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A practical diagnostic approach to hepatic masses.

Monika Vyas1, Dhanpat Jain1

  • 1Department of Pathology, Yale School of Medicine, New Haven, CT, USA.

Indian Journal of Pathology & Microbiology
|March 24, 2018
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Summary

Diagnosing liver masses in adults requires a systematic approach. This review outlines differential diagnoses and an algorithmic strategy using clinicopathological correlation and immunohistochemical markers for accurate identification.

Keywords:
Adenomacarcinomacholangiocarcinomahepatocellular

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Area of Science:

  • Pathology
  • Hepatology
  • Oncology

Background:

  • Differential diagnosis of hepatic mass lesions is broad and challenging, particularly on needle biopsies.
  • Liver tumors in adults differ from those in children and depend on patient factors like age, gender, and liver disease.
  • Hepatic lesions are categorized as primary (hepatocellular or nonhepatocellular origin) or metastatic.

Purpose of the Study:

  • To outline the differential diagnosis of hepatic masses in adults.
  • To discuss an algorithmic approach for accurate diagnosis of liver lesions.
  • To highlight the role of clinicopathological correlation and immunohistochemical markers.

Main Methods:

  • Review of literature on hepatic mass differential diagnosis in adults.
  • Categorization of primary liver lesions into hepatocellular and nonhepatocellular origins.
  • Emphasis on systematic approach integrating histology, imaging, clinical presentation, and immunohistochemistry.

Main Results:

  • Hepatocellular lesions include dysplastic nodules, focal nodular hyperplasia, hepatic adenoma, and hepatocellular carcinoma.
  • Metastatic liver lesions are common and may present with an unknown primary.
  • Immunohistochemical markers are crucial for differentiating challenging cases.

Conclusions:

  • Accurate diagnosis of adult hepatic masses requires a systematic approach combining clinical, imaging, and histopathological data.
  • Immunohistochemistry plays a vital role in refining the diagnosis of liver lesions.
  • An algorithmic strategy aids pathologists in navigating the complex differential diagnosis of hepatic masses.