Benign tumors of the liver
Benign tumors of the liver in mostits low-symptom clinically benign tumors derived from epithelial tissues like (hepatocellular adenoma, etc.), or from stromal and vascular elements (hemangioma et al.).
Let us describe briefly the main ones.
hepatocellular adenoma - Clinically benign malosimptomnoadenoma tumor type, emerging from hepatocytes, often demarcated capsule. With vigorous growth of the tumor can break with the damage of blood vessels and bleeding.
Focal nodular hyperplasia of the liver - Clinically benign malosimptomnoswelling of the central part of which is represented by scar connective tissue and peripheral - uzelkovotransformirovannoy gepatotsellyulyarioy cloth. Often seen in the tumor foci of necrosis and hemorrhage. As a rule, it does not develop in a cirrhotic liver, therefore sometimes referred to as "focal cirrhosis."
Nodular regenerative hyperplasia of the liver close, and sometimes combined with the focalnodular hyperplasia of the liver. In contrast to the latter it presents significantly less connective tissue elements. It can be considered as preliminary stages gepatotsellyulyarioy carcinoma. Sometimes, when the growth of the tumor cells are squeezed major bile ducts, or large branches of the portal vein. As a rule, it does not develop in a cirrhotic liver.
hemangioma of the liver - Clinically benign malosimptomnotumors originating from vascular, mainly hepatic venous components. Refers seems to mean most recognizable of benign liver tumors.
All major types of benign tumorsLiver diseases are oligosymptomatic. In many cases, finding them refers to random findings. At larger sizes, and the corresponding location of the tumor are sometimes symptoms of compression of the biliary tract, at least - the symptoms of portal hypertension.
Diagnosis of liver benign tumors
The liver is usually not significantly increased (with the exceptionare large hemangiomas). Peripheral blood is not changed. The content of a-fetoprotein, carcinoembryonic antigen, aminotransferases, GGTF, alkaline phosphatase, LDH, and GDH, serum bilirubin within normal limits. The exceptions are patients who have benign liver tumor develops on the background of the active diffuse liver diseases.
Of informative instrumental methods. Radionuclide liver scintigraphy performed as usual with suspected surround the process in the liver in two projections. With this method it is possible to detect a tumor diameter of 4.5 cm or more. In connection with this method has fundamental importance in the recognition of hemangiomas, since the other three types of tumor are often smaller. When hemangiomas 4-5 cm size of the liver and a tumor is detected in 70-80% of patients. With the help of ultrasound during liver hemangioma detected hyperechoic, well-marked degree. Often, especially in the left lobe, clearly visible vascular pedicle.
Differential diagnosis at this stage beforeall carried out with the parasitic liver cysts (hydatid disease). In favor of the latter show a positive reaction to hydatid antigen reaction Katsoni, as well as in the area of detection of tumor formation of calcifications.
Computed tomographic studyIt provides data close to the ultrasound results, but often provides diagnostic and additional information relating to the first condition of the surrounding tissues and organs. Tseliakografiya most informative in recognition of hemangiomas. Usually clearly visible hypervascular areas with clear boundaries, allowing to detect a size of 2-3 cm hemangioma and more in 80-85% of patients.
Indirect radionuclide angiography, performed using gammakamery gives similar, but less accurate than with tseliakografiey results.
In no hepatocellular adenomas tend bile ducts. Therefore, during the radionuclide biliary scintigraphy in adenomas can register "silent zones".
In the diagnosis of hepatocellular adenoma, focalnodular hyperplasia of the liver and nodular regenerative hyperplasia of the liver play a decisive role of the sighting (under ultrasound and computed tomography) liver biopsy. The complexity of the morphological assessment of the resulting material often requires study of its morphology and cytology, which specialize in the field of liver disease.
The differential diagnosis is carried out beforewith only the most common benign tumors of the liver, followed by malignant tumors. In recent years, it is increasingly subject to differential diagnosis becomes a kind of focal fatty liver, especially in cases when the background of focal fatty degeneration occur rounded portions of the intact liver. These sites are of different density with steatosis, and the difference is quite clearly recorded with the help of ultrasound and computed tomography. These psevdoopuholevye education is usually not visible at radionuclide scintigraphy liver. However, this differential-diagnostic feature is not very reliable. A crucial role in the detection of focal fatty degeneration plays a sighting of a liver biopsy.
Treatment of liver tumors dobrakachestvennyh
Hepatocellular adenoma, focal nodularhyperplasia of the liver and liver nodular regenerative hyperplasia in the medical and surgical treatment, as a rule, not need. The exception is a tumor compressing the bile ducts. In these cases, there are indications for liver resection respective segments. Methods for secondary prevention. For all types of benign liver tumors prohibited drugs such as oral contraceptives, anabolic steroids. Not Recommended intake of drugs such as phenobarbital and ziksarin. Large hemangiomas, squeezing bile ducts removed surgically.
All patients are in need of constant medicalobservation. When first discovered tumor examination carried out after 3-6 9-12 months, then -. 1 once a year. Besides the usual examination of the patient with Kurlov determination of liver size, examine the level of bilirubin, transaminases, alkaline phosphatase, GGTF, GDH and LDH and-fetoprotein and carcinoembryonic antigen.