Liver mass overview
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American Roentgen Ray Society Images of Liver mass overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]
Overview
Liver mass (also known as "hepatic mass") is generally defined as the neoplastic growth of tissue in the liver. Abnormal growths found in the liver can be benign or malignant. Liver mass may be classified according to imaging features (hyperechoic vs. hypoechoic), histopathological origin (benign vs. malignant), and distribution (single/focal/solitary vs. multiple).[1] The most common cause of a liver mass is liver cancer. Common causes of benign liver mass, include: hepatic hemangioma, focal nodular hyperplasia, hepatic adenoma, idiopathic noncirrhotic portal hypertension (including nodular regenerative hyperplasia, regenerative nodules. Conversely, common causes malignant liver masses, include: hepatocellular carcinoma, cholangiocarcinoma, metastatic disease. "Primary liver tumors", which originate in the liver or from hepatic-derived cells and tissues, and "secondary tumors" which originate in other sites and metastasize to the liver.
Classification
Liver mass may be classified according to imaging features (hyperechoic vs. hypoechoic), histopathological origin (benign vs. malignant), and distribution (single/focal/solitary vs. multiple).[1]
Causes
The most common cause of a liver mass is hepatocellular carcinoma. Common causes of benign liver mass, include: hepatic hemangioma, focal nodular hyperplasia, hepatic adenoma, idiopathic non-cirrhotic portal hypertension, nodular regenerative hyperplasia, regenerative nodules. Common causes malignant liver masses, include: hepatocellular carcinoma, cholangiocarcinoma, metastatic disease
Differentiating Liver Mass from Other Diseases
Liver mass may be differentiated according to clinical features, laboratory findings, imaging features, histological features, and genetic studies, from other diseases that cause abdominal pain, pruritus, low-grade fever, and ascities. Common differential diagnosis includes: liver abscess, simple liver cyst, and fungal infections.
Epidemiology and Demographics
Liver masses are common. The annual incidence rate of malignant liver mass is approximately 6 per 100,000 individuals in the United States. The incidence rate of liver mass increases with age; The median age at diagnosis varies widely between 5 to 60 years. Females are more commonly affected with benign liver masses than males. The female to male ratio is approximately 2.3 to 1. However, males are more commonly affected with malignant liver masses than females. The male to female ratio is approximately 3 to 1. The incidence of malignant liver mass varies widely according to the ethnicity and geographic location.
Screening
According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for liver mass.[2]
Diagnosis
Evaluation of Liver Mass
A hallmark feature in the evaluation of liver mass is the malignancy assessment. The evaluation approach of liver mass will mainly depend in the initial morphological evaluation of the mass (size, margins, contours, imaging pattern, and growth). Other characteristics, such as: location, clinical features, and distribution may be helpful for the therapeutical management, surveillance, and follow-up of liver mass. Liver mass can be divided into 2 categories: benign liver mass and malignant liver mass. Based upon these categories, complementary diagnostic studies and management, include: PET/CT scan, CT scan, non-surgical biopsy, and surgical resection.
Staging
According to the American Joint Committee on Cancer (AJCC) staging system, there are 4 stages of malignant liver mass, based on 3 factors: tumor size, lymph node invasion, and metastasis. Each stage is assigned a letter and a number that designate T for tumor size, N for node invasion, and M for metastasis.
History and Symptoms
The hallmark symptoms of liver mass, include: right upper quadrant abdominal pain, pruritus, and unintentional weight loss. However, in some cases, liver masses may be asymptomatic. A positive history of chronic hepatitis, cirrhosis, nonalcoholic fatty liver disease, prolonged contraceptive use, and alcohol abuse may be suggestive of a liver mass. Symptoms related with liver mass will vary depending on the size and location of the tumor. For instance, compression symptoms from left lobe lesions, such as early satiety. Other symptoms of liver mass may also include: loss of appetite, fatigue, nausea, and vomiting.[3][4]
Physical Examination
Physical examination findings of liver mass will depend on location and size of the tumor. Usually large liver tumors may cause pain and tenderness in palpation of the abdomen due to stretching of the liver capsule. On the other hand, liver masses with smaller size can present with no remarkable findings. Common physical examination of patients with liver mass, may include: janudice, hepatomegaly, abdominal tenderness, splenomegaly, abdominal wall vascular collaterals, and weight loss.
Laboratory Findings
Imaging
Chest X Ray
CT
MRI
Other Imaging Studies
Other Diagnostic Studies
Treatment
Therapeutic Management
Surgery
Prevention
References
- ↑ 1.0 1.1 Mergo PJ, Ros PR. Benign Lesions of the Liver. In: The Radiologic Clinics of North America, 2, W.B. Saunders, Philadelphia 1998. Vol 36, p.319.
- ↑ Recommendations. US preventive services task force(2015) http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=liver+mass Accessed on March, 24th 2016
- ↑ Roche SP, Kobos R (2004). "Jaundice in the adult patient". Am Fam Physician. 69 (2): 299–304. PMID 14765767.
- ↑ Bonder A, Afdhal N (2012). "Evaluation of liver lesions". Clin Liver Dis. 16 (2): 271–83. doi:10.1016/j.cld.2012.03.001. PMID 22541698.