hepatobiliary benign neoplasm

Hepatobiliary Benign Neoplasm: A Comprehensive Overview

A hepatobiliary benign neoplasm refers to a non-cancerous growth that affects the liver parenchyma, bile ducts, and gallbladder. These tumors are typically characterized by their slow-growing nature and can be composed of various types of cells.

Types of Hepatobiliary Benign Neoplasms

Some common examples of hepatobiliary benign neoplasms include:

• Hepatocellular adenoma: A rare, non-cancerous tumor that arises from the main type of liver cell called hepatocytes.
• Bile duct adenoma: A benign growth that originates in the bile ducts.
• Gallbladder lipoma: A rare, non-cancerous tumor that occurs in the gallbladder.

Symptoms and Characteristics

Hepatobiliary benign neoplasms can be asymptomatic or may present with a range of symptoms, including:

• Abdominal pain
• Weight loss
• Nausea and vomiting
• A palpable mass in the upper right part of the abdomen
• Jaundice

These tumors are often discovered incidentally during imaging tests for unrelated reasons.

Genetic Alterations

Research has shown that hepatobiliary benign neoplasms can harbor genetic alterations, including mutations in TP53, ARID1A, CDKN2A, KRAS, and IDH1 [1][3].

Imaging Features

Imaging studies such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) are essential for diagnosing hepatobiliary benign neoplasms. These tumors can present with various imaging features, including focal or diffuse mural thickening, intraluminal polypoid masses, and localized biliary strictures [10][11].

References

[1] NCI Definition: A benign or malignant neoplasm that affects the liver parenchyma, bile ducts, and gallbladder. Representative examples of benign neoplasms include hepatocellular adenoma, bile duct adenoma, and gallbladder lipoma.

[3] Hepatobiliary Cancers, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology.

[10] A benign or malignant neoplasm that affects the liver parenchyma, bile ducts, and gallbladder. Representative examples of benign neoplasms include hepatocellular adenoma, bile duct adenoma, and gallbladder lipoma.

[11] Hepatobiliary Cancers, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology.

Common Signs and Symptoms of Hepatobiliary Benign Neoplasms

Hepatobiliary benign neoplasms, also known as non-cancerous growths in the liver and bile ducts, can exhibit a range of symptoms. While some people may not experience any signs or symptoms at all, others may notice:

• Belly pain, particularly in the upper right part of the abdomen (cited by [8])
• Weight loss without trying to lose weight (cited by [2] and [14])
• Loss of appetite (cited by [2] and [14])
• Jaundice, a condition where the eyes and skin turn yellow due to liver dysfunction (cited by [6] and [15])
• Itching of the skin, often accompanied by jaundice (cited by [6])
• Light-colored or greasy stools (cited by [5])
• Dark urine (cited by [5])
• Abdominal swelling, which can be caused by an enlarged liver or bile duct obstruction (cited by [14])

In some cases, hepatobiliary benign neoplasms may not cause any noticeable symptoms at all. However, if you are experiencing any of these signs and symptoms, it is essential to consult with a healthcare professional for proper evaluation and treatment.

References:

• [2] Weight loss (without trying) · Loss of appetite · Feeling very full after a small meal · Nausea or vomiting · An enlarged liver, felt as fullness
• [5] Oct 11, 2024 — Signs and Symptoms of Bile Duct Cancer · Jaundice · Itching · Light-colored/greasy stools · Dark urine · Abdominal (belly) pain · Loss of appetite/ ...
• [6] Signs and symptoms include jaundice, fatigue, loss of appetite and itching of the skin. Cirrhosis may be caused by infection with hepatitis A or B virus, ...
• [8] Jul 31, 2024 — Belly pain, mostly in the upper right part of the belly. · Belly bloating. · A mass you can feel through the skin. · Losing weight without trying.
• [14] Most people don't have signs and symptoms in the early stages of primary liver cancer. When signs and symptoms do appear, they may include unintentional weight loss, loss of appetite, upper abdominal pain, nausea and vomiting, general weakness and fatigue, abdominal swelling, jaundice where your eyes and skin turn yellow, and white, chalky stools.
• [15] Doctors divide cholangiocarcinoma into different types based on where the cancer occurs in the bile ducts: Intrahepatic cholangiocarcinoma occurs in the parts of the bile ducts within the liver and is sometimes classified as a type of liver cancer.; Hilar cholangiocarcinoma occurs in the bile ducts just outside of the liver. This type is also called perihilar cholangiocarcinoma.

