Diagnosis and treatment of benign liver nodules: Brazilian Society of Hepatology (SBH) recommendations

• Published in: Arquivos de gastroenterologia Vol. 52 Suppl 1; no. suppl 1; pp. 47 - 54
• Main Authors: Strauss, Edna, Ferreira, Adalgisa de Souza Paiva, França, Alex Vianey Callado, Lyra, Andre Castro, Barros, Fabio Marinho do Rego, Silva, Ivonete, Garcia, José Huygens Parente, Parise, Edison Roberto
• Format: Journal Article
• Language: English
• Published: Brazil Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia e Outras Especialidades - IBEPEGE 01-12-2015; Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia (IBEPEGE)
• Subjects: Adenoma hepatocelular; Adenoma, Liver Cell - diagnosis; Adenoma, Liver Cell - therapy; Brazil; Cistos hepáticos; Female; Focal Nodular Hyperplasia - diagnosis; Focal Nodular Hyperplasia - therapy; GASTROENTEROLOGY & HEPATOLOGY; Hemagioma; Hemangioma - diagnosis; Hemangioma - therapy; Hiperplasia nodular focal; Humans; Liver Neoplasms - diagnosis; Liver Neoplasms - therapy; Pregnancy; Societies, Medical; Brazil; Hemagioma; Hemangioma; Hepatocellular adenoma; Hepatic cysts; Adenoma hepatocelular; Hiperplasia nodular focal; Cistos hepáticos; Focal nodular hyperplasia
• ISSN: 0004-2803; 1678-4219; 1678-4219; 0004-2803
• DOI: 10.1590/s0004-28032015000500003

Space-occupying lesions of the liver may be cystic or solid. Ultrasonography is an extremely useful method for initial screening, and suffices for diagnosis of simple hepatic cysts. Complex cysts and solid masses require computed tomography or magnetic resonance imaging for confirmation. Wide surgical excision is indicated in cystadenoma or cystadenocarcinoma. Clinical and epidemiological data are important, as nodules in noncirrhotic livers are more likely to be benign. Hemangiomas, the most common benign tumors, require no follow-up after diagnostic confirmation if they are small and asymptomatic. Patients with giant, symptomatic hemangiomas or compression of adjacent structures should be referred to hepatobiliary centers for potential surgery. The genetic heterogeneity of hepatocellular adenomas and their epidemiology and prognosis prompted classification of these tumors into four subtypes based on histology and immunohistochemistry. The major complications of hepatocellular adenomas are rupture with bleeding and malignant transformation. Rupture occurs in approximately 30% of cases. The main risk factors are tumors size >5 cm and inflammatory subtype. Hepatocellular adenomas may enlarge during pregnancy due to marked hormonal stimulation. As oral contraceptive pills and anabolic steroids have associated with hepatocellular adenomas growth, particularly of the hepatocyte nuclear factor-1alfa subtype, these drugs should be discontinued. Focal nodular hyperplasia is the second most common benign tumor of the liver. It is most frequent in women aged 20 to 60, and 70% to 90% of cases are asymptomatic. In the absence of a central scar and/or other hallmarks of Focal nodular hyperplasia, with uncertainty between this diagnosis and hepatocellular adenoma, liver-specific contrast agents are indicated.