Pagina Iniziale » Fegato » Tumori del Fegato » Tumori Benigni
I Tumori Benigni del Fegato
I tumori benigni del fegato rappresentano un capitolo in qualche maniera abbastanza nuova nella pratica clinica.
La conoscenza della loro diffusione e del loro aspetto hanno subito drastiche modificazioni negli ultimi 20 anni, grazie alla sempre maggiore diffusione dell’ecografia addominale e ai migliorati risultati ottenibili con la TAC (tomografia assiale computerizzata), in particolare con le nuove macchine che impiegano la tecnica a doppia spirale e con la RMN (risonanza magnetica nucleare), indagine che ha assunto negli ultimi anni uno spazio sempre maggiore nella diagnosi di queste formazioni.

I principali tumori benigni del fegato sono:
- Angioma
- Angioma atipico
- Adenoma
- Adenomatosi multipla
- Cisti sierose semplici (Cisti biliari)
- Iperplasia nodulare focale
- Pseudotumore infiammatorio
Le problematiche dei tumori benigni del fegato sono assai comuni fra questi diversi tipi istologici.
Queste caratteristiche condizionano in maniera assai decisiva l’indicazione o meno ad un eventuale intervento chirurgico di asportazione.

In questo caso sono state eseguite resezioni multiple per pseudotumore infiammatorio, un tumore benigno.
Per queste lesioni bisogna infatti sempre considerare:
- la certezza della diagnosi (la possibilità di ottenere una diagnosi certa della natura della malattia)
- il possibile accrescimento volumetrico (la tendenza della lesione ad espandere il suo diametro)
- il rischio di rottura (la possibilità di dare emorragie intra-addominali o ematomi all’interno del fegato spontaneamente o dopo biopsia)
- il rischio di degenerazione neoplastica (il cambiamento in un tumore maligno)
Queste considerazioni devono essere discusse e risolte quando ci si trovi di fronte ad una di queste lesioni.
- Ultimo aggiornamento della pagina: 03/10/2023
Linee Guida per la Diagnosi ed il Trattamento dei Tumori Benigni del Fegato
2022
Pompili M; Ardito F; Brunetti E; Cabibbo G; Calliada F; Cillo U; de Sio I; Golfieri R; Grova M; Gruttadauria S; Guido M; Iavarone M; Manciulli T; Pagano D; Pettinari I; Santopaolo F; Soresi M; Colli A
In: Dig Liver Dis, 2022, ISSN: 1878-3562.
@article{pmid36089525,
title = {Benign liver lesions 2022: Guideline for clinical practice of Associazione Italiana Studio del Fegato (AISF), Società Italiana di Radiologia Medica e Interventistica (SIRM), Società Italiana di Chirurgia (SIC), Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB), Associazione Italiana di Chirurgia Epatobilio-Pancreatica (AICEP), Società Italiana Trapianti d'Organo (SITO), Società Italiana di Anatomia Patologica e Citologia Diagnostica (SIAPEC-IAP) - Part I - Cystic lesions},
author = {Maurizio Pompili and Francesco Ardito and Enrico Brunetti and Giuseppe Cabibbo and Fabrizio Calliada and Umberto Cillo and Ilario de Sio and Rita Golfieri and Mauro Grova and Salvatore Gruttadauria and Maria Guido and Massimo Iavarone and Tommaso Manciulli and Duilio Pagano and Irene Pettinari and Francesco Santopaolo and Maurizio Soresi and Agostino Colli},
doi = {10.1016/j.dld.2022.08.030},
issn = {1878-3562},
year = {2022},
date = {2022-09-01},
urldate = {2022-09-01},
journal = {Dig Liver Dis},
abstract = {Benign liver lesions are increasingly diagnosed in daily clinical practice due to the growing use of imaging techniques for the study of the abdomen in patients who have non-specific symptoms and do not have an increased risk of hepatic malignancy. They include simple or parasitic cysts and solid benign tumors which differ widely in terms of prevalence, clinical relevance, symptoms and natural history and often lead to significant clinical problems relating to diagnosis and clinical management. Following the need to have updated guidelines on the management of benign focal liver lesions, the Scientific Societies mainly involved in their management have promoted the drafting of a new dedicated document. This document was drawn up according to the present Italian rules and methodologies necessary to produce clinical, diagnostic, and therapeutic guidelines based on evidence. Here we present the first part of the guideline, concerning the characterization of focal hepatic lesions detected by ultrasound, and the diagnosis and clinical management of simple and parasitic hepatic cysts, and of polycystic liver disease.},
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Pompili M; Ardito F; Brunetti E; Cabibbo G; Calliada F; Cillo U; de Sio I; Golfieri R; Grova M; Gruttadauria S; Guido M; Iavarone M; Manciulli T; Pagano D; Pettinari I; Santopaolo F; Soresi M; Colli A
In: Dig Liver Dis, 2022, ISSN: 1878-3562.
