Review
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jul 14, 2009; 15(26): 3217-3227
Published online Jul 14, 2009. doi: 10.3748/wjg.15.3217
Characteristics of common solid liver lesions and recommendations for diagnostic workup
Nimer Assy, Gattas Nasser, Agness Djibre, Zaza Beniashvili, Saad Elias, Jamal Zidan
Nimer Assy, Liver Unit, Ziv Medical Center, Zefat 13100, Israel, Faculty of Medicine, Technion Institute of Technology, Haifa 32000, Israel
Gattas Nasser, Liver Unit, Ziv Medical Center, Zefat 13100, Israel
Agness Djibre, Department of Medicine, Western Galilee Hospital, Nahariya 22100, Israel
Zaza Beniashvili, Liver Unit, Ziv Medical Center, Zefat 13100, Israel
Saad Elias, Department of Medicine, Ziv Medical Center, Zefat 13100, Israel
Jamal Zidan, Institute of Oncology, Ziv Medical Center, Zefat 13100, Israel; Faculty of Medicine, Technion Institute of Technology, Haifa 32000, Israel
Author contributions: The manuscript was written by Assy N, Nasser G, Djibre A, Beniashvili Z; Elias S collected data and designed the manuscript; Zidan J reviewed the manuscript prior to submission.
Correspondence to: Nimer Assy, MD, Liver Unit, Ziv Medical Center, Zefat 13100, Israel. assy.n@ziv.health.gov.il
Telephone: +972-4-6828441
Fax: +972-4-6828442
Received: May 4, 2009
Revised: June 8, 2009
Accepted: June 15, 2009
Published online: July 14, 2009
Abstract

Due to the widespread clinical use of imaging modalities such as ultrasonography, computed tomography and magnetic resonance imaging (MRI), previously unsuspected liver masses are increasingly being found in asymptomatic patients. This review discusses the various characteristics of the most common solid liver lesions and recommends a practical approach for diagnostic workup. Likely diagnoses include hepatocellular carcinoma (the most likely; a solid liver lesion in a cirrhotic liver) and hemangioma (generally presenting as a mass in a non-cirrhotic liver). Focal nodular hyperplasia and hepatic adenoma should be ruled out in young women. In 70% of cases, MRI with gadolinium differentiates between these lesions. Fine needle core biopsy or aspiration, or both, might be required in doubtful cases. If uncertainty persists as to the nature of the lesion, surgical resection is recommended. If the patient is known to have a primary malignancy and the lesion was found at tumor staging or follow up, histology is required only when the nature of the liver lesion is doubtful.

Keywords: Liver mass; Hepatic nodule; Tumor; Lesion; Cirrhosis; Hepatocellular carcinoma; Magnetic resonance imaging; Ultrasonography; Computed tomography; Fine needle aspiration; Biopsy