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Hepatic incidentaloma: a modern problem.

J M Little1, J Kenny, M J Hollands

  • 1Department of Surgery, Westmead Hospital, New South Wales, Australia.

World Journal of Surgery
|July 1, 1990
PubMed
Summary
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Hepatic incidentalomas, unexpected liver lesions found via imaging, are often benign. A structured investigation approach can help diagnose these liver findings, reducing hospital admissions.

Area of Science:

  • Hepatology
  • Diagnostic Imaging
  • Oncology

Background:

  • The increasing reliance on organ imaging has led to the identification of hepatic incidentalomas, defined as unexpected solid liver lesions in asymptomatic patients.
  • These findings represent a growing clinical challenge in differentiating benign from malignant conditions.

Purpose of the Study:

  • To analyze the nature of hepatic incidentalomas.
  • To evaluate clinical and biochemical predictors of malignancy.
  • To propose an investigational strategy for managing these liver lesions.

Main Methods:

  • Retrospective review of 36 cases of hepatic incidentalomas over 36 months.
  • Analysis of patient demographics, clinical signs, laboratory results (including serum alkaline phosphatase), and imaging findings.
Keywords:
AustraliaContraceptionContraceptive Methods--side effectsDeveloped CountriesDiseasesExaminations And DiagnosesFamily PlanningLiver NeoplasmsNeoplasmsOceaniaOral Contraceptives--side effectsPhysical Examinations And DiagnosesUltrasonics

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  • Correlation of findings with histopathological diagnoses where available.

    • Main Results:

    • Of 36 hepatic incidentalomas, 81% were benign (67% nonneoplastic, 14% benign tumors) and 19% were malignant (14% secondary, 5% primary liver tumors).
    • Hepatic hemangioma was the most frequent benign diagnosis (56%).
    • Physical signs of liver mass and elevated serum alkaline phosphatase (SAP) were associated with malignancy.

    Conclusions:

    • Hepatic incidentalomas are predominantly benign, with hemangiomas being the most common.
    • Clinical presentation and elevated SAP can suggest malignancy.
    • A proposed diagnostic pathway aims to manage approximately half of these cases non-operatively, while others require hospitalization for further investigation like angiography and biopsy.