Benign Liver Masses

Asymptomatic cysts are benign and require no follow-up
Large cysts rarely present with abdominal pain and can be treated with surgical defenestration or, if surgery is contraindicated, with cyst aspiration and sclerotherapy
Cystadenomas are distinguished from simple cysts by the presence of thick, complex walls on ultrasonography; they require surgical resection because of risk for malignancy.

Benign masses although larger ones may rupture and hemorrhage, or undergo malignant transformation.
Associated with oral contraceptives and are eight times more common in women than men
- Other risk factors include androgen treatment, type 1 and 3 glycogen storage disease, and obesity
Hepatic adenomas can be differentiated from focal nodular hyperplasia with MRI with bile-excreted contrast material, such as gadobenate dimeglumine or gadoxetate disodium, because they typically do not have normal biliary excretion
Management:
- All patients taking oral contraceptives should discontinue those drugs and undergo follow-up CT or MRI every 6 to 12 months to confirm stability or regression in lesion size. The duration of surveillance and treatment depends on subsequent imaging findings
- In women not taking oral contraceptives, hepatic adenomas 5 cm or smaller can be managed with serial imaging every 6 months; however, with larger adenomas, the risk for hemorrhage or malignant transformation is elevated and surgical resection should be considered.
- Men with hepatic adenomas of any size are at increased risk for malignant transformation, and resection is recommended
- Pregnancy can result in adenoma growth, and resection or ablation of adenomas can be considered if pregnancy is contemplated

Most common benign liver tumor and a frequent incidental finding
Caused by a congenital arterial anomaly leading to a focal area of regeneration that appears as a stellate scar on CT or MRI.
CT or MRI with and without contrast can confirm the diagnosis
FNH typically does not have malignant potential or risk for bleeding and does not require follow-up.
- Seems there are some weak suggestions that women who continue to use oral contraceptives should get annual liver ultrasonography should be performed for a period of 2 to 3 years to assess the lesion for growth. It is unclear why, given no clear evidence it is hormonally stimulated, perhaps because it may be a misdiagnosed #Hepatic Adenoma

Benign (no potential for malignant transformation), common, and more frequent in women
Hepatic hemangiomas are rarely symptomatic, and, in most cases, symptoms that might be ascribed to a hemangioma are due to other causes
Hepatic hemangiomas do not require intervention or follow-up except in the rare instance when they cause symptoms

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