The diagnostic and therapeutic approach for primary solid liver tumours in adults

The finding of a focal solid liver lesion represents a challenge for the clinician in terms of the most optimal diagnostic and therapeutic algorithm. Tumours may arise from hepatocytes (hepatocellular adenoma, dysplastic nodules and carcinoma), bile ducts (cholangiocarcinoma) or mesenchymal tissue (hemangioma, epithelioid haemangioendothelioma), or are metastases from primary tumours outside the liver. Focal nodular hyperplasia is the most frequent tumour-like lesion. Imaging techniques are able to detect and characterise most lesions. However, small hypervascular lesions in a cirrhotic liver may be difficult to characterise. More insight has been gathered recently in the histological classification of hepatocellular adenomas, but the differential diagnosis by imaging of adenoma versus FNH or well-differentiated hepatocellular carcinoma remains often difficult. The therapy of a focal liver lesion is determined by its natural history and the functional status of the surrounding liver parenchyma. Selected patients with primary liver cancer are candidates for liver transplantation, while patients with advanced malignant tumours have a poor outcome.