Are hepatic solid space-occupying lesions necessarily liver cancer?

Hepatic parenchymal space-occupying lesions are a relatively serious liver lesion. This is a special term in medical imaging diagnosis. It mainly refers to the presence of something extra in the liver, which may be a benign tumor or a malignant tumor. Parasitic stones and so on may also be such cases. Generally speaking, benign space-occupying lesions of the liver are relatively rare, accounting for only about 5% to 10%. So we should be vigilant when this happens.

Are hepatic solid space-occupying lesions necessarily liver cancer?

Liver space-occupying lesions is a special term in medical imaging diagnosis, usually appearing in B-ultrasound, CT, and MRI examination results. It generally refers to the presence of "something extra" in the liver being examined, without involving the cause of the disease. It includes tumors (benign or malignant), parasites, stones and other diseases of different natures. It is not a synonym for liver cancer and is usually used for diagnosis when imaging examinations are difficult to confirm.

Hepatic space-occupying lesions can be divided into malignant space-occupying lesions and benign space-occupying lesions according to their nature. Malignant space-occupying lesions of the liver mainly include liver cancer, liver sarcoma, etc., among which liver cancer is the most common. Liver cancer is further divided into hepatocellular carcinoma, cholangiocarcinoma, and metastatic liver cancer.

Benign liver space-occupying lesions are much less common than malignant space-occupying lesions, accounting for about 5% to 10% of primary liver space-occupying lesions. Benign liver space-occupying lesions can be roughly divided into two types: cystic space-occupying and solid space-occupying. The former mainly includes liver cysts, liver abscesses, echinococcosis, etc., among which congenital liver cysts (commonly known as liver cysts) are more common; the latter mainly include hepatic hemangioma, hepatocellular adenoma, focal nodular hyperplasia, focal fatty liver, inflammatory pseudotumor, hepatic tumor-like hyperplasia, etc., among which hepatic hemangioma is the most common.

There are two types of hepatic hemangiomas: capillary hemangiomas and cavernous hemangiomas.

The latter is more common. Typical CT diagnostic indicators for hemangioma are as follows: (1) low density on plain scan; (2) nodular high-density enhancement at the edge of the lesion in the early stage of enhanced scan (45-120 seconds), with a density close to that of the aorta; and (3) progressive centripetal filling of contrast agent on delayed scan (5-15 minutes). The central area of ​​larger hemangiomas is often not completely filled, mainly due to thrombosis or fibrosis.

Hepatocellular adenoma is also a relatively rare benign tumor, which is common in women taking birth control pills and can also occur in some infants and young children with embryonic maldevelopment. Nodular hyperplastic lesions that occur on the basis of chronic hepatitis and cirrhosis are collectively referred to as adenomatous hyperplasia (AH). The pathological characteristics are the presence or absence of a capsule, rich blood supply, bleeding inside larger tumors, no obvious atypia of hepatocytes, few portal vein branches and bile duct branches among the hepatocytes, and lack of sinusoidal spaces. AFP is often negative. Some cases may develop into liver cancer or the tumor may rupture and bleed, leading to death. Treatment mainly involves stopping birth control pills and surgical removal of the lesion.

Focal nodular hyperplasia is a benign tumor composed of reticuloendothelial cells, hepatocytes, and blood vessels, and is usually unencapsulated. About 14% to 44% of tumors may have a stellate scar in the center, which contains small arteries, small veins and bile ducts. It is currently generally believed that focal nodular hyperplasia has no tendency to malignant transformation and is a reactive proliferation of local hepatocytes to congenital vascular malformations rather than a true tumor. The prognosis is good after local resection.

Focal fatty liver is a special type of fatty liver. It is a benign lesion with focal fat accumulation in the liver. It is more common in individuals with underlying metabolic diseases, such as diabetes, obesity, alcoholism, taking steroid drugs and overnutrition.

Inflammatory pseudotumor of the liver is a lesion characterized by the formation of tumor-like nodules due to inflammatory proliferation of local non-hepatic parenchymal cell components in the liver. It is generally considered to be a benign lesion with a good prognosis, and there have been no reports of canceration.

Hepatic tumor-like hyperplasia is a nodular hyperplastic lesion that develops on the basis of long-term chronic damage to the liver (such as chronic hepatitis, cirrhosis). It is a tumor-like lesion and has been confirmed to be a precancerous lesion of hepatocellular carcinoma.

After discovering a space-occupying lesion in the liver, the first thing to do is to make a qualitative diagnosis, that is, to determine the nature of the patient's liver space-occupying lesion, whether it is benign or malignant. The main means of qualitative diagnosis is to check the content of alpha-fetoprotein. If necessary, multiple tests can be carried out in conjunction with liver function tests and hepatitis virus index tests.