Hepatic incidentaloma: a modern problem

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 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.

PIP: Hepatic incidentaloma, a new entity--an unexpected solid filling defect in the liver of a well patient discovered incidentally by scanning--was characterized in a series of 36 patients. These undiagnosed solid liver masses were referred between 1985-1988 after ultrasound or CAT scans. There were 27 women and 9 men with a median age of 44.5. 67% had nonneoplastic lesions, 20 of them hemangiomas, 14 in women. 19% had malignant lesions, 5 with metastatic carcinoma of colorectal origin, and 2 women with primary hepatocellular carcinomas. 13 women had taken oral contraceptives for 3 months in the last 5 years. All of 4 of the patients with hepatic cell adenoma, and the patient with focal nodular hyperplasia had taken orals, while only 8 of the remaining patients had done so. 25% of the group had diagnoses not known to be linked to oral contraceptives. Other than those with malignancies who had a poor prognosis, the patients with hepatic cell adenoma and leiomyoma must have the lesion resected because of the risk of progression to malignancy.