Liver Masses: A Clinical, Radiologic, and Pathologic Perspective

Abstract

Liver masses present a relatively common clinical dilemma, particularly with the increasing use of various imaging modalities in the diagnosis of abdominal and other symptoms. The accurate and reliable determination of the nature of the liver mass is critical, not only to reassure individuals with benign lesions but also, and perhaps more importantly, to ensure that malignant lesions are diagnosed correctly. This avoids the devastating consequences of missed diagnosis and the delayed treatment of malignancy or the unnecessary treatment of benign lesions With appropriate interpretation of the clinical history and physical examination, and the judicious use of laboratory and imaging studies, the majority of liver masses can be characterized noninvasively. Accurate characterization of liver masses by cross-sectional imaging is particularly dependent on an understanding of the unique phasic vascular perfusion of the liver and the characteristic behaviors of different lesions during multiphasic contrast imaging. When non-invasive characterization is indeterminate, a liver biopsy may be necessary for definitive diagnosis. Standard histologic examination is usually complemented by immunohistochemical analysis of protein biomarkers. Accurate diagnosis allows the appropriate selection of optimal management, which is frequently reassurance or intermittent follow up for benign masses. For malignant lesions or those at risk of malignant transformation, management depends on the tumor staging, the functional status of the uninvolved liver and technical surgical considerations. Unresectable metastatic masses require oncologic consultation and therapy. The efficient characterization and management of liver masses therefore requires a multidisciplinary collaboration between the gastroenterologist/hepatologist, radiologist, pathologist, hepatobiliary or transplant surgeon, and medical oncologist.

MR elastography of hepatocellular carcinoma: Correlation of tumor stiffness with histopathology features—Preliminary findings

“…However, HCC is a unique malignancy in that it does not require histologic confirmation but rather is primarily diagnosed by cross-sectional imaging [11–13]. As such, imaging biomarkers may provide important surrogate HCC tumor biologic, pathologic and ultimately prognostic information for patient stratification in clinical trials and clinical practice [14].…”

Liver elastography malignancy prediction score for noninvasive characterization of focal liver lesions

“…Focal liver lesions (FLL) are a common finding on ultrasound (US) examination, and the discrimination between benign and malignant nature can be extremely challenging in patients with chronic liver disease and subjects with history of malignancy, and sometimes in individuals previously considered healthy. [1][2][3][4] Doppler and contrast-enhanced ultrasound help in the characterisation of FLL. [5][6][7][8][9] Nonetheless, a proportion of up to 30%-40% remain undetermined, so requiring cross-sectional imaging assessment and/or biopsy.…”

Pseudotumor inflamatorio por Fasciola hepática: a propósito de un caso

“…Por ello, se realizó una biopsia percutánea guiada por ecografía, cuyo hallazgo más relevante fue la presencia de un infiltrado inflamatorio con gran eosinofilia. Esto permitió el descarte de diagnósticos diferenciales de una masa hepática sólida como: hemangioma cavernoso, hiperplasia nodular focal, adenoma hepático, traumatismo, absceso hepático y hepatocarcinoma 8 . El hemangioma cavernoso es la lesión hepática benigna más común, predominante en mujeres y que cursan en forma asintomática.…”

“…Tampoco había antecedentes de algún traumatismo abdominal. El hepatocarcinoma se descartó debido a que no se encontraron hallazgos histológicos sugerentes como: nódulos displásicos con aumento de la vascularización arterial o pérdida de la fuente de sangre venosa portal, entre otros 8 . Por último, el cuadro clínico y la serología para hepatitis B y C fueron negativos.…”