Benign Hepatic Tumours

Zusammenfassung

Gutartige Lebertumoren umfassen ein großes Spektrum von regenerativen und echt-neoplastischen Prozessen. Fortschritte in den bildgebenden Verfahren wie NMR, CT und Sonographie sowie verbesserte Möglichkeiten der histologischen Untersuchung durch den Einsatz immunhistochemischer Verfahren ermöglichen die richtige Diagnose bei den meisten Patienten. Laparotomie und Resektion sind daher oft zu vermeiden. Die Differenzialdiagnose zwischen fokal-nodulärer Hyperplasie und hepatozellulärem Adenom ist klinisch am wichtigsten, da es beim hepatozellulären Adenom zur Ruptur und Blutung kommen kann. Das kavernöse Hämangiom, der häufigste benigne Lebertumor, muss fast nie behandelt werden. Die Diagnose der nodulär-regenerativen Hyperplasie gestaltet sich häufig schwierig und die Patienten werden erst durch Zeichen und Komplikationen der portalen Hypertension auffällig. Das seltene Angiomyolipom muss nicht behandelt werden. Die Relevanz besteht in der Abgrenzung zu malignen Prozessen. Auch der inflammatorische Pseudotumor kann zu Verwechslungen mit malignen Geschehen Anlass geben, da die klinischen Zeichen wie z.B. eine B-Symptomatik sich häufig gleichen. Therapeutische Optionen sind die medikamentöse Therapie oder ein chirurgisches Vorgehen. Das kindliche benigne Hämangioendotheliom ist selten, kann aber lebensgefährliche Komplikationen verursachen. Das Gallengangsadenom ist häufig eine Zufallsdiagnose, der keine klinische Bedeutung zukommt, wohingegen das biliäre Zystadenom oft symptomatisch wird und aufgrund der möglichen malignen Entartung reseziert werden muss.

Abstract

Benign hepatic tumours include a broad spectrum of regenerative and true neoplastic processes. Due to advances in imaging procedures like MRI, CT-scan and ultrasound as well as progress in immunohistochemistry, the appropriate diagnosis is made in a high percentage of patients without laparotomy and resection. Most important in clinical practice is the differential diagnosis of focal nodular hyperplasia and hepatocellular adenoma because of the risk of rupture and bleeding in the latter. Cavernous haemangioma, the most common benign hepatic tumour, rarely needs treatment. The diagnosis of nodular regenerative hyperplasia is often missed and patients present with secondary complications and signs of portal hypertension that necessitate treatment. The main problem in angiomyolipoma is to distinguish it from malignant processes which do require treatment. Because of its clinical presentation, inflammatory pseudotumour is also sometimes confused with a malignant tumour. Therapeutic options are drug therapy or surgical resection. Benign haemangioendothelioma of the infant is rare but may cause life-threatening complications. Bile duct adenoma is an incidental finding that is not known to cause any symptoms whereas biliary cystadenoma is often symptomatic and may progress to cystadenocarcinoma and therefore needs resection.

Schlüsselwörter

Gutartige Lebertumoren - kavernöses Hämangion - hepatozelluläres Adenom - fokal noduläre Hyperplasie - noduläre regenerative Hyperplasie - Angiomyolipom - infammatorischer Pseudotumor - benignes Hämangioendothelion - Gallengangsadenom - biliäres Zystadenom

Key words

Benign hepatic tumours - cavernous haemangioma - hepatocellular adenoma - focal nodular hyperplasia - nodular regenerative hyperplasia - angiomyolipoma - inflammatory pseudotumour - benign haemangioendothelioma - bile duct adenoma - biliary cystadenoma

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