@article{pmid36089523,
title = {Benign liver lesions 2022: Guideline for clinical practice of Associazione Italiana Studio del Fegato (AISF), Società Italiana di Radiologia Medica e Interventistica (SIRM), Società Italiana di Chirurgia (SIC), Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB), Associazione Italiana di Chirurgia Epatobilio-Pancreatica (AICEP), Società Italiana Trapianti d'Organo (SITO), Società Italiana di Anatomia Patologica e Citologia Diagnostica (SIAPEC-IAP) - Part II - Solid lesions},
author = {Maurizio Pompili and Francesco Ardito and Enrico Brunetti and Giuseppe Cabibbo and Fabrizio Calliada and Umberto Cillo and Ilario de Sio and Rita Golfieri and Mauro Grova and Salvatore Gruttadauria and Maria Guido and Massimo Iavarone and Tommaso Manciulli and Duilio Pagano and Irene Pettinari and Francesco Santopaolo and Maurizio Soresi and Agostino Colli},
doi = {10.1016/j.dld.2022.08.031},
issn = {1878-3562},
year = {2022},
date = {2022-09-01},
urldate = {2022-09-01},
journal = {Dig Liver Dis},
abstract = {Benign liver lesions are increasingly diagnosed in daily clinical practice due to the growing use of imaging techniques for the study of the abdomen in patients who have non-specific symptoms and do not have an increased risk of hepatic malignancy. They include simple or parasitic hepatic cysts and solid benign tumors which differ widely in terms of prevalence, clinical relevance, symptoms and natural history and often lead to significant clinical problems relating to diagnosis and clinical management. Following the need to have updated guidelines on the management of benign focal liver lesions, the Scientific Societies mainly involved in their management have promoted the drafting of a new dedicated document. This document was drawn up according to the present Italian rules and methodologies necessary to produce clinical, diagnostic, and therapeutic guidelines based on evidence. Here we present the second part of the guideline, concerning the diagnosis and clinical management of hemangioma, focal nodular hyperplasia, and hepatocellular adenoma.},
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pubstate = {published},
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}
Pompili M; Cabibbo G; de Sio I; Grova M; Iavarone M; Santopaolo F; Calliada F; Golfieri R; Pettinari I; Gruttadauria S; Pagano D; Soresi M; Ardito F; Cillo U; Guido M; Brunetti E; Manciulli T; Colli A
2022, (Open Access).
@workingpaper{nokey,
title = {Lesioni benigne epatiche 2022: linea guida per la pratica clinica dell’Associazione Italiana per lo Studio del Fegato (AISF), della Società Italiana di Radiologia Medica (SIRM), della Società Italiana di Chirurgia (SIC), della Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB), dell’Associazione Italiana di Chirurgia Epatobilio-Pancreatica (AICEP), della Società Italiana Trapianti d’Organo (SITO), della Società Italiana di Anatomia patologica e di Citologia Diagnostica (SIAPECIAP)},
author = {Maurizio Pompili and Giuseppe Cabibbo and Ilario de Sio and Mauro Grova and Massimo Iavarone and Francesco Santopaolo and Fabrizio Calliada and Rita Golfieri and Irene Pettinari and Salvatore Gruttadauria and Duilio Pagano and Maurizio Soresi and Francesco Ardito and Umberto Cillo and Maria Guido and Enrico Brunetti and Tommaso Manciulli and Agostino Colli},
editor = {SISTEMA NAZIONALE LINEE GUIDA DELL’ISTITUTO SUPERIORE DI SANITÀ},
url = {https://snlg.iss.it/wp-content/uploads/2022/08/LG-506_Lesioni-epatiche-benigne.pdf},
year = {2022},
date = {2022-08-11},
note = {Open Access},
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Drenth J; Barten T; Hartog H; Nevens F; Taubert R; Balcells R T; Vilgrain V; Böttler T
EASL Clinical Practice Guidelines on the management of cystic liver diseases Journal Article
In: Journal of Hepatology, 2022, ISSN: 01688278, (Cited by: 0; All Open Access, Bronze Open Access).
