Clinical characteristics of patients undergoing surgical resection of benign liver tumors in Taiwan, an endemic area for hepatocellular carcinoma.

Background and Purpose: The management of benign liver tumors in Asian countries endemic for hepatocellular carcinoma (HCC) may be different from that in western countries with a lower prevalence of HCC. The aim of this study was to investigate the characteristics of surgically treated benign liver tumors in a liver disease treatment center in Taiwan, an area prevalent for HCC. Methods: Between January 1991 and June 2001, 57 patients with benign liver tumors underwent liver resection. The demographic data, radiologic diagnosis, and postoperative pathologic diagnosis of these patients were reviewed and analyzed. Results: Cavernous hemangioma (n=15), focal nodular hyperplasia (n=12), and macro-regenerative nodule (n=9) were the most frequent pathologic diagnoses of the resected liver tumors. HOC was the most frequent preoperative radiologic diagnosis (27/57, 47%). Four of the 9 macro-regenerative nodules had associated focal dysplastic change. All of the patients with macro-regenerative nodule had a preoperative imaging diagnosis of HCC. Only 1 liver biopsy was performed among the 57 patients. Conclusions: HCC was the most frequent preoperative radiologic diagnosis for benign liver tumors undergoing liver resection at a tertiary referral center in Taiwan. Macro-regenerative nodule of liver was commonly misdiagnosed as HCC by radiology alone in this study. In order to avoid unnecessary surgery, aspiration cytology should be performed for all patients without elevated serum a-fetoprotein and typical radiologic features of HOC. Patients with macro-regenerative nodules without atypical hepatocytes can be followed safely without surgical intervention, but when a macro-regenerative nodule with dysplastic change is found, it should be treated either by surgical resection or local ablation.