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{{Liver mass}}
{{Liver mass}}
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==Overview==
==Overview==
Liver mass may be classified according to imaging features (hyperechoic vs. hypoechoic), histopathological origin (benign vs. malignant), and distribution (single/focal/solitary vs. multiple)
A liver mass may be grouped into several subtypes based on the number of nodules (solitary or multiple), type of histopathology (benign or malignant), and consistency (solid or cystic).
 
==Classification==
==Classification==
Liver mass may be classified according to imaging features, histopathological origin, size, and distribution
A liver mass may be classified into several sub-types based on number of nodules, type of histo-pathology, and consistency.<ref name="benign">Mergo PJ, Ros PR. Benign Lesions of the Liver. In: The Radiologic Clinics of North America, 2, W.B. Saunders, Philadelphia 1998. Vol 36, p.319.</ref><ref name="pmid26770920">{{cite journal |vauthors=Kim TK, Lee E, Jang HJ |title=Imaging findings of mimickers of hepatocellular carcinoma |journal=Clin Mol Hepatol |volume=21 |issue=4 |pages=326–43 |year=2015 |pmid=26770920 |pmc=4712159 |doi=10.3350/cmh.2015.21.4.326 |url=}}</ref><ref name="Ferrell2000">{{cite journal|last1=Ferrell|first1=Linda|title=Liver Pathology: Cirrhosis, Hepatitis and Primary Liver Tumors. Update and Diagnostic Problems|journal=Modern Pathology|volume=13|issue=6|year=2000|pages=679–704|issn=0893-3952|doi=10.1038/modpathol.3880119}}</ref><ref name="KimLee2015">{{cite journal|last1=Kim|first1=Tae Kyoung|last2=Lee|first2=Eunchae|last3=Jang|first3=Hyun-Jung|title=Imaging findings of mimickers of hepatocellular carcinoma|journal=Clinical and Molecular Hepatology|volume=21|issue=4|year=2015|pages=326|issn=2287-2728|doi=10.3350/cmh.2015.21.4.326}}</ref><ref name="DooLee2009">{{cite journal|last1=Doo|first1=Kyung Won|last2=Lee|first2=Chang Hee|last3=Choi|first3=Jae Woong|last4=Lee|first4=Jongmee|last5=Kim|first5=Kyeong Ah|last6=Park|first6=Cheol Min|title=“Pseudo Washout” Sign in High-Flow Hepatic Hemangioma on Gadoxetic Acid Contrast-Enhanced MRI Mimicking Hypervascular Tumor|journal=American Journal of Roentgenology|volume=193|issue=6|year=2009|pages=W490–W496|issn=0361-803X|doi=10.2214/AJR.08.1732}}</ref><ref name="pmid17510541">{{cite journal |vauthors=Zech CJ, Herrmann KA, Reiser MF, Schoenberg SO |title=MR imaging in patients with suspected liver metastases: value of liver-specific contrast agent Gd-EOB-DTPA |journal=Magn Reson Med Sci |volume=6 |issue=1 |pages=43–52 |year=2007 |pmid=17510541 |doi= |url=}}</ref><ref name="ChengTsai1995">{{cite journal|last1=Cheng|first1=H C|last2=Tsai|first2=S H|last3=Chiang|first3=J H|last4=Chang|first4=C Y|title=Hyalinized liver hemangioma mimicking malignant tumor at MR imaging.|journal=American Journal of Roentgenology|volume=165|issue=4|year=1995|pages=1016–1017|issn=0361-803X|doi=10.2214/ajr.165.4.7676959}}</ref><ref name="pmid1370873">{{cite journal |vauthors=Haratake J, Horie A, Nagafuchi Y |title=Hyalinized hemangioma of the liver |journal=Am. J. Gastroenterol. |volume=87 |issue=2 |pages=234–6 |year=1992 |pmid=1370873 |doi= |url=}}</ref><ref name="TakayasuMoriyama1986">{{cite journal|last1=Takayasu|first1=K|last2=Moriyama|first2=N|last3=Shima|first3=Y|last4=Muramatsu|first4=Y|last5=Yamada|first5=T|last6=Makuuchi|first6=M|last7=Yamasaki|first7=S|last8=Hirohashi|first8=S|title=Atypical radiographic findings in hepatic cavernous hemangioma: correlation with histologic features|journal=American Journal of Roentgenology|volume=146|issue=6|year=1986|pages=1149–1153|issn=0361-803X|doi=10.2214/ajr.146.6.1149}}</ref><ref name="pmid11039718">{{cite journal |vauthors=Yamashita Y, Shimada M, Taguchi K, Gion T, Hasegawa H, Utsunomiya T, Hamatsu T, Matsumata T, Sugimachi K |title=Hepatic sclerosing hemangioma mimicking a metastatic liver tumor: report of a case |journal=Surg. Today |volume=30 |issue=9 |pages=849–52 |year=2000 |pmid=11039718 |doi= |url=}}</ref><ref name="KimLee20152">{{cite journal|last1=Kim|first1=Tae Kyoung|last2=Lee|first2=Eunchae|last3=Jang|first3=Hyun-Jung|title=Imaging findings of mimickers of hepatocellular carcinoma|journal=Clinical and Molecular Hepatology|volume=21|issue=4|year=2015|pages=326|issn=2287-2728|doi=10.3350/cmh.2015.21.4.326}}</ref>
 