@article{Drenth2022,
title = {EASL Clinical Practice Guidelines on the management of cystic liver diseases},
author = {Joost Drenth and Thijs Barten and Hermien Hartog and Frederik Nevens and Richard Taubert and Roser Torra Balcells and Valerie Vilgrain and Tobias Böttler},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85136308707&doi=10.1016%2fj.jhep.2022.06.002&partnerID=40&md5=6512ea0a342bbc506bce2aae3db9d063},
doi = {10.1016/j.jhep.2022.06.002},
issn = {01688278},
year = {2022},
date = {2022-01-01},
urldate = {2022-01-01},
journal = {Journal of Hepatology},
publisher = {Elsevier B.V.},
abstract = {The advent of enhanced radiological imaging techniques has facilitated the diagnosis of cystic liver lesions. Concomitantly, the evidence base supporting the management of these diseases has matured over the last decades. As a result, comprehensive clinical guidance on the subject matter is warranted. These Clinical Practice Guidelines cover the diagnosis and management of hepatic cysts, mucinous cystic neoplasms of the liver, biliary hamartomas, polycystic liver disease, Caroli disease, Caroli syndrome, biliary hamartomas and peribiliary cysts. On the basis of in-depth review of the relevant literature we provide recommendations to navigate clinical dilemmas followed by supporting text. The recommendations are graded according to the Oxford Centre for Evidence-Based Medicine system and categorised as ‘weak’ or ‘strong’. We aim to provide the best available evidence to aid the clinical decision-making process in the management of patients with cystic liver disease. © 2022 European Association for the Study of the Liver},
note = {Cited by: 0; All Open Access, Bronze Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Nault J; Paradis V; Ronot M; Zucman-Rossi J
Benign liver tumours: understanding molecular physiology to adapt clinical management Journal Article
In: Nature Reviews Gastroenterology and Hepatology, 2022, ISSN: 17595045, (Cited by: 0).
@article{Nault2022,
title = {Benign liver tumours: understanding molecular physiology to adapt clinical management},
author = {Jean-Charles Nault and Valérie Paradis and Maxime Ronot and Jessica Zucman-Rossi},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85134344871&doi=10.1038%2fs41575-022-00643-5&partnerID=40&md5=78deb8b9fa10ec5964c11e36e77eedb5},
doi = {10.1038/s41575-022-00643-5},
issn = {17595045},
year = {2022},
date = {2022-01-01},
urldate = {2022-01-01},
journal = {Nature Reviews Gastroenterology and Hepatology},
publisher = {Nature Research},
abstract = {Improvements in understanding the pathophysiology of the different benign liver nodules have refined their nosological classification. New criteria have been identified using imaging, histology and molecular analyses for a precise diagnosis of these tumours. Improvement in the classification of liver tumours provides a more accurate prediction of disease progression and has modified patient management. Haemangioma and focal nodular hyperplasia, the most common benign liver tumours that develop in the absence of chronic liver disease, are usually easy to diagnose on imaging and do not require specific treatment. However, hepatocellular adenomas and cirrhotic macronodules can be difficult to discriminate from hepatocellular carcinoma. The molecular subtyping of hepatocellular adenomas in five major subgroups defined by HNF1A inactivation, β-catenin mutation in exon 3 or exon 7/8, and activation of inflammatory or Hedgehog pathways helps to identify the tumours at risk of malignant transformation or bleeding. New clinical, biological and molecular tools have gradually been included in diagnostic and treatment algorithms to classify benign liver tumours and improve patient management. This Review aims to explain the main pathogenic mechanisms of benign liver tumours and how this knowledge could influence clinical practice. © 2022, Springer Nature Limited.},
note = {Cited by: 0},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2018
Aerts R M M; Laarschot L F M; Banales J M; Drenth J P H
Clinical management of polycystic liver disease Journal Article
In: Journal of Hepatology, vol. 68, no 4, pp. 827 – 837, 2018, ISSN: 01688278, (Cited by: 71; All Open Access, Bronze Open Access).
