Liver Masses: A Clinical, Radiologic, and Pathologic Perspective

Sudhakar K. Venkatesh; Vishal Chandan; Lewis R. Roberts

Clin Gastroenterol Hepatol. 2014;12(9):1414-1429.

Endoscopic, Interventional Radiologic, and Molecular Pathologic Techniques for Evaluation of Liver Mass Lesions

Endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, and endoscopic ultrasonography allow access to detailed imaging of the biliary system and the hepatic hilum, pancreas, and associated lymph nodes. Ancillary techniques such as cholangioscopy, bile duct biopsy and brushing, lymph node sampling by fine-needle aspiration, and cytologic and fluorescence in situ hybridization examination of cells obtained from pancreatobiliary strictures or lymph nodes can further enhance the diagnostic armamentarium.^[23,24]

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Abstract and Introduction
Initial Clinical Evaluation
Radiologic Imaging Studies are Critical for Accurate Characterization of Liver Mass Lesions
Surveillance for Hepatocellular Carcinoma
The Use of Multiphasic Cross-sectional Imaging in the Evaluation of Liver Masses
Needle Biopsy, Histopathology, and Immunohistochemical Studies
Endoscopic, Interventional Radiologic, and Molecular Pathologic Techniques for Evaluation of Liver Mass Lesions
Clinical and Radiologic Features of the Common Liver Mass Lesions
References

Table 1. Clinical Classification of Liver Mass Lesions
Benign mass lesions for which no treatment is needed
Hepatic hemangioma
FNH
Benign liver cyst
Focal fat or focal fat sparing
Benign mass lesions for which treatment or follow-up evaluation is required
Hepatic adenoma and adenomatosis
Biliary cystadenoma
Hepatic abscess
Echinococcal cysts
Granulomatous Inflammation
Inflammatory pseudotumor of the liver
Malignant mass lesions for which treatment is required if feasible
HCC
Cholangiocarcinoma
Liver metastases from other primary sites
Biliary cystadenocarcinoma
Hepatic angiosarcoma
Lymphoma

Table 2. Recommended High-Risk Population for Screening for HCC
Patients with chronic HBV infection (hepatitis B surface antigen positivity)
Asian men older than age 40
Asian women older than age 50
Africans older than age 20
Patients with a family history of HCC
Patients with high HBV viral loads
Patients with evidence of active hepatitis
Patients with cirrhosis of any cause
Chronic hepatitis B
Chronic hepatitis C
Alcoholic cirrhosis
Nonalcoholic steatohepatitis
Hereditary hemochromatosis
Autoimmune hepatitis
Primary biliary cirrhosis
α-1 antitrypsin deficiency