboring tissues or organs.
Benign liver tumors are common and typically do not cause serious complications.
There are three major types of benign liver tumors: cavernous hemangiomas, focal nodular hyperplasias, and hepatocellular adenomas.
Cavernous hemangiomas are the most common form of benign liver tumor, characterized by masses of endothelial cells in liver blood vessels.
Cavernous hemangiomas appear as large vascular spaces resembling a system of caves on histology.
Most patients with cavernous hemangiomas have small lesions under 1.5 cm and usually do not exhibit symptoms.
In rare cases, larger lesions of cavernous hemangiomas can cause symptoms or rupture, leading to internal bleeding.
Diagnosis of cavernous hemangiomas can be done through imaging techniques such as ultrasound, CT scans, and MRI.
Focal nodular hyperplasia (FNH) is the most common non-blood vessel related benign liver tumor, seen more in women.
FNH is thought to be a response to vascular injury, leading to rapid reproduction of hepatocytes.
CT scans are used to diagnose FNH, looking for masses of cells with a characteristic large blood vessel in the center.
FNH is often found incidentally and is typically left alone unless associated with pain.
Hepatic adenomas are rarer benign liver tumors composed of liver epithelial cells, often enlarged and nonfunctional.
Hepatic adenomas are highly associated with the use of estrogen-based drugs, such as oral contraceptives.
The development of hepatic adenomas may be influenced by estrogen binding to hepatocytes, though the exact mechanism is unclear.
Genetic predisposition and glycogen storage diseases, like von Gierke's disease, are also associated with hepatic adenomas.
Hepatic adenomas are more likely to rupture and cause internal bleeding, especially during pregnancy.
Management of hepatic adenomas includes adjusting estrogen-based drug dosages and managing diet in cases of von Gierke's disease.
Transcripts
benign tumors are masses of cells that
can't invade neighboring tissues or
organs and therefore are usually defined
as
non-cancerous benign liver tumors are
actually pretty common and typically
don't cause any serious complications
and there are three major types
cavernous hemangiomas focal nodular
hyperplasias and hepatocellular
adenomas cavernous homas are the most
common form and are these masses or
swelling of the endothelial cells in the
blood vessels of the liver that when we
check it out on histology they form
these huge vascular spaces that sort of
look like a system of caves in other
words instead of blood flowing through a
tube the blood goes into a giant Cavern
with endothelial cells randomly
sprinkled
throughout although these vascular
spaces look huge on histology most
patients have relatively small lesions
usually about less than 1.5 cm
and therefore they don't have any
symptoms in more rare cases with larger
lesions patients might develop symptoms
and in very rare cases experience
rupture and intop peronal
bleeding finding and diagnosing these
homas can be done through several
Imaging techniques like ultrasound CT
scans and
MRI the second most common type of
benign liver tumor is a focal nodular
hyperplasia or
fnh and these are like these localized
Aggregates of rapidly reproducing liver
cells fnh is actually the most common
non-blood vessel related benign tumor in
the liver and are seen slightly more in
women than in men but can happen at any
age basically this is a Loosely used
term to describe when nodules or these
aggregations of seemingly benign
hepatocytes are found in the liver
ultimately we don't really know why
these form but it's thought that they
could be a response to vascular injury
of some kind
that leads the hepatocytes to ramp up
reproduction and form these Aggregates
of
cells another reason it's thought to be
a result of vascular injury is that
there's almost always an abnormally
large blood vessel in the center with
smaller branches radiating out into the
periphery and further supporting this
vascular injury hypothesis is that
there's almost always a characteristic
gross finding of a centralized fibrous
Scar Tissue produced by stellate cells
on Esty often find this fibrous tissue
as well sometimes called fibrous sep
which means wall or
separation diagnosis is usually done by
a CT scan where you look for these
masses of cells in almost all cases
though focal nodular hyperplasias are
found incidentally during some other
exam unless associated with pain these
benign tumors are typically left alone
though all right another type of benign
hepatite tumor one that's a lot more
rare is a hepatic
adenoma these are tumors thought to be
made up of liver epithelial cells and
often develop in an otherwise healthy
liver usually these hepatocytes are
enlarged nonfunctional and contain more
glycogen and lipids than normal the
tisue around them is usually highly
vascularized and both bile ducts and
portal areas are absent again just like
focal nodular hyperplasias we don't
really know why they form but one
important distinction is that these are
highly highly associated with the use of
estrogen-based drugs especially oral
contraceptives but also other anabolic
steroids before the introduction of
birth control or oral contraceptives
ocps for short hepatic adenomas were
rarely reported and have increased along
with increasing ocp use over time and
are associated more with higher dose
regimens and the introduction of lower
do ocps has resulted in a reduction in
cases
that being said how the estrogen
influences the development of hepatic
adenomas is unclear one theory is that
the estrogen might bind to estrogen
receptors on the hepatocytes themselves
and cause conversion of these
hepatocytes into hepatic adenoma cells
though it probably has a lot to do with
genetic predisposition or specific
genetic mutations in combination with
estrogen-based
therapies along with ocps genetic
glycogen storage diseases particularly
vonis disease are also highly associated
with hepatic adenomas patients with
vonis disease have liver cells that
can't generate glucose from glycogen
what isn't clear is why or how this
deficiency tends to lead to hepatic
adenomas although less common than the
other forms of benign tumors hepatic
adenomas are more likely to rupture and
lead to internal bleeding especially
during pregnancy if patients with
adenomas are using ocps and stop or
reduce their dosage the Omas usually
tend to
regress likewise for patients with Von's
disease managing their diet like their
glucose insulin and glucagon levels has
led to Improvement and even seen
resolution of these
adenomas helping current and future
clinicians Focus learn retain and Thrive
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