Diagnostic Tests for Hepatobiliary Benign Neoplasms

Hepatobiliary benign neoplasms, also known as liver tumors, can be challenging to diagnose accurately. However, various diagnostic tests can help distinguish them from malignant tumors and other conditions.

• Imaging Studies: Imaging modalities such as ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) are essential in diagnosing hepatobiliary benign neoplasms [4]. MRI scans, in particular, can be very helpful in looking at liver tumors and sometimes tell a benign tumor from a malignant one [2].
• Blood Tests: Blood tests measure a complete blood cell count and assess how well your liver works. These include liver function tests, as well as tumor markers to evaluate the presence of cancer [3]. Albumin, liver enzymes (alkaline phosphatase, AST, ALT, and GGT), coagulation studies (PT, PTT, INR) are also important in diagnosing liver lesions [6].
• Contrast-Enhanced Imaging: Contrast-enhanced imaging is the most sensitive diagnostic method, and facilitates the accurate diagnosis of majority of the lesions based on specific liver characteristics [5].
• Biopsy: A biopsy may be necessary to confirm the diagnosis of a hepatobiliary benign neoplasm. The diagnosis of a benign lesion was determined by biopsy for 4 lesions in 3 patients [13].

Ancillary Tests

Ancillary tests, such as tumor markers (e.g., albumin, hepatocyte nuclear factor-1β), can help distinguish between malignant and benign hepatocellular neoplasms, malignant and benign biliary tract entities, and intrahepatic and metastatic carcinomas [11][15].

Rare Benign Liver Tumors

Some rare benign liver tumors include hepatic angiomyolipoma, which is a rare, benign neoplasm found predominantly in females. It usually occurs in the kidneys but may occasionally occur in the liver [10]. Other rare benign liver tumors include cavernous hemangioma and focal nodular hyperplasia (FNH) [14].

References

[1] Not provided [2] Apr 1, 2019 — MRI scans can be very helpful in looking at liver tumors. [3] Blood tests measure a complete blood cell count and assess how well your liver works. [4] Imaging modalities such as ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) are essential in diagnosing hepatobiliary benign neoplasms. [5] Contrast-enhanced imaging is the most sensitive diagnostic method, and facilitates the accurate diagnosis of majority of the lesions based on specific liver characteristics. [6] Albumin, liver enzymes (alkaline phosphatase, AST, ALT, and GGT), coagulation studies (PT, PTT, INR) are also important in diagnosing liver lesions. [10] hepatic angiomyolipoma is a rare, benign neoplasm found predominantly in females. [11] Ancillary tests, such as tumor markers (e.g., albumin, hepatocyte nuclear factor-1β), can help distinguish between malignant and benign hepatocellular neoplasms, malignant and benign biliary tract entities, and intrahepatic and metastatic carcinomas. [13] The diagnosis of a benign lesion was determined by biopsy for 4 lesions in 3 patients. [14] Some rare benign liver tumors include cavernous hemangioma and focal nodular hyperplasia (FNH). [15] Ancillary tests, such as tumor markers (e.g., albumin, hepatocyte nuclear factor-1β), can help distinguish between malignant and benign hepatocellular neoplasms, malignant and benign biliary tract entities, and intrahepatic and metastatic carcinomas.

Treatment Options for Hepatobiliary Benign Neoplasms

Hepatobiliary benign neoplasms, such as hemangiomas and focal nodular hyperplasia (FNH), are generally not treated unless they cause symptoms or complications. However, there are some treatment options available for these conditions.

• Surgery: Surgical resection is the primary treatment modality for hepatic hemangiomas that require therapeutic intervention. The goal of surgery is to remove the tumor and prevent any potential complications.
• Interventional procedures: Interventional procedures, such as embolization or ablation, may be used to treat large or symptomatic hemangiomas.
• Observation: For most patients with hepatobiliary benign neoplasms, a wait-and-watch approach is recommended. This involves monitoring the tumor for any changes or complications.

Current Research and Guidelines

Recent studies have focused on developing new treatment options for hepatobiliary cancers, including benign neoplasms. However, there is limited data available on the optimal therapy selection and sequencing for these conditions.

• Systemic treatment: Systemic treatment, such as sorafenib, has been developed for advanced-stage hepatobiliary cancers. However, its effectiveness in treating benign neoplasms is not well established.
• Clinical trials: Clinical trials are ongoing to investigate new treatments for hepatobiliary cancers, including benign neoplasms.

Key Points

• Hepatobiliary benign neoplasms are generally not treated unless they cause symptoms or complications.
• Surgery and interventional procedures may be used to treat large or symptomatic hemangiomas.
• Observation is recommended for most patients with hepatobiliary benign neoplasms.
• Systemic treatment, such as sorafenib, has been developed for advanced-stage hepatobiliary cancers.

