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.

Outlines

00:00

🏥 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.

05:00

🛑 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.

Keywords

💡Benign tumors

Benign tumors are non-cancerous growths that do not invade neighboring tissues or organs. They are characterized by their slow growth and lack of metastasis. In the context of the video, benign liver tumors are the main focus, and they are usually not life-threatening, unlike malignant tumors.

💡Cavernous hemangiomas

Cavernous hemangiomas are the most common type of benign liver tumor. They are masses of endothelial cells within the blood vessels of the liver that form large vascular spaces, resembling a system of caves. These tumors are typically asymptomatic unless they grow large enough to cause complications, as mentioned in the script.

💡Focal nodular hyperplasias (FNH)

FNH refers to localized aggregates of rapidly reproducing liver cells, which are the most common non-blood vessel related benign liver tumors. They are thought to be a response to vascular injury, leading to an increase in hepatocyte reproduction. The script explains that FNH often has an abnormally large blood vessel in the center and a characteristic fibrous scar tissue, which supports the vascular injury hypothesis.

💡Hepatocellular adenomas

Hepatocellular adenomas are rarer benign liver tumors thought to be composed of liver epithelial cells. They are often associated with the use of estrogen-based drugs, such as oral contraceptives, and can lead to complications like rupture and internal bleeding, especially during pregnancy. The script mentions that managing the use of these drugs or conditions like glycogen storage diseases can lead to the regression of these adenomas.

💡Endothelial cells

Endothelial cells line the interior surface of blood vessels and lymphatic vessels. In the context of cavernous hemangiomas, these cells form masses that create large vascular spaces within the liver, which is a key characteristic of this type of benign tumor.

💡Vascular injury

Vascular injury is suggested as a possible cause for the formation of focal nodular hyperplasias and hepatocellular adenomas. It is thought that damage to blood vessels might trigger an abnormal response in hepatocytes, leading to the formation of these benign tumors.

💡Estrogen-based drugs

Estrogen-based drugs, particularly oral contraceptives, are highlighted in the script as a significant risk factor for the development of hepatocellular adenomas. The script suggests that the use of these drugs has led to an increase in the incidence of these tumors and that managing their use can help in the treatment.

💡Glycogen storage diseases

Glycogen storage diseases, such as von Gierke's disease, are mentioned in the script as being highly associated with hepatic adenomas. These diseases affect the liver's ability to metabolize glycogen, and the script implies a link between this metabolic dysfunction and the development of adenomas.

💡Imaging techniques

Imaging techniques such as ultrasound, CT scans, and MRI are used for diagnosing benign liver tumors. The script notes that these methods are essential for identifying and monitoring the size and characteristics of tumors like cavernous hemangiomas and focal nodular hyperplasias.

💡Rupture

Rupture refers to the tearing or breaking of a tumor, which can lead to internal bleeding. The script mentions that hepatic adenomas are more likely to rupture, especially during pregnancy, and this can be a serious complication.

💡Incidental findings

Incidental findings are discoveries made during medical examinations that were not prompted by symptoms or clinical concerns related to the finding itself. The script notes that focal nodular hyperplasias are often found incidentally, meaning they are discovered unexpectedly during other exams.

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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