Abstract
As clinical skills give way to increased reliance on organ imaging, a new clinical problem is identified-the hepatic “incidentaloma.” This may be defined as an unexpected solid filling defect in the liver of a well patient. Thirty-six such lesions have been seen in one practice over a period of 36 months. Twenty-nine (81%) were benign: 24 (67%) nonneoplastic conditions and 5 (14%) benign tumors. The remaining 7 (19%) were malignant: 5 secondary tumors and 2 primary tumors. Patients with physical signs of liver mass or enlargement were more likely to harbor malignancies. An elevated serum alkaline phosphatase (SAP) was suggestive of malignancy. Hepatic hemangioma was the most common single diagnosis (20 patients, 56%). We propose a regimen of investigation which should allow diagnosis to be reached in about one-half of these patients without admission to the hospital. The rest will need at least a short hospital admission for angiography and fine-needle aspiration biopsy.
Résumé
Plus l'imagerie se développe, moins on se fie à la clinique et un nouveau problème clinique est identifié—“l'incidentalome” hépatique. Il peut se définir comme une lésion pleine inattendue au foie d'un patient en bonne santé. Dans notre pratique, en 36 mois, ont été vues 36 lésions de ce type. Il y avait 29 (81%) lésions bénignes dont 24 (67%) non néoplasiques et 5 (14%) tumeurs bénignes. Les 7 autres (19%) étaient malignes, 5 tumeurs secondaires et 2 primaires. Les patients ayant des signes physiques de masse du foie ou d'hépatomégalie étaient plus vraisemblablement porteurs de tumeurs malignes. Un taux de phosphatases alkalines élevé était signe de malignité. L'hémangiome hépatique était le diagnostic le plus courant (20 patients, 56%). Nous proposons une méthode d'investigation qui devrait permettre de faire le diagnostic pour la moitié des patients environ sans hospitalisation. Les autres demanderont au minimum une courte hospitalisation pour angiographie et ponction à l'aiguille fine.
Resumen
Los avances en la imagenología diagnóstica han dado lugar a la identificación de un nuevo problema clínico: el “incidenteloma” hepático. Este puede ser definido como un no sospechado defecto de llenamiento en el hígado de un paciente asintomático. Hemos visto 36 de tales lesiones en nuestra práctica en el curso de 36 meses. Veintinueve (81%) fueron benignas: 24 (67%) de ellas no neoplásicas, y 5 (14%) tumores benignos. Las otras 7 (19%) resultaron malignas: 5 tumores secundarios y 2 primarios. Los pacientes con signos de masa hepática o de aumento de tamaño del hígado exhibieron mayor probabilidad de tener una neoplasia maligna. La fosfatasa alcalina elevada fue sugestiva de malignidad. El hemangioma hepático representó el diagnóstico más común (20 pacientes, 56%). Proponemos un proceso de diagnóstico, el cual debe permitir establecer el diagnóstico en aproximadamente la mitad de estos pacientes, sin necesidad de hospitalización. El resto requiere por lo menos una corta hospitalización para realizar angiografía y biopsia mediante aspiración con aguja fina.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Copeland, P.M.: The incidentally discovered adrenal mass. Ann. Surg.199:116, 1984
Belldegrun, A., Hussain, S., Seltzer, S.E., Loughlin, K.R., Gittes, R.F., Richie, J.P.: Incidentally discovered mass of the adrenal gland. Surg. Gynecol. Obstet.163:203, 1986
Scheible, W.: A diagnostic algorithm for liver masses. Sem. Roentgenol.18:84, 1983
Snow, J.H., Goldstein, H.M., Wallace, S.: Comparison of scintigraphy, sonography, and computed tomography in the evaluation of hepatic neoplasms. Am. J. Roentgenol.132:915, 1979
Foster, J.H.: Primary benign solid tumours of the liver. Am. J. Surg.133:536, 1977
Foster, J.H.: Benign liver tumours. World J. Surg.6:25, 1982
Farlow, D.C., Chapman, P.R., Gruenewald, S.M., Antico, V.F., Farrell, G.C., Little, J.M.: Investigation of focal hepatic lesions: Is tomographic red blood cell imaging useful? World J. Surg.14:463, 1990
Little, J.M.: A comparison between primary and secondary liver cancer. Aust. N.Z. J. Surg.54:341, 1984
Kemeny, M.M., Sugerbaker, P.H., Smith, T.J.: Prospective analysis of laboratory tests and imaging studies to detect hepatic lesions. Ann. Surg.195:163, 1982
Chu, T.M., Douglass, Jr., H.O.: Laboratory tests in the diagnosis of liver disease. In Liver Surgery, S. Bengmark, L. Blumgart, editors, Edinburgh, Churchill Livingstone, 1986, pp. 8–18
Little, J.M., Hollands, M.J.: Hepatic resection for colorectal metastases-Selection of cases and determinants of success. Aust. N.Z. J. Surg.57:355, 1987
Hollands, M.J., Huang, J.F., Adams, W., Little, J.M.: Hepatocellular carcinoma in Western Sydney. Ann. Acad. Med. Singapore17:89, 1988
Lunderquist, A.: Radiology in hepato-pancreatico-biliary disease. In Progress in Surgery of the Liver, Pancreas and Biliary System, S. Bengmark, editor, Dordrecht, Martinuus Nijhoff, 1988, pp. 45–56
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Little, J.M., Kenny, J. & Hollands, M.J. Hepatic incidentaloma: A modern problem. World J. Surg. 14, 448–451 (1990). https://doi.org/10.1007/BF01658665
Issue Date:
DOI: https://doi.org/10.1007/BF01658665