%0 Journal Article
%T ¡°Incidentaloma¡± of the Liver: Management of a Diagnostic and Therapeutic Dilemma
%A Denis Ehrl
%A Katharina Rothaug
%A Peter Herzog
%A Bernhard Hofer
%A Horst-G¨¹nter Rau
%J HPB Surgery
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/891787
%X The continuous development of highly sensitive clinical imaging increased the detection of focal lesions of the liver. These accidentally detected liver tumors without liver-specific symptoms such as cholestasis have been named ¡°incidentalomas.¡± Diagnostic tools such as sonography, computed tomography, or magnetic resonance imaging are used increasingly in asymptomatic individuals without defined suspected diagnoses in the setting of general prevention or followup after a history of malignancy. But despite continuous improvement of diagnostics, some doubt regarding the benign or malign behavior of a tumor remains. In case an asymptomatic hemangioma or FNH can be preoperatively detected with certainty, the indication for surgery must be very strict. In case of symptomatic liver lesions surgical resection should only be indicated with tumor-specific symptoms. In the remaining cases of benign lesions of the liver, a ¡°watch and wait¡± strategy is recommended. In case of uncertain diagnosis, especially in patients with positive history of a malignant tumor or the suspected diagnosis of hepatocellular adenoma, surgical resection is indicated. Due to the continuous improvement of surgical techniques, liver resection should be done in the laparoscopic technique. Laparoscopic surgery has lower morbidity and shorter hospitalization than open technique. 1. Introduction In recent years the rapid development of highly sensitive clinical imaging has led to the detection of focal lesions of the liver more frequently. In addition, diagnostic tools are used increasingly in asymptomatic individuals without defined suspected diagnoses in the setting of general prevention or followup after a history of malignancy [1¨C4]. Unfortunately, the histological nature of a hepatic tumor is rarely proven by one method of imaging, and even sophisticated technologies some doubt regarding the benign or malign behavior of a tumor remain in 10¨C40% [5, 6]. These accidentally detected liver tumors without liver-specific symptoms such as cholestasis or portal hypertension have been named ¡°incidentalomas¡± [4]; the reported incidence of these findings ranges from 10.2 to 52% [7, 8]. Autopsy studies have demonstrated up to 52% benign liver lesions in the western population [9, 10]. Other authors could demonstrate an incidence of incidentalomas of 10.2¨C14.3% of CT scans [7¨C9]. Generally, these tumors can be true benign or malign neoplasms or so-called tumor-like lesions [3]. Malignant tumors of the liver become usually only in stages of an advanced disease symptomatic. In case of metastases
%U http://www.hindawi.com/journals/hpb/2012/891787/