Home > Benign Liver Tumors: Hepatic Adenoma, Liver Cysts, Hemangiomas

Benign Liver Tumors: Hepatic Adenoma, Liver Cysts, Hemangiomas

Symptomatic centrally located hemangioma extending in to portal hilum.

What are Benign Liver Tumors?

These are non-cancerous masses or lesions within the liver.
Benign tumors of the liver affect nearly 20% of the population in the United States. Benign lesions of the liver are correspondingly increasing as the use of diagnostic imaging increases. The major benign lesions include cystic tumors such as simple cysts, cystadenomas and echinococcal cysts. Major benign solid lesions include hepatic adenomas, focal nodular hyperplasia and hemangiomas.

Hepatic Adenoma

Hepatic adenomas (HA) occur mostly in 20-40 year-old premenopausal women on oral contraceptives. These lesions have a 25% risk of rupturing and bleeding, and patients commonly present with abdominal pain. The association with oral contraceptives was established in the 70’s and it has become well known that HA are associated with estrogen and progesterone.

Understandably, HA have a tendency to grow and rupture during pregnancy, and the risks to the mother and fetus are extremely high. Surgical resection is the rule for HA because of the risks of rupture, bleeding and malignant transformation. Although there have been anecdotal reports of complete resolution of small HA following the cessation of oral contraceptives, resection is still the recommended.

22 cm LiverCyst- Although this was removed via open surgery because of other concomitant pathology- most of these are now removed laparoscopically by our surgical team.

Liver Cysts

Asymptomatic simple cysts may be followed routinely. Surgical treatment is recommended for cysts that are symptomatic. Percutaneous aspiration has a 100% recurrence rate and is performed only to secure a diagnosis or as a therapeutic test. The current recommended therapy is laparoscopic unroofing of the cyst.

Cystadenomas are most commonly found in the liver parenchyma and less often in the extrahepatic biliary ducts. The pathogenesis is unclear, and may be congenital in origin from abnormal bile ducts or from aberrant germ cells. The disease tends to occur in females 30-50 years old. These cystic tumors are often large and symptomatic, causing abdominal pain or presentation with an abdominal mass. Ten percent of cystadenomas are malignant and there is a 25% chance of malignant degeneration. Diagnosis is usually made on an ultrasound and/ or a CT scan and appear as multiloculated cystic lesions with papillary projections. Cystadenomas carry the risk of malignant degeneration, enlargement and infection and should undergo complete resection.

What is a Liver Resection?

Liver resection is “resecting or removing a portion of the liver”. This can often range from being a straight forward wedge resection to fairly complex resections where the whole lobe of the liver needs to be removed. The illustration enumerates the various types of resections that are commonly done. The key is to remove the tumor and yet be able to leave behind enough functional liver. Usually 30-40% volume of liver left behind is considered sufficient volume. The Liver is one of the few organs in the body that regenerates back to almost 100% in volume in approximately 3 months. This allows for the liver to return to complete function, and also allows for repeated resections if deemed necessary in cases of recurrence.

Can liver resections be done laparoscopically?

Yes. A good number of these cases can be done using the minimally invasive techniques, i.e. by making very small incisions (5- 10 mm) for introducing instruments to allow dissection. However it is important to note that not all cases lend themselves to a laparoscopic resection and that decisions have to be made on a case by case basis. Dr. Singh, is one of the few surgeons in the United States doing these major liver surgeries laparoscopically and was invited to speak at the 93rd Annual Clinical Congress of the American College of Surgeons on Laparoscopic Liver Resections.

Can liver resections be done using Robotic Technology?

Yes. Robotic technology offers all the advantages of minimally invasive surgery without the technical challenges of a conventional laparoscopic approach. Plus, robotic technology shows the surgical field in 3-D, which allows greater precision than the 2-D laparoscopic view. Once again, decisions are made on a on a case by case basis upon reviewing the scans and making sure we are not compromising on the quality of the cancer operation. At the Liver and Pancreas Center, we are using the Da Vinci Robotic Surgical System to perform these surgeries.