<aside>

Benign hepatic tumors are non-malignant masses that may arise from hepatocytes, bile duct epithelium, or vascular elements.

</aside>

https://youtu.be/WbHA2oQtw_Q?si=f0EFrJkg_Q_2_mlY

https://www.youtube.com/watch?v=fC5CtgjHKek

https://www.youtube.com/watch?v=s3TzDzlTREg

The three most common types are:

• Focal nodular hyperplasia (FNH) (hepatocytes & vessels)
• Hepatocellular adenoma (HCA) (hepatocytes)
• Hepatic hemangioma (vascular endothelium)

Radiology

Key Radiological Pearls

• FNH: Central scar + uptake on hepatobiliary phase = classic.
• Adenoma: Washout + no scar + no Eovist uptake = suspect.
• Hemangioma: Progressive peripheral to central fill + bright T2 = diagnostic.

![Hepatic haemangioma and focal nodular hyperplasia: a | Liver ultrasonography of hepatic haemangioma (HH) showed a homogeneous hyperechogenic nodule (arrow). b | MRI with the injection of gadolinium chelate of HH with hyperintensity on T2-weighted imaging and peripheral discontinuous and progressive centripetal enhancement from arterial to portal venous phases.  c | The main histological features (in red) and pathophysiological mechanisms (in blue) of focal nodular hyperplasia (FNH) are represented. d | Histology of FNH with a central fibrous scar, a central dystrophic artery and regenerative hepatocellular nodules. e | Map-like pattern of glutamine synthetase, a target gene of the Wnt–β-catenin pathway, at immunohistochemistry in a FNH sample. f | MRI with the injection of gadolinium chelate of an FNH showing a homogeneous nodule without capsule and arterial phase hyperenhancement except for the central scar that harbours a progressive enhancement on portal venous and late phases.

Nault, JC., Paradis, V., Ronot, M. et al. Benign liver tumours: understanding molecular physiology to adapt clinical management. Nat Rev Gastroenterol Hepatol 19, 703–716 (2022). https://doi.org/10.1038/s41575-022-00643-5](attachment:15896692-0e72-4f1d-bc2d-c2b9e299c453:41575_2022_643_Fig1_HTML.webp)

Hepatic haemangioma and focal nodular hyperplasia: a | Liver ultrasonography of hepatic haemangioma (HH) showed a homogeneous hyperechogenic nodule (arrow). b | MRI with the injection of gadolinium chelate of HH with hyperintensity on T2-weighted imaging and peripheral discontinuous and progressive centripetal enhancement from arterial to portal venous phases.  c | The main histological features (in red) and pathophysiological mechanisms (in blue) of focal nodular hyperplasia (FNH) are represented. d | Histology of FNH with a central fibrous scar, a central dystrophic artery and regenerative hepatocellular nodules. e | Map-like pattern of glutamine synthetase, a target gene of the Wnt–β-catenin pathway, at immunohistochemistry in a FNH sample. f | MRI with the injection of gadolinium chelate of an FNH showing a homogeneous nodule without capsule and arterial phase hyperenhancement except for the central scar that harbours a progressive enhancement on portal venous and late phases.

Nault, JC., Paradis, V., Ronot, M. et al. Benign liver tumours: understanding molecular physiology to adapt clinical management. Nat Rev Gastroenterol Hepatol 19, 703–716 (2022). https://doi.org/10.1038/s41575-022-00643-5

Comparison of imaging Features

![Stereotypical simplified MRI features of benign liver lesions: Lesions depicted include; haemangiomas, FNH, hepatocellular adenoma and angiomyolipomas. Abbreviations: FNH, focal nodular hyperplasia; HB, hepatobiliary; HCA, hepatocellular adenoma.

Belghiti, J., Cauchy, F., Paradis, V. et al. Diagnosis and management of solid benign liver lesions. Nat Rev Gastroenterol Hepatol 11, 737–749 (2014). https://doi.org/10.1038/nrgastro.2014.151](attachment:0d55783e-0e8a-4450-9cf7-45bf096c15b8:image.png)

Stereotypical simplified MRI features of benign liver lesions: Lesions depicted include; haemangiomas, FNH, hepatocellular adenoma and angiomyolipomas. Abbreviations: FNH, focal nodular hyperplasia; HB, hepatobiliary; HCA, hepatocellular adenoma.

Belghiti, J., Cauchy, F., Paradis, V. et al. Diagnosis and management of solid benign liver lesions. Nat Rev Gastroenterol Hepatol 11, 737–749 (2014). https://doi.org/10.1038/nrgastro.2014.151

Less Common Benign Liver Lesions