Hepatic incidentaloma. Retrospective analysis of 35 cases.
At present imaging techniques and laboratory tests are employed very extensively to investigate obscure visceral symptoms. During these investigations it can happen that a liver lesion is discovered. This lesion, solid or cystic, when discovered in the liver of a healthy person, is called hepatic incidentaloma. This study analyzes retrospectively the diagnostic and therapeutic management of a series of 35 patients, with an asymptomatic lesion of the liver discovered incidentally. These patients had been observed over a period of five years (1988-1993). There were 22 benign lesions and 13 hepatic cell carcinomas (HCCs), three of which discovered in patients with non diagnosed cirrhosis. The presence of a risk factor for HCC in the past history of the patient with a hepatic incidentaloma strongly suggests that the lesion is malignant (p < 0.05). The average age of patients with malignant lesions was significantly higher than that of patients with benign lesions (65 vs 45 years; p < 0.01). Symptoms and/or signs did not help to distinguish between patients with benign and malignant lesions. Serum alkaline phosphatase (SAP) and alpha-fetoprotein levels were significantly higher in patients with malignancies (p < 0.01). A certain diagnosis was achieved preoperatively in 85% of the cases. In the remaining 15%, a definitive diagnosis was reached only after surgery. Surgical or percutaneous treatment was required in 80% of the cases. In conclusion, although in a minority of cases, surgery is still required for definitive diagnosis of a hepatic incidentaloma.
Department of General Surgery and Organ Transplants, University of Naples Federico II, School of Medicine, Italy.
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Belli
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D'Agostino
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Iannelli
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Marano
D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis; D003952:Diagnostic Imaging; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis*; D008113:Liver Neoplasms / Q000175:diagnosis; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors