Liver mass classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2] Aditya Ganti M.B.B.S. [3]

## Overview

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A liver mass may be grouped into several subtypes based on the number of nodules (solitary or multiple), type of histopathology (benign or malignant), and consistency (solid or cystic).

## Classification

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A liver mass may be classified into several sub-types based on number of nodules, type of histo-pathology, and consistency.[1][2][3][4][5][6][7][8][9][10][11]

| Liver mass|

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| Based on number of nodules|

| Type of histopathology|

| Imaging/consistency|

| Solitary|

| Multiple|

| Benign|

| Malignant|

| Solid|

| Cystic|

### CLassification based on the number of nodules

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* Liver mass based on the number of nodules on imaging can be classified into 2 types:
* Solitary nodule
* Multiple nodules

| Solid liver mass|

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| No history of liver disease|

| History of liver disease|

| Asymptomatic|

| Symptomatic|

| Arterial enchancement with washout|

| Only arterial enchancement|

| Persistant arterial enhancement|

| Weight loss|

| HCC|

| Dyspatic nodule|

| Cholangiocarcinoma|

Adenoma|

| FNH*|

| Hemangioma|

| Metastasis
H/O of cancer|

| Fibrolammellar HCC
No H/O of cancer|

Abbreviations:

* FNH: Focal nodular hyperplasia

### Classification based on histopathology

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* Based on the type of histopathology, liver mass can be classified into 2 types:
* Benign
* Malignant

WHO Classification of Liver Tumors

Benign Tumors  | Malignant Tumors
Epithelial  | Hepatocytes  |

* Focal nodular hyperplasia
* Hepatocellular adenoma

* HCC
* Fibrolamellar carcinoma
* Hepatoblastoma
* Carcinosarcoma

Biliary cells  |

* Intrahepatic bileduct adenoma
* Intrahepatic bileduct cystadenoma
* Biliary papillomatosis

* Cystadenocarcinoma
* Cholangiocarcinoma

Non-Epithelial  | Mesenchymal  |

* Hemangioma
* Lymphangioma
* Lymphangiomatosis
* Angiomyolipoma
* Infantile Hemangioma

* Hemangioendothelioma
* Primary lymphoma
* Angiosarcoma
* Epitheloid

### Classification based on consistency

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* Based on the consitency of the mass, liver mass can be classified into 2 types:
* Solid
* Cystic
* Complex cysts
* Solid cysts

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| Cystic|

| Solid|

| Thin walled|

| Thick walled Septations|

Single|

| Multiple|

| Cystadenoma|

| Cyst adenocarcinoma|

| Choledochal cyst|

Simple Hepatic cyst|

| Polycystic Liver Disease|

## References

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1. ↑ Mergo PJ, Ros PR. Benign Lesions of the Liver. In: The Radiologic Clinics of North America, 2, W.B. Saunders, Philadelphia 1998. Vol 36, p.319.
2. ↑ Kim TK, Lee E, Jang HJ (2015). "Imaging findings of mimickers of hepatocellular carcinoma". Clin Mol Hepatol. 21 (4): 326–43. doi:10.3350/cmh.2015.21.4.326. PMC 4712159. PMID 26770920.
3. ↑ Ferrell, Linda (2000). "Liver Pathology: Cirrhosis, Hepatitis and Primary Liver Tumors. Update and Diagnostic Problems". Modern Pathology. 13 (6): 679–704. doi:10.1038/modpathol.3880119. ISSN 0893-3952.
4. ↑ Kim, Tae Kyoung; Lee, Eunchae; Jang, Hyun-Jung (2015). "Imaging findings of mimickers of hepatocellular carcinoma". Clinical and Molecular Hepatology. 21 (4): 326. doi:10.3350/cmh.2015.21.4.326. ISSN 2287-2728.
5. ↑ Doo, Kyung Won; Lee, Chang Hee; Choi, Jae Woong; Lee, Jongmee; Kim, Kyeong Ah; Park, Cheol Min (2009). ""Pseudo Washout" Sign in High-Flow Hepatic Hemangioma on Gadoxetic Acid Contrast-Enhanced MRI Mimicking Hypervascular Tumor". American Journal of Roentgenology. 193 (6): W490–W496. doi:10.2214/AJR.08.1732. ISSN 0361-803X.
6. ↑ Zech CJ, Herrmann KA, Reiser MF, Schoenberg SO (2007). "MR imaging in patients with suspected liver metastases: value of liver-specific contrast agent Gd-EOB-DTPA". Magn Reson Med Sci. 6 (1): 43–52. PMID 17510541.
7. ↑ Cheng, H C; Tsai, S H; Chiang, J H; Chang, C Y (1995). "Hyalinized liver hemangioma mimicking malignant tumor at MR imaging". American Journal of Roentgenology. 165 (4): 1016–1017. doi:10.2214/ajr.165.4.7676959. ISSN 0361-803X.
8. ↑ Haratake J, Horie A, Nagafuchi Y (1992). "Hyalinized hemangioma of the liver". Am. J. Gastroenterol. 87 (2): 234–6. PMID 1370873.
9. ↑ Takayasu, K; Moriyama, N; Shima, Y; Muramatsu, Y; Yamada, T; Makuuchi, M; Yamasaki, S; Hirohashi, S (1986). "Atypical radiographic findings in hepatic cavernous hemangioma: correlation with histologic features". American Journal of Roentgenology. 146 (6): 1149–1153. doi:10.2214/ajr.146.6.1149. ISSN 0361-803X.
10. ↑ Yamashita Y, Shimada M, Taguchi K, Gion T, Hasegawa H, Utsunomiya T, Hamatsu T, Matsumata T, Sugimachi K (2000). "Hepatic sclerosing hemangioma mimicking a metastatic liver tumor: report of a case". Surg. Today. 30 (9): 849–52. PMID 11039718.
11. ↑ Kim, Tae Kyoung; Lee, Eunchae; Jang, Hyun-Jung (2015). "Imaging findings of mimickers of hepatocellular carcinoma". Clinical and Molecular Hepatology. 21 (4): 326. doi:10.3350/cmh.2015.21.4.326. ISSN 2287-2728.