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{{Liver mass}}
{{Liver mass}}
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==Overview==
==Overview==
A liver mass may be classified into several sub-types based on number of nodules, type of histo-pathology, and consistency.
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==
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===Based on the number of nodules===
===CLassification based on the number of nodules===
* Liver mass based on the number of nodules on imaging can be classified into 2 types:
* Liver mass based on the number of nodules on imaging can be classified into 2 types:
** Solitary nodule
** Solitary nodule
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{{familytree/start}}
{{familytree/start}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | A01 | | | | | | | | |A01=Solid liver mass}}
{{familytree | | | | | | | | | | | | | | | | | | A01 | | | | | | | | |A01=Solid liver mass}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | | | | | | | | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | | | | | | | | | | |,|-|-|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|.| | | |}}
{{familytree | | | | | | | | | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| |}}
{{familytree | | | | | | | | | | | | | | | B01 | | | | | | | | | | | | | | | | | | | | B02 | | | | | |B01=No history of liver disease|B02=History of liver disease|}}   
{{familytree | | | | | | | | | | B01 | | | | | | | | | | | | | | B02 | | | | | |B01=No history of liver disease|B02=History of liver disease|}}   
{{familytree | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | |!| | |}}
{{familytree | | | | | | | | | | |!| | | | | | | | | | | | | | | |!| | |}}
{{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 | | | | | C01 | | | | | | | | | C02 | | | | C03 | | C04 | | C05 |C01=Asymptomatic|C02=Symptomatic|C03=Arterial enchancement with washout|C04=Only arterial enchancement|C05=Persistant arterial enhancement|}}
{{familytree | | | | | | | |!| | | | | | | | | | | | | | | |!| | | | | | |!| | | | | | |!| | | | | | |!|}}
{{familytree | | | | | |!| | | | | | | | | | |!| | | | | |!| | | |!| | | |!|}}
{{familytree | |,|-|-|-|-|-|+|-|-|-|-|-|.| | | | | | | | | D01 | | | | | D02 | | | | | D03 | | | | | D04 |D01=Weight loss|D02=HCC|D03=Dyspatic nodule|D04=Cholangiocarcinoma|}}
{{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 | E01 | | E02 | | E03 | | | | | |!| | | | | | | | |E01=Adenoma|E02=FNH*|E03=Hemangioma|}}
{{familytree | | | | | | | | | | | | | | | | | |,|-|-|-|-|-|^|-|-|-|-|-|.| |}}
{{familytree | | | | | | | | | | | | | |,|-|-|^|-|-|.| |}}
{{familytree | | | | | | | | | | | | | | | | | F01 | | | | | | | | | | F02 | |F01=Metastasis<br>H/O of cancer|F02=Fibrolammellar HCC<br> No H/O of cancer}}
{{familytree | | | | | | | | | | | | | F01 | | | | F02 | |F01=Metastasis<br>H/O of cancer|F02=Fibrolammellar HCC<br> No H/O of cancer}}
{{familytree/end}}     
{{familytree/end}}     
<small>
<small>
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</small>
</small>


 
===Classification based on histopathology===
</div>
* Based on the type of histopathology, liver mass can be classified into 2 types:
* Based on the type of histo-pathology liver mass can be classified into 2 types.
