HEPATIC INCIDENTALOMA - RETROSPECTIVE ANALYSIS OF 35 GASES

At present imaging techniques and laboratory tests are employed very e xtensively to investigate obscure visceral symptoms. During these inve stigations it can happen that a liver lesion is discovered. This lesio n, solid or cystic, when discovered in the liver of a healthy person, is called hepatic incidentaloma. This study analyzes retrospectively t he diagnostic and therapeutic management of a series of 35 patients, w ith an asymptomatic lesion of the liver discovered incidentally. These patients had been observed over a period of five years (1988-1993). T here were 22 benign lesions and 13 hepatic cell carcinomas (HCCs), thr ee of which discovered in patients with non diagnosed cirrhosis, The p resence of a risk factor for HCC in the past history of the patient wi th a hepatic incidentaloma strongly suggests that the lesion is malign ant (p<0.05). The average age of patients with malignant lesions was s ignificantly higher than that of patients with benign lesions (65 vs 4 5 years; p<0.01). Symptoms and/or signs did not help to distinguish be tween patients with benign and malignant lesions. Serum alkaline phosp hatase (SAP) and alpha-fetoprotein levels were significantly higher in patients with malignancies (p<0.01). A certain diagnosis was achieved preoperatively in 85% of the cases. In the remaining 15%, a definitiv e diagnosis was reached only after surgery Surgical or percutaneous tr eatment was required in 80% of the cases. In conclusion, although in a minority of cases, surgery is still required for definitive diagnosis of a hepatic incidentaloma.