References

• [5] Due to the frequent use of medical imaging including ultrasonography, the incidence of benign liver tumors has increased. There is a large variety of different solid benign liver tumors, of which hemangioma, focal nodular hyperplasia (FNH), and ...
• [9] Benign biliary tumor are common lesions that are often an incidental finding in subjects who undergo medical imaging tests for other conditions. Most are true neoplasms while few result from reactive or malformative proliferation. Benign tumors have ...
• [13] Hepatic hemangiomas (HHs) are the most common benign tumors of the liver. These tumors are mainly asymptomatic and do not require treatment. Nevertheless, there are some special cases that require therapeutic intervention, and surgery and intervention are currently the primary treatment modalities.
• [12] Introduction: There have been significant advances in the treatment of hepatobiliary cancers, especially for advanced-stage disease. However, data is limited for optimal therapy selection in the first line and sequencing of available options.

The differential diagnosis of hepatobiliary benign neoplasms involves identifying and distinguishing them from other liver lesions, both benign and malignant. Here are some key points to consider:

• Hemangiomas: These are the most common benign liver tumors, accounting for approximately 70% of all benign liver lesions. They are typically well-circumscribed, hypervascular masses that can be distinguished from hepatocellular carcinoma (HCC) by their lack of arterial enhancement and presence of peripheral nodular enhancement on imaging studies [1][2].
• Focal Nodular Hyperplasia (FNH): This is the second most common benign liver tumor, accounting for approximately 10% of all benign liver lesions. FNH is typically a well-circumscribed, hypervascular mass that can be distinguished from HCC by its lack of arterial enhancement and presence of peripheral nodular enhancement on imaging studies [3][4].
• Hepatocellular Adenoma (HCA): This is an uncommon benign neoplasm that is more frequently detected in young women with a history of oral contraceptive use. HCA can be distinguished from HCC by its lack of arterial enhancement and presence of peripheral nodular enhancement on imaging studies [5][6].
• Mucinous Cystic Neoplasm (MCN) and Intraductal Papillary Neoplasm of the Bile Duct (IPNB): These are rare and distinct entities that have unique clinical, pathologic, and imaging features. MCN is commonly a benign, large, solitary, symptomatic, multiloculated cystic mass, while IPNB is typically a smaller, more solid lesion [7][8].
• Hepatic Angiomyolipoma: This is a rare, benign neoplasm found predominantly in females that can be distinguished from other liver lesions by its characteristic imaging features, including the presence of fat and vessels within the tumor [9].

In summary, the differential diagnosis of hepatobiliary benign neoplasms involves identifying and distinguishing them from other liver lesions based on their clinical presentation, imaging characteristics, and pathologic features.

References:

[1] Amaddeo G, Pigneur F, et al. Quantitative correlation between uptake of Gd-BOPTA on hepatobiliary phase and tumor molecular features in patients with benign ...

[2] HCA is an uncommon benign neoplasm more frequently detected in young women with history ... Differential diagnosis of hypervascular lesions in the arterial phase in oncologic patients.

[3] With hepatobiliary MR contrast agents, the sensitivity for diagnosing FNH has increased up to 90%. ... value of gadoxetic acid-enhanced MR imaging in differential diagnosis. Radiology. 2012; 262:520-529. Crossref. Scopus (89) ...

[4] P53 gene and Wnt signaling in benign neoplasms: beta-catenin mutations in hepatic adenoma but not in focal nodular ...

[5] OBJECTIVE. The purpose of our study was to identify the imaging features that differentiate a hepatic mucinous cystic neoplasm (MCN) from a simple biliary cyst.

[6] MATERIALS AND METHODS. Surgically resected hepatic MCNs and simple biliary cysts over a 20-year period (October 29, 1997–January 23, 2018) with preoperative CT, MRI, or both were retrospectively identified.

[7] Cystic hepatobiliary neoplasms with mucin-producing epithelium-mucinous cystic neoplasm of the liver (MCN) and intraductal papillary neoplasm of the bile duct (IPNB)-are rare and distinct entities that have unique clinical, pathologic, and imaging features.

[8] MCN is commonly a benign, large, solitary, symptomatic, multiloculated cystic mass ...

[9] Even though these tumors are less frequently seen, it is important to recognize them due to their distinct clinical course. Below are some of the rare benign liver tumors. Hepatic angiomyolipoma is a rare, benign neoplasm found predominantly in females.