DIAGNOSTIC APPROACH TO HEPATIC NEOPLASMS
Most hepatic neoplasms present with right upper quadrant abdominal pain or an abdominal mass. Hemorrhage, systemic manifestations, and biliary obstruction (from strategically located tumors] may also occur. Visualization of discrete focal lesions and histological examination of tissue are generally required for diagnosis. Thus evaluation employs one or more imaging procedures followed by percutaneous, laparoscopic, or surgical biopsy of one or more lesions. Radionuclide scanning is a reasonable first step in the work-up, although imaging by computed tomography or ultrasound may be more sensitive in detecting small lesions and offers the advantage of performing guided percutaneous biopsy or aspiration cytology. Localization of lesions is generally followed by biopsy; however, additional factors must be considered. Percutaneous biopsies of vascular lesions such as hemangiomas, angiosarcomas, and perhaps hepatocellular adenomas are potentially dangerous, whereas cells obtained by aspiration cytology frequently fail to differentiate hepatocellular adenoma, hepatocellular carcinoma, and normal hepatocytes. Thus, the choice of procedures will depend on the diagnostic and therapeutic options under consideration.