title: Benign liver masses and lesions in children: 53 cases over 12 years.
abstract: BACKGROUND
  Primary liver masses in children may require intervention because of symptoms or concern about malignant transformation.
  
  
  OBJECTIVE
  To review the management and outcome of benign liver masses in children.
  
  
  METHODS
  We conducted a retrospective chart review of children with liver masses referred to our institution during the period 1997-2009.
  
  
  RESULTS
  Benign liver masses were identified in 53 children. Sixteen of these children (30%) had hemangioma/infantile hepatic hemangioendothelioma (IHH) and 15 (28%) had focal nodular hyperplasia. The remainder had 6 cysts, 4 hamartomas, 3 nodular regenerative hyperplasia, 2 adenomas, 2 vascular malformations, and one each of polyarteritis nodosa, granuloma, hepatic hematoma, lymphangioma, and infarction. Median age at presentation was 6 years, and 30 (57%) were female. Masses were initially noticed on imaging studies performed for unrelated symptoms in 33 children (62%), laboratory abnormalities consistent with liver disease in 11 (21%), and palpable abdominal masses in 9 (17%). Diagnosis was made based on characteristic radiographic findings in 31 (58%), but histopathological examination was required for the remaining 22 (42%). Of the 53 children, 27 (51%) were under observation while 17 (32%) had masses resected. Medications targeting masses were used in 9 (17%) and liver transplantation was performed in 4 (8%). The only death (2%) occurred in a child with multifocal IHH unresponsive to medical management and prior to liver transplant availability.
  
  
  CONCLUSIONS
  IHH and focal nodular hyperplasia were the most common lesions. The majority of benign lesions were found incidentally and diagnosed radiologically. Expectant management was sufficient in most children after diagnosis, although surgical intervention including liver transplant was occasionally necessary.
authors: Pediatric Hepatology, Division of Pediatric Hepatology and RMTI, Department of Surgery, Mount Sinai School of Medicine, New York City, NY 10029, USA. israel.kochin@mssm.edu
authors: Israel N
authors: IN
authors: Kochin
authors: Tamir A
authors: TA
authors: Miloh
authors: Ronen
authors: R
authors: Arnon
authors: Kishore R
authors: KR
authors: Iyer
authors: Frederick J
authors: FJ
authors: Suchy
authors: Nanda
authors: N
authors: Kerkar
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D006390:Hemangioendothelioma / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D006391:Hemangioma / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D033162:Incidental Findings; D007223:Infant; D007231:Infant, Newborn; D008099:Liver / Q000473:pathology / Q000601:surgery; D008107:Liver Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult