The liver is a common site for both benign and malignant liver tumours.
The patient will understandably become very concerned about a comment
that there is a lump in the liver. There are often features about a
“lump in the liver” which can quickly reassure us that the
lesion is benign i.e. non malignant.
There are many causes of benign liver tumours but the most common ones
we see are:
1. Liver cysts.
3. Focal nodular hyperplasia.
4. Hepatic adenomas.
1. Liver cysts.
Liver cysts have a number of causes including parasitic infections
(hydatid disease), cystadenoma of the liver (a rare liver tumour which
has a strong tendency to recur and has the potential to turn malignant)
and Caroli’s Syndrome where there is dilatation of small bile
ducts with infection frequently occurring in these ducts (cholangitis).
The majority of cysts in the liver, however, are benign simple liver
Asymptomatic liver simple cysts are found in about 1% of adults and
usually discovered accidentally on ultrasonography or CT scanning.
In the vast majority of patients are asymptomatic. The cysts vary
in size from as small as a few mms to as big as 20 cms although the
majority are under 2 cms in size. A half of adults will have more than
1 cyst and occasionally there are multiple liver cysts. This can be
associated with polycystic kidney disease. In this condition, the kidney
disease is of clinical importance and the liver cysts only occasionally
will cause problems.
The vast majority of cysts cause no symptoms whatsoever. Very large
cysts can occasionally cause abdominal pain or discomfort. Interestingly,
very large cysts are almost exclusively seen in women.
The cysts can usually be diagnosed reliably on ultrasound and CT scanning.
It is important, however, to exclude hydatid disease (a parasitic infection
of the liver resulting in cysts), secondary cancers in the liver which
have become cystic and cystadenomas
Asymptomatic simple cysts, even when large, need no treatment. Removing
the fluid content of the cysts with a needle under ultrasound does not
provide definitive therapy and the cyst recurs usually rapidly. In the
occasional patient where the cyst is large and causing symptoms, it
can be removed surgically
This is the commonest benign liver tumour and when it is over 2 cms
in diameter, there are often very specific appearances present on
of the liver with an isotope scan. In addition, fairly characteristic
changes can occur on CT scanning & Magnetic Resonance Imaging (MRI).
In this condition, liver tests are normal and usually there are no
symptoms. Niggling or sharp abdominal pains can occur and the lesions
may expand during pregnancy and in women taking oral contraceptive pills.
Simple pain relief is usually the only treatment required but very
large lesions sometimes require resection, especially if pain is a problem.
Complications such as rupture are very rare and these lesions
do not become malignant.
It is usual for the radiologist to be able to give a confident diagnosis
of haemangioma on imaging studies. Occasionally, however, this is not
possible and these lesions are often then just observed. Very occasionally,
liver biopsy is performed and in those instances often the radiologist
will find that blood is aspirated when the needle is in the lesion.
3. Focal nodular hyperplasia (FNH)
This lesion is probably caused by abnormalities in the vascular supply
to a part of the liver. Characteristically a central scar will occur
in an area of focal nodular hyperplasia and this can give characteristic
features on scanning.
It is uncommon for these lesions to cause symptoms unless large when
they can be associated with pain.
It has been thought in the past that enlargement may occur during pregnancy
or with the oral contraceptive pill or oestrogen treatment. This is
controversial, however, and it is now not routinely suggested that patients
stop the oral contraceptive pill if a confident diagnosis of FNH has
This lesion has no malignant potential and complications such as rupture
and bleeding are rare.
These rare benign tumours are sometimes difficult to distinguish from
focal nodular hyperplasia (FNH). They are very vascular and thus liver
biopsy can be dangerous i.e. significant bleeding can occur.
It is sometime difficult to distinguish an hepatic adenoma from a primary
liver cancer in a non cirrhotic liver and surgical resection is usually
The risk of complications of this rare lesion is especially high during
pregnancy or in women taking oral contraceptives or oestrogen.
Gilberts Disease (The
Disease That Is Not A Disease)
What is it?
Gilbert’s Syndrome was named after a French gastroenterologist.
It is a common, often inherited disease, where the processing by the
liver of the pigment bilirubin is sluggish. This can lead to an abnormal
increase in bilirubin in the blood and a yellowish tinge to the skin
The liver, however, remains normal and it is not a disease. It cannot
cause any problems.
Gilbert’s Syndrome is probably caused by a decrease in the activity
of an enzyme in the liver which processes bilirubin. It affects approximately
5% of the population and is thus very common. It is usually detected
when blood tests are performed.
What are the Clinical Features?
Usually there are no symptoms but sufferers can experience mild jaundice.
It is said by some that bouts of abdominal pain, loss of appetite and
fatigue can also occur although this has never been confirmed. When
someone with Gilbert’s Syndrome does not eat for a period of time,
they will often develop the yellowing of the skin and it can also occur
when they are unwell for other reasons e.g. a respiratory tract infection.
Vigorous exercise, a feverish illness or repeated vomiting can also
cause the yellowing to occur.
Investigations and Treatment
Simple blood tests are usually carried out and can almost invariably
make the diagnosis. Occasionally, there can be some confusion with conditions
which cause an excess breakdown of red blood cells (haemolysis).
There is no treatment required for Gilbert’s Syndrome.
People with Gilbert’s Syndrome have a normal life expectancy
and there is no evidence that the disorder is associated with other
serious liver diseases.
We do bother about Gilbert’s Syndrome because suddenly becoming
yellow can be very alarming to a person. Jaundice itself can be a sign
of a serious or infectious disease and rightly causes concern to doctors
and also to sufferers and their families.
Knowing about the diagnosis as a harmless Gilbert’s Syndrome,
therefore not only provides reassurance to the sufferer but also to