Benign liver lesions
Liver Lesions
Liver lesions are abnormal growths in the liver. They are generally divided into 2 categories; malignant (cancerous) and benign (non-cancerous). This section will focus on benign liver lesions. For information on malignant (cancerous) lesions, please see the section titled ‘Liver Cancer / HCC’.
Benign Liver Lesions
Benign liver lesions are relatively common in the liver and usually do not have any symptoms (also known as ‘asymptomatic’). Some benign liver lesions require treatment, while others do not. The main types of benign liver lesions are;
1. Haemangioma
2. Focal nodular hyperplasia (FNH)
3. Hepatocellular adenoma
1. Haemangioma
A haemangioma is a common, usually benign, vascular lesion which is made from abnormal blood vessels. The most common form, is seen on the skin of infants and can be referred to as ‘strawberry marks’ as they can look similar to the surface of a strawberry. Haemangioma’s can vary in size, but usually measure less than 5cm. They are mostly seen on the skin and can be superficial or deep. However haemangiomas can also appear on the organs inside the body, most commonly on the liver, but also the airway, heart and brain could be affected.
Haemangiomas of the liver are the most common primary liver lesions. Haemangioma’s in the liver can be seen in all age groups and genders, but are more frequently diagnosed in women between 30-50 years of age. They are mostly small and solitary, but even when large most people do not experience any symptoms associated with it. They are usually picked up on imaging, like an ultrasound of your liver. If this is the case, further imaging with computed tomography (CT) or magnetic resonance imaging (MRI) scans may be needed to confirm the diagnosis. These scans give more detailed information about the tissue of specific organs, including the liver.
In most cases, haemangiomas in the liver do not require long term monitoring or treatment. In some rare circumstances, if the haemangioma is growing or causing symptoms, your case may be referred to a benign liver lesion multidisciplinary team for review. Possible interventions include (i) embolization, treatment to reduce the blood supply to the lesion reducing its size, or (ii) surgery, to remove it altogether. If you require any treatment for haemangioma in your liver, the specialist team will discuss this with you.
2. Focal Nodular Hyperplasia (FNH)
FNH accounts for the second most common type of benign liver lesion. FNH is more commonly seen in women than men. Their age at diagnosis is usually 35-50 years of age. It is usually a small lesion or mass measuring less than 5cm and occur as a single mass. However there is the possibility of having more than 1. FNH are usually stable in size and do not grow, they have no symptoms and complications are very rare.
Like haemangioma’s, FNH are usually picked up on liver imaging, like an ultrasound of your liver. The lesion typically has a central scar and this is used to help diagnose FNH. Further imaging with computed tomography (CT) or magnetic resonance imaging (MRI) scans may be needed to confirm the diagnosis. These scans give more detailed information about the tissue of specific organs, including the liver.
In most cases, FNH does not require long term monitoring or treatment. In some rare circumstances, if the FNH is causing symptoms, your case may be referred to a specialist benign liver lesion multidisciplinary team for review. Treatment is rare for FNH, but if required, surgery is the usual option. If you require any treatment for FNH, the specialist team will discuss this with you.
3. Hepatocellular Adenoma
Adenomas are non-cancerous tumours, which start in your glands and can affect a number of organs in your body. Hepatocellular adenomas are adenomas in the liver. They are much less common than the other benign liver lesions. They are more commonly seen in women than men and the age at diagnosis is usually 35-40 years of age. It is thought that hepatocellular adenomas are linked to exposure to certain hormones e.g. the oral contraceptive pill and anabolic substances related to sport. Hepatocellular adenomas are usually solitary and can vary in size. An MRI scan is required to fully assess a hepatocellular adenoma.
Of all the benign liver lesions, hepatocellular adenomas warrant the most clinical attention as they are at risk of bleeding (haemorrhage) and although rare, they are at risk of becoming cancerous (malignant). Due to the possible risks of rupture and cancer development associated with hepatocellular adenoma, the diagnosis, assessment and management plan for all hepatocellular adenomas should always involve a specialist benign liver lesion multidisciplinary team review. The management plan will be discussed with you and may involve lifestyle changes followed by a period of observation. If you require any treatment, surgery is the usual option and the specialist team will discuss this with you.