Gutartige Lebertumoren

The three clinically most relevant benign liver tumors and intrahepatic tumor-like lesions are (cavernous) hemangiomas, focal nodular hyperplasias (FNH) and hepatic adenomas (HCA). Most frequently, these lesions are detected as incidental findings in the context of abdominal ultrasound examinations and diagnosis can be accurately confirmed by dynamic, contrast-enhanced imaging (especially magnetic resonance imaging). Thus, liver histology is only required in rare, ambiguous cases. Importantly, the diagnosis of a benign liver lesion must be questioned and critically evaluated in all patients with pre-existing chronic liver disease, cirrhosis or known extrahepatic malignancies. Since the clinical course of hemangiomas and FNH is favorable and without complications, conservative strategies without long-term surveillance are usually recommended. However, in HCA occurrence of complications is directly related to the size of the lesion and comprises rupture or bleeding in approximately 30 % of the cases when size exceeds 5 cm. Depending on the proliferative capacity, gender, histological as well as molecular subtype (i. e. β‑HCA), risk of malignant transformation into hepatocellular carcinoma is also increased. Treatment strategies for HCAs primarily involve discontinuation of oral contraceptives, weight reduction and close monitoring of the lesions. If this approach is unsuccessful and lesions display progressive growth or cause persistent symptoms, resection should be performed. For HCA in men, resection is generally recommended regardless of the lesion size due to increased risk of malignant transformation.