Via practica 12/2009

The commonest liver tumors in clinical practice of general practitioner

Hemangiomas are the commonest benign liver tumors of the liver. They are discovered incidentally during liver ultrasound examination or computed tomography. Symptomatic hemangiomas and their fast enlargement are indication for surgical treatment. Focal nodular hyperplasia (FNH) accounts for the second most common benign liver process, after hemangioma. FNH remains asymptomatic and are discovered incidentally during liver ultrasound examination. Resection is clearly indicated in patients with large symptomatic FNH located in the left liver and in those with pedunculated lesion. Hepatocellular adenoma (HA) is a benign liver neoplasm occurring more frequently in young women taking oral contraceptive. The vast majorities of FNH are asymptomatic and are discovered incidentally during liver ultrasound examination. The risk for developing HA increases with the duration of oral contraceptive and with their estrogen contents. The risk of HA includes hemorrhage and malignant transformation and surgical resection, including liver transplantation in some patients with multiple HA, is therefore advocated for treatment and prevention of these complications. Malignant liver tumors are on the 3rd place in the global mortality between all malignant tumors. Important risk factors for development of hepatocellular carcinoma (HCC) are chronic hepatitis B, chronic hepatitis C, alcohol and aflatoxin (tropic regions of Asia and Africa). The diagnosis of HCC is made on behalf of ultrasound examination, computed tomography, magnetic resonance and high concentration of AFP. The only curative therapeutic modality is chirurgic treatment: surgical resection and transplantation. Other therapeutic modalities are percutaneous ablation, mainly radiofrequency and percutaneous ethanol injection, transcatheter arterial embolisation and chemoembolisation with lipiodol, regional and systemic chemotherapy.

Keywords: hemangioma, focal nodular hyperplasia (FNH), hepatocellular adenoma (HA), hepatocellular carcinoma (HCC), abdominal ultrasonography of the liver (USG), computed tomography (CT), nuclear magnetic resonance (NMR), alfa-phetoprotein (AFP).