** Benign
** Benign
** Malignant
** Malignant
{| border="1" cellpadding="5" cellspacing="0" align="center" |class="wikitable"
<center>
! colspan="4" style="background:#efefef;" |WHO Classification of Liver Tumors
{|
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" + |WHO Classification of Liver Tumors
|-
|-
! colspan="3" style="background:#efefef;" |Benign Tumors
! colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Benign Tumors
! style="background:#efefef;" |Malignant Tumors
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Malignant Tumors
|-
|-
| rowspan="2" |'''Epithelial'''
! rowspan="2" ! align="center" style="background:#DCDCDC;" + |Epithelial
|'''Hepatocytes'''
! align="center" style="background:#DCDCDC;" + |Hepatocytes
|
| align="left" style="background:#F5F5F5;" + |
*[[Focal nodular hyperplasia]]
*[[Focal nodular hyperplasia]]
*[[Hepatocellular adenoma]]
*[[Hepatocellular adenoma]]
|
| align="left" style="background:#F5F5F5;" + |
*[[HCC]]
*[[HCC]]
*Fibrolamellar carcinoma
*Fibrolamellar carcinoma
Line 65: Line 65:
*[[Carcinosarcoma of the thyroid|Carcinosarcoma]]
*[[Carcinosarcoma of the thyroid|Carcinosarcoma]]
|-
|-
|'''Biliary cells'''
! align="center" style="background:#DCDCDC;" + |Biliary cells
|
| align="left" style="background:#F5F5F5;" + |
*Intrahepatic bileduct adenoma
*Intrahepatic bileduct adenoma
*Intrahepatic bileduct cystadenoma
*Intrahepatic bileduct cystadenoma
*Biliary papillomatosis
*Biliary papillomatosis
|
| align="left" style="background:#F5F5F5;" + |
*[[Cystadenocarcinoma]]
*[[Cystadenocarcinoma]]
*[[Cholangiocarcinoma]]
*[[Cholangiocarcinoma]]
|-
|-
|'''Non-Epithelial'''
! align="center" style="background:#DCDCDC;" + |Non-Epithelial
|'''Mesenchymal'''
! align="center" style="background:#DCDCDC;" + |Mesenchymal
|
| align="left" style="background:#F5F5F5;" + |
*[[Hemangioma]]
*[[Hemangioma]]
*[[Lymphangioma]]
*[[Lymphangioma]]
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*[[Angiomyolipoma]]
*[[Angiomyolipoma]]
*[[Hemangioma|Infantile Hemangioma]]
*[[Hemangioma|Infantile Hemangioma]]
|
| align="left" style="background:#F5F5F5;" + |
*[[Hemangioendothelioma]]
*[[Hemangioendothelioma]]
*Primary lymphoma
*Primary lymphoma
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*[[Epithelioid sarcoma|Epitheloid]]
*[[Epithelioid sarcoma|Epitheloid]]
|}
|}
</center>


* Based on the consitency of the mass, liver mass can be classified into 2 types.
===Classification based on consistency===
** Complex cysts
* Based on the consitency of the mass, liver mass can be classified into 2 types:
** Solid cysts
** Solid
<div style="width: 50%;">
** Cystic
*** Complex cysts
*** Solid cysts
{{familytree/start}}
{{familytree/start}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | A01 | | | | | | | | |A01=Cystic liver mass}}
{{familytree | | | | | | | | | | | | | | | | A01 | | | | | | | | |A01=Liver mass}}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | | | | | | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | | | | | | |,|-|-|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|.| | | |}}
{{familytree | | | | | | | | | | | |,|-|-|-|-|^|-|-|-|-|.| | | |}}
{{familytree | | | | | | | | | | | B01 | | | | | | | | | | | | | | | | | | | | B02 | | | | | |B01=Thin walled|B02=Thick walled Septations|}}   
{{familytree | | | | | | | | | | | B01 | | | | | | | | B02 | | | | | |B01=Cystic|B02=Solid|}}   
{{familytree | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | |!| | |}}
{{familytree | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | |}}
{{familytree | | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| | | | | | |,|-|-|-|-|-|-|+|-|-|-|-|-|-|.}}
{{familytree | | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|.| | | | | | |}}
{{familytree | | | C01 | | | | | | | | | | | | | | C02 | | | | | C03 | | | | | C04 | | | | | C05 | |C01=Single|C02=Multiple|C03=Cystadenoma|C04=Cyst adenocarcinoma|C05=Choledochal cyst|}}
{{familytree | | | | C01 | | | | | | | | | | | C02 | | | | | |C01=Thin walled|C02=Thick walled Septations|}}
{{familytree | | | |!| | | | | | | | | | | | | | | |!| }}
{{familytree | | | | |!| | | | | | | | | | | | |!| | |}}
{{familytree | | | D01 | | | | | | | | | | | | | | D02 | |D01=Simple Hepatic cyst|D02=Polycystic Liver Disease}}
{{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}}
{{familytree/end}}
</div>
{| border="1" cellpadding="5" cellspacing="0" align="center" |class="wikitable"
! style="background:#efefef;" |Classification of Hepatic Cysts
|-
|
*[[Hepatic cysts|Simple cysts]]
*Multiple cysts arising in the setting of polycystic liver disease (PCLD)
*[[Echinococcal cyst|Parasitic cysts]]
*Cystic tumors
**[[Cystadenoma]], [[cystadenocarcinoma]], [[squamous cell carcinoma]]
*[[Hepatic abscess|Abscesses]]
|}
* Clinically a liver mass can be classified into 3 catogeries
** Benign mass lesions for which no treatment is needed
** Benign mass lesions for which treatment is needed
** Malignant mass lesions for which treatment is always required
==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.