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Benign tumors of a liver

Benign tumors of a liver in the majority clinically oligosymptomatic high-quality new growths coming as from epithelial fabric (hepatocellular adenoma, etc.), and from stromal and vascular elements (a hemangioma, etc.).

Let's stop on the short characteristic of the main of them.

Hepatocellular adenoma — clinically oligosymptomatic benign tumor like adenoma developing from hepatocytes is more often delimited by a capsule. With a vigorous growth the rupture of a tumor with damage of vessels and bleeding is possible.

Focal nodular hyperplasia of a liver — clinically oligosymptomatic benign tumor which central part is provided by cicatricial connecting fabric, and peripheral — uzelkovotransformirovanny gepatotsellyulyariy fabric. Quite often in a tumor the centers of a necrosis and hemorrhage are observed. As a rule, develops not in cirrhotically the changed liver therefore sometimes is called as "focal cirrhosis".

The nodular regenerator hyperplasia of a liver is close, and sometimes and is combined with a focal nodular hyperplasia of a liver. Unlike the last in it elements of connecting fabric are much less provided. Can be considered as a prestage of a gepatotsellyulyariy carcinoma. Sometimes with a growth of elements of this tumor large bilious channels or large branches of a portal vein are squeezed. As a rule, develops not in cirrhotically the changed liver.

Liver hemangioma — clinically oligosymptomatic benign tumor coming from vascular, mainly venous elements of a liver. Treats, apparently, the most often recognizable type of benign tumors of a liver.

Epidemiology
Data on the frequency of benign tumors of a liver are absent.

Etiology and pathogeny
The etiology and pathogeny of tumors of a liver are in many respects not specified. Development of hepatocellular adenoma is observed against long reception of peroral contraceptives, is more rare — anabolic steroids. The focal nodular hyperplasia and a nodular regenerator hyperplasia are perhaps close on an etiology to liver cirrhoses. The nodular regenerator hyperplasia of a liver, quite often develops against malignant diseases of extrahepatic localization (myeloproliferative diseases, sarcomas, etc.).

Classification
There is no standard classification of benign tumors of a liver yet.

Approximate formulation of the diagnosis:
1. A hemangioma of the I segment of a liver (7 cm in the diameter) with a prelum of a large bilious channel and development of an easy non-constant cholestatic syndrome.
2. Slow cryptogenic cirrhosis. Clinically asymptomatic hepatocellular adenoma of the VI segment of a liver (4 cm in the diameter).

Preliminary diagnosis
All main types of benign tumors of a liver belong to oligosymptomatic diseases. In many cases their detection belongs to accidental finds. At the big sizes and the corresponding localization of a tumor sometimes there are symptoms of a prelum of zhelchevyvodyashchy ways, is more rare — symptoms of portal hypertensia.

The liver usually is much not increased (an exception large hemangiomas make). Peripheral blood is not changed. Contents and - fetoprotein, carcinoembryonic antigen, aminotransferases, GGTF, an alkaline phosphatase, GDG and LDG, blood serum bilirubin within norm. The exception is made by patients at whom the benign tumor of a liver develops against active diffusion diseases of a liver.

Tool methods of research are informative. The radionuclide stsintigrafiya of a liver is carried out as usual at suspicion on volume process of a liver in two projections. By means of this method it is possible to find a tumor with a diameter of 4 — 5 cm and more. In this regard major importance has a method in recognition of hemangiomas as other three types of tumors more often appear the smaller sizes. At hemangiomas of a liver of 4 in size — 5 cm and more tumor reveal at 70 — 80% inspected. By means of ultrasonography at a hemangioma of a liver reveal the hyper echoic, well outlined education. Quite often, especially in the left share, the vascular leg clearly is visible.

Differential diagnosis at this stage first of all is carried out with parasitic cysts of a liver (echinococcosis). In favor of the last positive reaction with echinococcal antigen, Katsoni's reaction, and also detection in a zone of tumorous formation of calcifications testify.

Final diagnosis
The verified diagnosis is under construction with use of the researches given a row.
Computer and tomographic research allows to obtain the data close to results of ultrasonography though quite often gives also the additional diagnostic information concerning first of all a condition of surrounding fabrics and bodies. Tseliakografiya is most informative at recognition of hemangiomas. The gipervaskulyarizirovanny sites with a clear boundary allowing to find a hemangioma of 2 in size — 3 cm and more at 80 — 85% inspected are usually well visible.
The indirect radionuclide angiography which is carried out by means of the gamma camera gives results, close, but less exact in comparison with a tseliakografiya.

In hepatocellular adenomas there are no bilious channels, as a rule. Therefore when carrying out a biliary radionuclide stsintigrafiya in the field of adenoma "mute zones" can be registered.
In diagnosis of hepatocellular adenoma, focal nodular hyperplasia of a liver and a nodular regenerative hyperplasia of a liver the crucial role is played by results aim (under control of ultrasonography and a computer tomography) liver biopsies. Complexity of a morphological assessment of the received material quite often demands studying by his morphologist and cytologist which specialize in area of pathology of a liver.

Differential diagnosis is carried out first of all with the most frequent benign tumors of a liver, then with malignant tumors (see below). In recent years even more often a peculiar focal fatty dystrophy of a liver, especially in cases when against focal fatty dystrophy roundish sites of an intact liver meet becomes object of differential diagnosis. These sites have density, different with fatty dystrophy, and this difference rather accurately is registered by means of ultrasonography and a computer tomography. These pseudo-tumoral educations are usually not visible at a radionuclide stsintigrafiya of a liver. However this differential diagnostic character is not really reliable. The crucial role in detection of focal fatty dystrophies is played by an aim biopsy of a liver,

Treatment
Hepatocellular adenoma, focal nodular hyperplasia of a liver and nodular regenerator hyperplasia of a liver, as a rule, do not need drug and surgical treatment. The exception is made by the tumors squeezing the bilious courses. In these cases indications to a resection of the corresponding segments of a liver appear. Methods of secondary prevention. At all types of benign tumors of a liver medicines like peroral contraceptives, anabolic steroids are prohibited. Reception of such drugs as phenobarbital and ziksarin is undesirable. The large hemangiomas squeezing bilious channels delete in the surgical way.

All patients need continuous medical supervision. At for the first time the found tumor examination is conducted 3 — 6 — 9 — 12 months later, further — once a year. Except usual survey of the patient with size discrimination of a liver across Kurlov, investigate the level of bilirubin, aminotransferases, an alkaline phosphatase, GGTF, GDG and LDG, and - fetoprotein and carcinoembryonic antigen.

 
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