{{familytree/start}}
{{familytree | | | | | | | | | | | | | | | | | A01 | | | | | | | | | | |A01=Liver mass}}
{{familytree | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | |}}
{{familytree | | | | | | |,|-|-|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|-|-|.| | | | | | |}}
{{familytree | | | | | | B01 | | | | | | | | | B02 | | | | | | | | | B03 | | | | | |B01=Based on number of nodules|B02=Type of histopathology|B03=Imaging/consistency|}}
{{familytree | | | | | | |!| | | | | | | | | | |!| | | | | | | | | | |!| | | | | |}}
{{familytree | | |,|-|-|-|^|-|-|-|.| | | |,|-|-|^|-|-|.| | | |,|-|-|-|^|-|-|-|.| | |}}
{{familytree | | C01 | | | | | | C02 | | C03 | | | | C04 | | C05 | | | | | | C06 | | C01=Solitary|C02=Multiple|C03=Benign|C04=Malignant|C05=Solid|C06=Cystic}}
{{familytree/end}}
 
===CLassification based on the number of nodules===
* Liver mass based on the number of nodules on imaging can be classified into 2 types:
** Solitary nodule
** Multiple nodules


*'''Imaging features'''
{{familytree/start}}
:*Hyperechoic
{{familytree | | | | | | | | | | | | | | | | | | A01 | | | | | | | | |A01=Solid liver mass}}
:*Hypoechoic
{{familytree | | | | | | | | | | | | | | | | | | |!| | | | | | | | }}
*'''Histopathological origin'''
{{familytree | | | | | | | | | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| |}}
:*Benign
{{familytree | | | | | | | | | | B01 | | | | | | | | | | | | | | B02 | | | | | |B01=No history of liver disease|B02=History of liver disease|}} 
:*Malignant
{{familytree | | | | | | | | | | |!| | | | | | | | | | | | | | | |!| | |}}
*'''Distribution '''
{{familytree | | | | | |,|-|-|-|-|^|-|-|-|-|-|.| | | | | |,|-|-|-|+|-|-|-|.}}
:*Single (also known as "solitary" or "focal")
{{familytree | | | | | C01 | | | | | | | | | C02 | | | | C03 | | C04 | | C05 |C01=Asymptomatic|C02=Symptomatic|C03=Arterial enchancement with washout|C04=Only arterial enchancement|C05=Persistant arterial enhancement|}}
:*Multiple
{{familytree | | | | | |!| | | | | | | | | | |!| | | | | |!| | | |!| | | |!|}}
{{familytree | |,|-|-|-|+|-|-|-|.| | | | | | D01 | | | | D02 | | D03 | | D04 |D01=Weight loss|D02=HCC|D03=Dyspatic nodule|D04=Cholangiocarcinoma|}}
{{familytree | E01 | | E02 | | E03 | | | | | |!| | | | | | | | |E01=Adenoma|E02=FNH*|E03=Hemangioma|}}
{{familytree | | | | | | | | | | | | | |,|-|-|^|-|-|.| |}}
{{familytree | | | | | | | | | | | | | F01 | | | | F02 | |F01=Metastasis<br>H/O of cancer|F02=Fibrolammellar HCC<br> No H/O of cancer}}
{{familytree/end}}   
<small>
'''Abbreviations:'''
*FNH: Focal nodular hyperplasia
</small>
 
