Neoplasm of Liver-I
Dr. Ashraf Abdelfatah
Faculty of Medicine
Objectives
1. Classify common benign liver tumors.
2. Discuss etiopathogenesis.
3. Morphological features.
4. Clinical features & Complications.
Benign Liver Lesions
Nodule or tumors of liver may generate epigastric
fullness and discomfort or be detected by
routine physical examination or radiographic
studies for other indications. Classify into:
I. NEOPLASTIC LESION:
1.Hemangioma “Cavernous”
2.Adenoma
II. NON-NEOPLASTIC LESION:
1.Focal nodular hyperplasia
2.Cysts
Focal Nodular Hyperplasia (FNH)
Clinical Features
Benign nodule formation of normal liver.
Non-neoplastic lesion but Hyperplastic.
Confused with Nodular regenerative hyperplasia (Focal
vs Diffuse)
More common in young and middle age.
Usually asymptomatic, May cause minimal pain
Etiology: Long-term use of anabolic hormones or of
contraceptives have been implicated in the
development of focal nodular hyperplasia.
Focal nodular hyperplasia.
A, Resected specimen showing lobulated contours and a central
stellate scar. Well –demarcated, poorly encapsulated.
B. More lighter than yellowish than the adjacent.
Focal nodular hyperplasia
Well-demarcated, subcapsular, light brown to yellow ; bulging
nodule, 70-80% solitary, up to 5 -10cm; has central gray-white
stellate scar; hemorrhage, necrosis, infarction, bile staining often
seen; larger tumors may have multiple scars; adjacent liver is
normal
Focal nodular hyperplasia
(FNH)
There is a central gray-white, depressed stellate scar with fibrous septa
radiating to the periphery. The central scar contains large vessels with
fibromuscular hyperplasia +intense lymphocytic infiltrates and bile duct
proliferation + normal hepatocytes with regeneration.
Cavernous Hemangioma
Clinical Features
The most commonest benign liver tumor,
arising from blood vessels.
5% of autopsies
Usually single small
Well demarcated capsule
Usually asymptomatic
Hemangioma
Gross: solitary (70-90%), usually less < 2 cm, although tumors
up to 20 cm; soft, red-purple, well circumscribed; subcapsular or
deep; collapse when sectioned as blood oozes out
Hemangioma. The photomicrograph shows the thinwalled vascular channels embedded in fibrous stroma.
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Cavernous Hemangioma
Micro: variably sized
vascular spaces lined
by flat endothelial cells.
Myxoid or fibrous
stroma; large fibrous
septa may trap bile
ducts.
Variable thrombosis,
calcification.
Increased fibrosis with
age of lesion may
obliterate lumen
Hepatic Adenoma
Clinical features
Benign solitary capsulated nodule of the liver composed
of neoplastic hepatocytes with no portal tract, central
veins, or bile ducts. Very vascular.
More common in women who have used oral
contraceptives.
generally regress if contraceptive use is terminated.
Etiopathogenesis:
Hormonal stimulation is clearly associated, still the
causal events are unknown.
2. Mutations in the genes HNF1α and β-catenin
1.
3.
Glycogen storage disease.
Hepatic Adenoma
Clinical features
have clinical significance for three reasons:
1. An intrahepatic mass they may be mistaken for the
more ominous hepatocellular carcinomas.
2. Subcapsular adenomas have a tendency to rupture,
particularly during pregnancy (under estrogen
stimulation), causing life-threatening intraperitoneal
hemorrhage.
3. May transform into carcinomas,

Glycogen storage disease,
 Mutations of the β-catenin gene.
Liver Cell Adenoma
Gross: solitary pale, yellow-tan, frequently bile-stained
nodules, often subcapsular, 10-30 cm, sharply demarcated or
encapsulated; usually right lobe; usually no fibrous septa or
central scar; adjacent liver is non-cirrhotic
Liver cell adenoma.- Resected specimen presenting as a
pendulous mass arising from the liver..
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Liver Cell Adenoma
* Normal liver tissue with a portal tract is seen on the left.
* The hepatic adenoma is on the right show of loss of lobular
architecture and is composed of sheet and cords of cells that
closely resemble normal hepatocytes, but the neoplastic liver
tissue has disorganized (portal tracts are absent) . + Focal
clearing (of glycogen origin) +\- Steatosis+ Arterial vascular
supply
Liver Cysts
May be single or multiple
common in developing
countries
Causes:
Non-infectious: May be part of
polycystic kidney disease.
2. Infectious: Echinococcal
(ingestion of tapworm eggs) and
amebic infections+ other.
1.
Patients often asymptomatic,
sometimes complicated with
bacterial infection Pyogenic
Hydated cyst
Echinococcal infection demonstrating laminated
cystic wall
(B) showing the laminated cystic wall with hooklet
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Liver cyst\Abscess
Route of infection
The organisms reach
the liver by
(1) Portal vein.
(2) Arterial supply.
(3) Ascending infection
in the biliary tract
(ascending cholangitis).
(4) Direct invasion of
the liver from a nearby
source.
(5) Penetrating injury
Complications
Rupture of subcapsular
liver abscesses can
lead to:
1. Peritonitis.
2. Localized peritoneal
abscesses.
3. Anaphylactic shock