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Benign liver tumors are relatively common. Most are asymptomatic, but some cause hepatomegaly, right upper quadrant discomfort, or intraperitoneal hemorrhage. Most are detected incidentally on ultrasound or other scans. Liver function tests are usually normal or only slightly abnormal. Diagnosis is usually possible with imaging tests but may require biopsy. Treatment is needed only in a few specific circumstances.

Hepatocellular adenoma: Hepatocellular adenoma is the most important benign tumor to recognize. It occurs primarily in women of childbearing age, particularly those taking oral contraceptives, possibly via estrogen's effects. Most adenomas are asymptomatic, but large ones may cause right upper quadrant discomfort. Rarely, adenomas manifest as peritonitis and shock due to rupture and intraperitoneal hemorrhage. Rarely, they become malignant.

Diagnosis is often suspected based on ultrasound or CT results, but biopsy is sometimes needed for confirmation.

Adenomas due to contraceptive use often regress if the contraceptive is stopped. If the adenoma does not regress or if it is subcapsular or > 5 cm, surgical resection is often recommended.

Focal nodular hyperplasia: This localized hamartoma may resemble macronodular cirrhosis histologically. Diagnosis is usually based on MRI or CT with contrast, but biopsy may be necessary. Treatment is rarely needed.

Hemangiomas: Hemangiomas are usually small and asymptomatic; they occur in 1 to 5% of adults. These tumors often have a characteristic highly vascular appearance. Rupture is rare, even when tumors are large. Hemangiomas are found incidentally during ultrasonography, CT, or MRI. Treatment is usually not indicated.

In infants, hemangiomas often regress spontaneously by age 2 yr. However, large hemangiomas occasionally cause arteriovenous shunting sufficient to cause heart failure and sometimes consumption coagulopathy. In these cases, treatment may include high-dose corticosteroids, sometimes diuretics and digoxin Some Trade Names
DIGITEK
LANOXIN
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to improve heart function, interferon-α (given sc), surgical removal, selective hepatic artery embolization, and, rarely, liver transplantation.

Other benign tumors: Lipomas (usually asymptomatic) and localized fibrous tumors (eg, fibromas) rarely occur in the liver.

Benign bile duct adenomas are rare, inconsequential, and usually detected incidentally. They are sometimes mistaken for metastatic cancer.

Last full review/revision September 2007 by Steven K. Herrine, MD

Content last modified September 2007