Benign and solid tumors of the liver: Relationship to sex, age, size of tumors, and outcome

From 1983 through 1997, our center diagnosed 130 cases of benign neoplasms: 27 with focal nodular hyperplasia (FNH), 25 with hepatic adenoma, 71 with cavernous hemangioma, and seven with mixed tumors of different diagnoses. M ost often these lesions were seen in females [female-to-male ratio (f/m): 5 .5/1]. Hepatic adenomas and mixed tumors were seen exclusively in females a nd FNH predominantly in females (f/m: 26/1). Hemangiomas, however, were not uncommon in men (f/m: 52/19) relative to the other tumors (P < 0.001). Fur thermore patients with hemangioma were older (mean age: 49 years) whereas p atients with hepatic adenoma, FNH, and mixed tumors were often younger (mea n age: 33, 35, and 44 years respectively; P < 0.004). Oral contraceptive st eroid use was related by 21 of 25 patients (84%) with hepatic adenoma, 22 o f 26 (85%) females with FNH, five of seven (71%) females with mixed tumors, and 10 of 52 (19%) patients with hemangioma. Ninety-five of the 130 patien ts (73%) had one or more symptoms. There was no statistically significant c orrelation between symptoms and the size of the lesion, the final diagnosis , and whether there were solitary or multiple masses. Three of 25 (12%) wit h hepatic adenoma presented with rupture, and one of 27 (4%) with FNH had s uch a consequence. None of the hemangiomas presented with rupture or progre ssed to such a state. One patient with hepatic adenoma (4%) had a focus of malignancy. Surgical removal of benign tumors was performed in 82 of 130 pa tients (63%), and there was one operative mortality (1.2%) in a patient who had a caudate lobe FNH. The types of surgical procedures included segmente ctomy (62%), lobectomy (34%), and trisegmentectomy (4%). In two of 84 patie nts who had undergone laparotomy resection was not technically possible. Re section is recommended in all cases of hepatic adenoma because of fear of r upture or associated focus of malignancy. FNH was not observed to undergo a malignant transformation and will rarely rupture. Surgery is only recommen ded for symptomatic hemangioma, and size of the lesion is not a criterion f or excision.