@article{vanAerts2018827,
title = {Clinical management of polycystic liver disease},
author = {René M. M. Aerts and Liyanne F. M. Laarschot and Jesus M. Banales and Joost P. H. Drenth},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85040116461&doi=10.1016%2fj.jhep.2017.11.024&partnerID=40&md5=c6897fb226def1f57cffbd7fb786b614},
doi = {10.1016/j.jhep.2017.11.024},
issn = {01688278},
year = {2018},
date = {2018-01-01},
urldate = {2018-01-01},
journal = {Journal of Hepatology},
volume = {68},
number = {4},
pages = {827 – 837},
publisher = {Elsevier B.V.},
abstract = {A 41-year old female underwent a computed tomography (CT) scan in 2010 because of symptoms suggestive of appendicitis. Incidentally, multiple liver lesions characterised as cysts were detected. The presence of small to medium sized liver cysts (diameter between <1 cm and 4 cm) in all liver segments (>100 cysts) and absence of kidney cysts in the context of normal renal function led to the clinical diagnosis of autosomal dominant polycystic liver disease (ADPLD). Five years later she was referred to the outpatient clinic with increased abdominal girth, pain in the right upper abdomen and right flank, and early satiety. She had difficulties bending over and could neither cut her toenails nor tie her shoe laces. In her early twenties she had used oral contraception for five years. She has been pregnant twice. Clinical examination showed an enlarged liver reaching into the right pelvic region and crossing the midline of the abdomen. Laboratory testing demonstrated increased gamma-glutamyl transferase (80 IU/L, normal <40 IU/L) and alkaline phosphatase (148 IU/L, normal <100 IU/L) levels. Bilirubin, albumin and coagulation times were within the normal range. A new CT scan in 2015 was compatible with an increased number and size of liver cysts. The diameter of cysts varied between <1 cm and 6 cm (anatomic distribution shown [Fig. 2B]). There were no signs of hepatic venous outflow obstruction, portal hypertension or compression on the biliary tract. Height-adjusted total liver volume (htTLV) increased from 2,667 ml/m in 2012 to 4,047 ml/m in 2015 (height 172 cm). The case we present here is not uncommon, and prompts several relevant questions: I. What causes the development of liver cysts?II. Is genetic testing and genetic counselling recommended?III. What is the natural course of polycystic liver disease and what can patients do to stop growth of liver cysts?IV. Which complications may occur during the course of polycystic liver disease?V. What treatment options are currently available?VI. What other potential new and effective therapies will be available in the near future? © 2017 European Association for the Study of the Liver},
note = {Cited by: 71; All Open Access, Bronze Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2016
Colombo M; Forner A; Ijzermans J; Paradis V; Reeves H; Vilgrain V; Zucman-Rossi J
EASL Clinical Practice Guidelines on the management of benign liver tumours Journal Article
In: Journal of Hepatology, vol. 65, no 2, pp. 386 – 398, 2016, ISSN: 01688278, (Cited by: 239; All Open Access, Bronze Open Access).
@article{Colombo2016386,
title = {EASL Clinical Practice Guidelines on the management of benign liver tumours},
author = {M. Colombo and A. Forner and J. Ijzermans and V. Paradis and H. Reeves and V. Vilgrain and J. Zucman-Rossi},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84964337016&doi=10.1016%2fj.jhep.2016.04.001&partnerID=40&md5=a5beb08a5c366c4886a56a91c55754b8},
doi = {10.1016/j.jhep.2016.04.001},
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year = {2016},
date = {2016-01-01},
urldate = {2016-01-01},
journal = {Journal of Hepatology},
volume = {65},
number = {2},
pages = {386 – 398},
publisher = {Elsevier B.V.},
note = {Cited by: 239; All Open Access, Bronze Open Access},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
