Analysis Of Clinical And Liver Biopsy Pathological Diagnosis Of Liver Benign Occupying Lesions

Objective To analyze the clinical and liver biopsy diagnosis of liver benign occupying lesions in order to have a good diagnosis and decrease the misdiagnosis rate.Methods A total of 76 patients, from January 2004 to December 2010 at the first affiliated hospital of GuangXi Medical University, were diagnosed liver benign occupying lesions by B-Ultrasonic guided percutaneous liver biopsy (except nodular hyperplasia coming from liver cirrhosis), and analyzed their data of the clinical and pathological diagnosis retrospectively.Results There were 50 cases with liver abscesses (65.78%), 13 cases with hepatic haemangiomas (17.10%), 10 cases with inflammatory pseudotumors of liver (13.16%), 1 case with focal hepatic tuberculosis, 1 case with hepatic adenoma and 1 case with lymphangioma of liver(each of the three cases accounted for 1.32% respectively ), Male to female ratio was 1.81∶1. Clinical features:①In the cases with Liver abscesses, hepatic haemangiomas and inflammatory pseudotumors, the ages from 19 to 77years and the courses from 1day to 2.5years. Right upper quadrant abdominal or liver area pain or tenderness, fever, were the most common features in the patients with liver abscesses.②Twenty-year-old female patient, with focal hepatic tuberculosis had history of pulmonary tuberculosis and right upper quadrant abdominal pain. The hepatic adenoma and the lymphangioma of liver had insignificant symptoms. Thirteen cases showed no symptoms. There were 38 cases with liver abscesses with some histories: cholelithiasis and (or) biliary tract surgery in 17cases,type 2 diabetes mellitus in 8 cases,hepatic parasitosis in 5 cases,hepatic malignant tumor in 4 cases,extra hepatic infectious disease in 5 cases。There were 36 cases showed the raising of blood white blood cells (WBC) and (or) neutrophilic granulocytes (liver abscesses 35cases, lymphangioma of liver only 1 case ). The average count of WBC was(16.24±7.35)X109/L,and serum AFP was lower than 200μg/L. Imaging exams before liver biopsy showed: single to multiple occupying lesions ratio was 2.04∶1; the lesion locations of right hepatic lobe to left hepatic lobe and both lobes ratio was 3.64∶1.23∶1; the average diameters of the lesions were: liver abscesses 4.89±2.33cm, hepatic haemangiomas 4.67±4.02cm, inflammatory pseudotumors of liver 2.48±1.18cm.In liver benign occupying lesions, the coincidence rates in abscesses, haemangiomas and inflammatory pseudotumors of liver was 73.91%, 58.33%, 22.22% respectively; The clinical misdiagnosis rates in liver abscesses, hepatic haemangiomas, inflammatory pseudotumor of liver, hepatic adenoma and the lymphangioma of liver were 26.09%, 41.67%, 77.78%, 100.00%, 100.00% respectively. Twenty one cases were misdiagnosed as hepatic malignant tumors , account for 73.08% (19/26).Conclusions 1. Liver abscess, hepatic haemangiomas and inflammatory pseudotumor of liver are common in liver benign occupying lesions; 2. Liver abscess has more striking findings in clinical symptoms, blood WBC and imaging, and has a higher clinical diagnosis coincidence rate in liver benign occupying lesions; 3. Liver benign occupying lesions are most often misdiagnosed as liver malignant tumors; 4. Inflammatory pseudotumor of liver has higher clinical misdiagnosis rate.