Liver mass classification: Difference between revisions

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Latest revision as of 22:31, 29 July 2020

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	Focal nodular hyperplasia Hepatocellular adenoma	HCC Fibrolamellar carcinoma Hepatoblastoma Carcinosarcoma
Epithelial	Biliary cells	Intrahepatic bileduct adenoma Intrahepatic bileduct cystadenoma Biliary papillomatosis	Cystadenocarcinoma Cholangiocarcinoma
Non-Epithelial	Mesenchymal	Hemangioma Lymphangioma Lymphangiomatosis Angiomyolipoma Infantile Hemangioma	Hemangioendothelioma Primary lymphoma Angiosarcoma Epitheloid

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

↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ Haratake J, Horie A, Nagafuchi Y (1992). "Hyalinized hemangioma of the liver". Am. J. Gastroenterol. 87 (2): 234–6. PMID 1370873.
↑ 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.
↑ 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.
↑ 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.

[benign-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.

[pmid26770920-2] 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.

[Ferrell2000-3] 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.

[KimLee2015-4] 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.

[DooLee2009-5] 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.

[pmid17510541-6] 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.

[ChengTsai1995-7] 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.

[pmid1370873-8] Haratake J, Horie A, Nagafuchi Y (1992). "Hyalinized hemangioma of the liver". Am. J. Gastroenterol. 87 (2): 234–6. PMID 1370873.

[TakayasuMoriyama1986-9] 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.

[pmid11039718-10] 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.

[KimLee20152-11] 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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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Liver mass}}
-{{CMG}}{{AE}}{{MV}}
+{{CMG}}; {{AE}}{{MV}} {{ADG}}
 ==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).<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>
+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==
-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>
-*'''Imaging features'''
+{{familytree/start}}
-:*Hyperechoic
+{{familytree | | | | | | | | | | | | | | | | | A01 | | | | | | | | | | |A01=Liver mass}}
-:*Hypoechoic
+{{familytree | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | |}}
-*'''Histopathological origin'''
+{{familytree | | | | | | |,|-|-|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|-|-|.| | | | | | |}}
-:*Benign
+{{familytree | | | | | | B01 | | | | | | | | | B02 | | | | | | | | | B03 | | | | | |B01=Based on number of nodules|B02=Type of histopathology|B03=Imaging/consistency|}}
-:*Malignant
+{{familytree | | | | | | |!| | | | | | | | | | |!| | | | | | | | | | |!| | | | | |}}
-*'''Distribution '''
+{{familytree | | |,|-|-|-|^|-|-|-|.| | | |,|-|-|^|-|-|.| | | |,|-|-|-|^|-|-|-|.| | |}}
-:*Single (also known as "solitary" or "focal")
+{{familytree | | C01 | | | | | | C02 | | C03 | | | | C04 | | C05 | | | | | | C06 | | C01=Solitary|C02=Multiple|C03=Benign|C04=Malignant|C05=Solid|C06=Cystic}}
-:*Multiple
+{{familytree/end}}
-*The table below summarizes the classification of liver masses according to histopathological origin.
+===CLassification based on the number of nodules===
-{|style="border: 5px; font-size: 90%; margin: 5px; width: 1000px" align=center
+* Liver mass based on the number of nodules on imaging can be classified into 2 types:
-!style="padding: 5px 5px; background: #4479BA; font-weight: bold; text-align:center;" colspan="2"|{{fontcolor|#FFF|'''Classification of liver mass'''}}
+** Solitary nodule
-|valign=top|
+** Multiple nodules
-|+
+{{familytree/start}}
+{{familytree | | | | | | | | | | | | | | | | | | A01 | | | | | | | | |A01=Solid liver mass}}
+{{familytree | | | | | | | | | | | | | | | | | | |!| | | | | | | | }}
+{{familytree | | | | | | | | | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| |}}
+{{familytree | | | | | | | | | | B01 | | | | | | | | | | | | | | B02 | | | | | |B01=No history of liver disease|B02=History of liver disease|}}
+{{familytree | | | | | | | | | | |!| | | | | | | | | | | | | | | |!| | |}}
+{{familytree | | | | | |,|-|-|-|-|^|-|-|-|-|-|.| | | | | |,|-|-|-|+|-|-|-|.}}
+{{familytree | | | | | C01 | | | | | | | | | C02 | | | | C03 | | C04 | | C05 |C01=Asymptomatic|C02=Symptomatic|C03=Arterial enchancement with washout|C04=Only arterial enchancement|C05=Persistant arterial enhancement|}}
+{{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]]
 |-
-| style="background: #4479BA; width: 300px; text-align:center;" | {{fontcolor|#FFF|'''Benign'''}}
+! align="center" style="background:#DCDCDC;" + |Biliary cells
-| style="background: #4479BA; width: 300px; text-align:center;" | {{fontcolor|#FFF|'''Malignant'''}}
+| align="left" style="background:#F5F5F5;" + |
+*Intrahepatic bileduct adenoma
+*Intrahepatic bileduct cystadenoma
+*Biliary papillomatosis
+| align="left" style="background:#F5F5F5;" + |
+*[[Cystadenocarcinoma]]
+*[[Cholangiocarcinoma]]
 |-
-|style="padding: 5px 5px; background: #F5F5F5;"|
+! align="center" style="background:#DCDCDC;" + |Non-Epithelial
-*Hepatic hemangioma
+! align="center" style="background:#DCDCDC;" + |Mesenchymal
-*Focal nodular hyperplasia
+| align="left" style="background:#F5F5F5;" + |
-*Hepatic adenoma
+*[[Hemangioma]]
-*Idiopathic noncirrhotic portal hypertension
+*[[Lymphangioma]]
-*Nodular regenerative hyperplasia
+*[[Lymphangiomatosis]]
-*Regenerative nodules
+*[[Angiomyolipoma]]
-|style="padding: 5px 5px; background: #F5F5F5;"|
+*[[Hemangioma|Infantile Hemangioma]]
-*Hepatocellular carcinoma
+| align="left" style="background:#F5F5F5;" + |
-*Cholangiocarcinoma
+*[[Hemangioendothelioma]]
-*Metastatic disease
+*Primary lymphoma
+*[[Angiosarcoma]]
+*[[Epithelioid sarcoma|Epitheloid]]
 |}
+</center>
-*The table below summarizes the classification of liver masses according to distribution.
+===Classification based on consistency===
+* Based on the consitency of the mass, liver mass can be classified into 2 types:
+** Solid
+** Cystic
-*The table below summarizes the classification of liver masses according to imaging features.
+*** 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==
 {{Reflist|2}}
+[[Category:Medicine]]
-[[Category:Disease]]
+[[Category:Gastroenterology]]
+[[Category:Hepatology]]
 [[Category:Oncology]]
+[[Category:Up-To-Date]]
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