===Classification based on histopathology===
* Based on the type of histopathology, liver mass can be classified into 2 types:
** Benign
** Malignant
<center>
{|
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" + |WHO Classification of Liver Tumors
|-
! colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Benign Tumors
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Malignant Tumors
|-
! rowspan="2" ! align="center" style="background:#DCDCDC;" + |Epithelial
! align="center" style="background:#DCDCDC;" + |Hepatocytes
| align="left" style="background:#F5F5F5;" + |
*[[Focal nodular hyperplasia]]
*[[Hepatocellular adenoma]]
| align="left" style="background:#F5F5F5;" + |
*[[HCC]]
*Fibrolamellar carcinoma
*[[Hepatoblastoma]]
*[[Carcinosarcoma of the thyroid|Carcinosarcoma]]
|-
! align="center" style="background:#DCDCDC;" + |Biliary cells
| align="left" style="background:#F5F5F5;" + |
*Intrahepatic bileduct adenoma
*Intrahepatic bileduct cystadenoma
*Biliary papillomatosis
| align="left" style="background:#F5F5F5;" + |
*[[Cystadenocarcinoma]]
*[[Cholangiocarcinoma]]
|-
! align="center" style="background:#DCDCDC;" + |Non-Epithelial
! align="center" style="background:#DCDCDC;" + |Mesenchymal
| align="left" style="background:#F5F5F5;" + |
*[[Hemangioma]]
*[[Lymphangioma]]
*[[Lymphangiomatosis]]
*[[Angiomyolipoma]]
*[[Hemangioma|Infantile Hemangioma]]
| align="left" style="background:#F5F5F5;" + |
*[[Hemangioendothelioma]]
*Primary lymphoma
*[[Angiosarcoma]]
*[[Epithelioid sarcoma|Epitheloid]]
|}
</center>
 
===Classification based on consistency===
* Based on the consitency of the mass, liver mass can be classified into 2 types:
** Solid
** Cystic
*** Complex cysts
*** Solid cysts
{{familytree/start}}
{{familytree | | | | | | | | | | | | | | | | A01 | | | | | | | | |A01=Liver mass}}
{{familytree | | | | | | | | | | | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | | | | | | |,|-|-|-|-|^|-|-|-|-|.| | | |}}
{{familytree | | | | | | | | | | | B01 | | | | | | | | B02 | | | | | |B01=Cystic|B02=Solid|}} 
{{familytree | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | |}} 
{{familytree | | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|.| | | | | | |}}
{{familytree | | | | C01 | | | | | | | | | | | C02 | | | | | |C01=Thin walled|C02=Thick walled Septations|}} 
{{familytree | | | | |!| | | | | | | | | | | | |!| | |}}
{{familytree | |,|-|-|^|-|-|.| | | |,|-|-|-|-|-|+|-|-|-|-|-|.|}}
{{familytree | D01 | | | | D02 | | D03 | | | | D04 | | | | D05 | |D01=Single|D02=Multiple|D03=Cystadenoma|D04=Cyst adenocarcinoma|D05=Choledochal cyst|}}
{{familytree | |!| | | | | |!| }}
{{familytree | E01 | | | | E02 | |E01=Simple Hepatic cyst|E02=Polycystic Liver Disease}}
{{familytree/end}}
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


 
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Latest revision as of 22:31, 29 July 2020

Liver Mass Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2] Aditya Ganti M.B.B.S. [3]

Overview

A liver mass may be grouped into several subtypes based on the number of nodules (solitary or multiple), type of histopathology (benign or malignant), and consistency (solid or cystic).

Classification

A liver mass may be classified into several sub-types based on number of nodules, type of histo-pathology, and consistency.[1][2][3][4][5][6][7][8][9][10][11]

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Liver mass
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Based on number of nodules
 
 
 
 
 
 
 
 
Type of histopathology
 
 
 
 
 
 
 
 
Imaging/consistency
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Solitary
 
 
 
 
 
Multiple
 
Benign
 
 
 
Malignant
 
Solid
 
 
 
 
 
Cystic
 

CLassification based on the number of nodules

  • Liver mass based on the number of nodules on imaging can be classified into 2 types:
    • Solitary nodule
    • Multiple nodules
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Solid liver mass
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No history of liver disease
 
 
 
 
 
 
 
 
 
 
 
 
 
History of liver disease
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Asymptomatic
 
 
 
 
 
 
 
 
Symptomatic
 
 
 
Arterial enchancement with washout
 
Only arterial enchancement
 
Persistant arterial enhancement
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Weight loss
 
 
 
HCC
 
Dyspatic nodule
 
Cholangiocarcinoma
 
 
 
 
 
 
 
 
 
 
 
Adenoma
 
FNH*
 
Hemangioma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Metastasis
H/O of cancer
 
 
 
Fibrolammellar HCC
No H/O of cancer
 

Abbreviations:

