Assy N, Nasser G, Djibre A, Beniashvili Z, Elias S, Zidan J. Characteristics of common solid liver lesions and recommendations for diagnostic workup. World J Gastroenterol 2009; 15(26): 3217-3227 [PMID: 19598296 DOI: 10.3748/wjg.15.3217]
Corresponding Author of This Article
Nimer Assy, MD, Liver Unit, Ziv Medical Center, Zefat 13100, Israel. assy.n@ziv.health.gov.il
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nimer Assy, Liver Unit, Ziv Medical Center, Zefat 13100, Israel, Faculty of Medicine, Technion Institute of Technology, Haifa 32000, Israel
Gattas Nasser, Liver Unit, Ziv Medical Center, Zefat 13100, Israel
Agness Djibre, Department of Medicine, Western Galilee Hospital, Nahariya 22100, Israel
Zaza Beniashvili, Liver Unit, Ziv Medical Center, Zefat 13100, Israel
Saad Elias, Department of Medicine, Ziv Medical Center, Zefat 13100, Israel
Jamal Zidan, Institute of Oncology, Ziv Medical Center, Zefat 13100, Israel; Faculty of Medicine, Technion Institute of Technology, Haifa 32000, Israel
Author contributions: The manuscript was written by Assy N, Nasser G, Djibre A, Beniashvili Z; Elias S collected data and designed the manuscript; Zidan J reviewed the manuscript prior to submission.
Correspondence to: Nimer Assy, MD, Liver Unit, Ziv Medical Center, Zefat 13100, Israel. assy.n@ziv.health.gov.il
Telephone: +972-4-6828441
Fax: +972-4-6828442
Received: May 4, 2009 Revised: June 8, 2009 Accepted: June 15, 2009 Published online: July 14, 2009
Abstract
Due to the widespread clinical use of imaging modalities such as ultrasonography, computed tomography and magnetic resonance imaging (MRI), previously unsuspected liver masses are increasingly being found in asymptomatic patients. This review discusses the various characteristics of the most common solid liver lesions and recommends a practical approach for diagnostic workup. Likely diagnoses include hepatocellular carcinoma (the most likely; a solid liver lesion in a cirrhotic liver) and hemangioma (generally presenting as a mass in a non-cirrhotic liver). Focal nodular hyperplasia and hepatic adenoma should be ruled out in young women. In 70% of cases, MRI with gadolinium differentiates between these lesions. Fine needle core biopsy or aspiration, or both, might be required in doubtful cases. If uncertainty persists as to the nature of the lesion, surgical resection is recommended. If the patient is known to have a primary malignancy and the lesion was found at tumor staging or follow up, histology is required only when the nature of the liver lesion is doubtful.
