1. Dr. Ashraf Abdelfatah Faculty of Medicine
Neoplasm of Liver-I
Dr. Ashraf Abdelfatah
Faculty of Medicine

2. Objectives Classify common benign liver tumors.
Discuss etiopathogenesis.
Morphological features.
Clinical features & Complications.

3. Benign Liver Lesions II. NON-NEOPLASTIC LESION:
Nodule or tumors of liver may generate epigastric fullness and discomfort or be detected by routine physical examination or radiographic studies for other indications. Classify into:
I. NEOPLASTIC LESION:
Hemangioma “Cavernous”
Adenoma
II. NON-NEOPLASTIC LESION:
Focal nodular hyperplasia
Cysts

4. Focal Nodular Hyperplasia (FNH) Clinical Features
Benign nodule formation of normal liver.
Non-neoplastic lesion but Hyperplastic.
Confused with Nodular regenerative hyperplasia (Focal vs Diffuse)
More common in young and middle age.
Usually asymptomatic, May cause minimal pain
Etiology: Long-term use of anabolic hormones or of contraceptives have been implicated in the development of focal nodular hyperplasia.

5. Focal nodular hyperplasia.
A, Resected specimen showing lobulated contours and a central stellate scar. Well –demarcated, poorly encapsulated.
B. More lighter than yellowish than the adjacent. .

6. Focal nodular hyperplasia
Well-demarcated, subcapsular, light brown to yellow ; bulging nodule, 70-80% solitary, up to 5 -10cm; has central gray-white stellate scar; hemorrhage, necrosis, infarction, bile staining often seen; larger tumors may have multiple scars; adjacent liver is normal

7. Focal nodular hyperplasia (FNH)
There is a central gray-white, depressed stellate scar with fibrous septa
radiating to the periphery. The central scar contains large vessels with
fibromuscular hyperplasia +intense lymphocytic infiltrates and bile duct
proliferation + normal hepatocytes with regeneration.

8. Cavernous Hemangioma Clinical Features
The most commonest benign liver tumor, arising from blood vessels.
5% of autopsies
Usually single small
Well demarcated capsule
Usually asymptomatic

9. Hemangioma
Gross: solitary (70-90%), usually less < 2 cm, although tumors up to 20 cm; soft, red-purple, well circumscribed; subcapsular or deep; collapse when sectioned as blood oozes out

10. Hemangioma. The photomicrograph shows the thin-walled vascular channels embedded in fibrous stroma.
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© 2005 Elsevier

11. Cavernous Hemangioma
Micro: variably sized vascular spaces lined by flat endothelial cells.
Myxoid or fibrous stroma; large fibrous septa may trap bile ducts.
Variable thrombosis, calcification.
Increased fibrosis with age of lesion may obliterate lumen

12. Hepatic Adenoma Clinical features
Benign solitary capsulated nodule of the liver composed of neoplastic hepatocytes with no portal tract, central veins, or bile ducts. Very vascular.
More common in women who have used oral contraceptives.
generally regress if contraceptive use is terminated.
Etiopathogenesis:
Hormonal stimulation is clearly associated, still the causal events are unknown.
Mutations in the genes HNF1α and β-catenin
Glycogen storage disease.

13. Hepatic Adenoma Clinical features
have clinical significance for three reasons:
An intrahepatic mass they may be mistaken for the more ominous hepatocellular carcinomas.
Subcapsular adenomas have a tendency to rupture, particularly during pregnancy (under estrogen stimulation), causing life-threatening intraperitoneal hemorrhage.
May transform into carcinomas,
Glycogen storage disease,
Mutations of the β-catenin gene.

14. Liver Cell Adenoma
Gross: solitary pale, yellow-tan, frequently bile-stained nodules, often subcapsular, cm, sharply demarcated or encapsulated; usually right lobe; usually no fibrous septa or central scar; adjacent liver is non-cirrhotic

15. Liver cell adenoma.- Resected specimen presenting as a pendulous mass arising from the liver..
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© 2005 Elsevier

16. Liver Cell Adenoma
* Normal liver tissue with a portal tract is seen on the left.
* The hepatic adenoma is on the right show of loss of lobular architecture and is composed of sheet and cords of cells that closely resemble normal hepatocytes, but the neoplastic liver tissue has disorganized (portal tracts are absent) . + Focal clearing (of glycogen origin) +\- Steatosis+ Arterial vascular supply

17. Liver Cysts Hydated cyst May be single or multiple
common in developing countries
Causes:
Non-infectious: May be part of polycystic kidney disease.
Infectious: Echinococcal (ingestion of tapworm eggs) and amebic infections+ other.
Patients often asymptomatic, sometimes complicated with bacterial infection Pyogenic
Hydated cyst

18. Echinococcal infection demonstrating laminated cystic wall
(B) showing the laminated cystic wall with hooklet
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19. Liver cyst\Abscess Complications Route of infection
The organisms reach the liver by
(1) Portal vein.
(2) Arterial supply.
(3) Ascending infection in the biliary tract (ascending cholangitis).
(4) Direct invasion of the liver from a nearby source.
(5) Penetrating injury
Rupture of subcapsular liver abscesses can lead to:
Peritonitis.
Localized peritoneal abscesses.
Anaphylactic shock