Benign liver tumors - causes, symptoms, diagnosis, treatment & pathology

Summary

This 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.