Benign liver tumors and hepatic cysts

Last updated: November 16, 2023

Summarytoggle arrow icon

Benign liver tumors and hepatic cysts are common and may occur in all age groups. Benign liver tumors are especially frequent in young women and include hepatic hemangiomas, focal nodular hyperplasia (FNH), and hepatocellular adenoma (also known as liver cell adenoma). Use of oral contraceptives, especially those containing estrogen, and pregnancy are associated with an increased risk of hepatocellular adenoma. Hepatic cysts include solitary and hydatid (echinococcal) cysts. Benign liver tumors and cysts are mainly asymptomatic and are often incidental findings in patients undergoing abdominal imaging. However, in some cases (e.g., large lesions), symptoms like upper abdominal pain and postprandial fullness may occur. Diagnosis is usually based on imaging, but may require biopsy in unclear cases. Treatment is generally conservative; surgery is reserved for specific lesion types and the presence of symptoms or complications.

Benign liver tumorstoggle arrow icon


The typical clinical picture of a hepatocellular adenoma is a young woman with a history of oral contraceptive or anabolic steroid use and upper right abdominal pain.

Additional diagnostic findings [11]

Diagnostic studies to differentiate benign liver tumors
Diagnostic studies Hepatic hemangioma Focal nodular hyperplasia (FNH) [3][12] Hepatocellular adenoma [13]


  • Usually well-demarcated, homogeneous, hyperechoic (pale)
  • Homogeneous, hypoechoic to isoechoic
  • Round/oval, sharply defined
  • Central, stellate scar (∼ 50% of cases)
  • Mainly isoechoic
  • No characteristic vascularization
  • Inhomogenous due to bleeding
  • More frequent in the right lobe of the liver
Contrast-enhanced sonography
  • From the central artery, radial arrangement of the peripheral arteries with a typical spoke-like pattern [6]
  • Fast centripetal or mixed filling in the arterial phase [14]
  • Hypervascularity compared to the adjacent liver parenchyma
  • Sustained enhancement or weak washout in the delayed phase [15]
Contrast-enhanced CT scan
  • Possibly pedunculated, cystic lesions with a dark color
  • Cavernous vascular spaces of variable size, lined by flat endothelial cells
  • Light yellow color compared with the surrounding liver tissue
  • Localized hepatocyte nodules, with large malformed arterial branches and centralized fibrous tissue (central stellate scar)
  • May resemble macronodular cirrhosis [16]
  • Normal hepatic lobular architecture is absent.
  • Enlarged hepatocytes, with small and regular nuclei, cytoplasmic glycogen and lipid deposits
  • Arranged in sheets or 2-cell thick cords

Hepatic cyststoggle arrow icon

Simple hepatic cysts [17]

Congenital polycystic liver

See polycystic kidney disease.

Hydatid (echinococcal) cysts

See echinococcosis.

Differential diagnosestoggle arrow icon

Referencestoggle arrow icon

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  2. Rawla P, Sunkara T, Muralidharan P, Raj JP. An updated review of cystic hepatic lesions. Clinical and Experimental Hepatology. 2019; 5 (1): p.22-29.doi: 10.5114/ceh.2019.83153 . | Open in Read by QxMD
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  6. Jarnagin WR. Blumgart's Surgery of the Liver, Biliary Tract, and Pancreas. Elsevier ; 2016
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  9. Rooks JB, Ory HW, Ishak KG, et al. Epidemiology of hepatocellular adenoma. The role of oral contraceptive use.. JAMA. 1979; 242 (7): p.644-8.
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