Diagnosis and Management of Benign Liver Tumors

Benign liver tumors include a heterogeneous group of lesions from different cellular origins that are found incidentally. As the name suggests, these lesions have a "benign" clinical course. Contrast-enhanced (CE) abdominal imaging is used to differentiate and confirm the diagnosis of these lesions. Benign liver tumors can be classified as 1) epithelial lesions and 2) non-epithelial lesions. Epithelial lesions originating from hepatocytes or cholangiocytes include focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA). Hepatic hemangioma (HH) is a representative example of non-epithelial lesions originating from mesenchymal cells. HH is the most common primary liver tumor, affecting 0.4-20% of the general population. CE imaging reveals a characteristic pattern, with early peripheral nodular enhancement followed by centripetal filling in the delayed phase. FNH is the second most common benign liver tumor. The fibrous tissue within the central scar and radiating septa show distinct persistent enhancement on CE imaging. HCA is relatively rare and significantly associated with the long-term use of oral contraceptive pills, obesity, and metabolic syndrome. Despite its benign nature, spontaneous rupture or malignant transformation can occur. Most benign liver tumors do not require treatment, but oral contraceptive pills should be discontinued in patients with HCA. A surgical resection can be considered in some cases of HCA based on the risk of spontaneous rupture or malignant transformation.