  • FNH: Focal nodular hyperplasia

Classification based on histopathology

  • Based on the type of histopathology, liver mass can be classified into 2 types:
    • Benign
    • Malignant
WHO Classification of Liver Tumors
Benign Tumors Malignant Tumors
Epithelial Hepatocytes
Biliary cells
  • Intrahepatic bileduct adenoma
  • Intrahepatic bileduct cystadenoma
  • Biliary papillomatosis
Non-Epithelial Mesenchymal

Classification based on consistency

  • Based on the consitency of the mass, liver mass can be classified into 2 types:
    • Solid
    • Cystic
      • Complex cysts
      • Solid cysts
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Liver mass
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cystic
 
 
 
 
 
 
 
Solid
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Thin walled
 
 
 
 
 
 
 
 
 
 
Thick walled Septations
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Single
 
 
 
Multiple
 
Cystadenoma
 
 
 
Cyst adenocarcinoma
 
 
 
Choledochal cyst
 
 
 
 
 
 
 
 
 
 
 
 
Simple Hepatic cyst
 
 
 
Polycystic Liver Disease
 

References

  1. ↑ Mergo PJ, Ros PR. Benign Lesions of the Liver. In: The Radiologic Clinics of North America, 2, W.B. Saunders, Philadelphia 1998. Vol 36, p.319.
  2. ↑ Kim TK, Lee E, Jang HJ (2015). "Imaging findings of mimickers of hepatocellular carcinoma". Clin Mol Hepatol. 21 (4): 326–43. doi:10.3350/cmh.2015.21.4.326. PMC 4712159. PMID 26770920.
  3. ↑ Ferrell, Linda (2000). "Liver Pathology: Cirrhosis, Hepatitis and Primary Liver Tumors. Update and Diagnostic Problems". Modern Pathology. 13 (6): 679–704. doi:10.1038/modpathol.3880119. ISSN 0893-3952.
  4. ↑ Kim, Tae Kyoung; Lee, Eunchae; Jang, Hyun-Jung (2015). "Imaging findings of mimickers of hepatocellular carcinoma". Clinical and Molecular Hepatology. 21 (4): 326. doi:10.3350/cmh.2015.21.4.326. ISSN 2287-2728.
  5. ↑ Doo, Kyung Won; Lee, Chang Hee; Choi, Jae Woong; Lee, Jongmee; Kim, Kyeong Ah; Park, Cheol Min (2009). ""Pseudo Washout" Sign in High-Flow Hepatic Hemangioma on Gadoxetic Acid Contrast-Enhanced MRI Mimicking Hypervascular Tumor". American Journal of Roentgenology. 193 (6): W490–W496. doi:10.2214/AJR.08.1732. ISSN 0361-803X.
  6. ↑ Zech CJ, Herrmann KA, Reiser MF, Schoenberg SO (2007). "MR imaging in patients with suspected liver metastases: value of liver-specific contrast agent Gd-EOB-DTPA". Magn Reson Med Sci. 6 (1): 43–52. PMID 17510541.
  7. ↑ Cheng, H C; Tsai, S H; Chiang, J H; Chang, C Y (1995). "Hyalinized liver hemangioma mimicking malignant tumor at MR imaging". American Journal of Roentgenology. 165 (4): 1016–1017. doi:10.2214/ajr.165.4.7676959. ISSN 0361-803X.
  8. ↑ Haratake J, Horie A, Nagafuchi Y (1992). "Hyalinized hemangioma of the liver". Am. J. Gastroenterol. 87 (2): 234–6. PMID 1370873.
  9. ↑ Takayasu, K; Moriyama, N; Shima, Y; Muramatsu, Y; Yamada, T; Makuuchi, M; Yamasaki, S; Hirohashi, S (1986). "Atypical radiographic findings in hepatic cavernous hemangioma: correlation with histologic features". American Journal of Roentgenology. 146 (6): 1149–1153. doi:10.2214/ajr.146.6.1149. ISSN 0361-803X.
  10. ↑ Yamashita Y, Shimada M, Taguchi K, Gion T, Hasegawa H, Utsunomiya T, Hamatsu T, Matsumata T, Sugimachi K (2000). "Hepatic sclerosing hemangioma mimicking a metastatic liver tumor: report of a case". Surg. Today. 30 (9): 849–52. PMID 11039718.
  11. ↑ Kim, Tae Kyoung; Lee, Eunchae; Jang, Hyun-Jung (2015). "Imaging findings of mimickers of hepatocellular carcinoma". Clinical and Molecular Hepatology. 21 (4): 326. doi:10.3350/cmh.2015.21.4.326. ISSN 2287-2728.
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