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Lesão Hepática Grande (17,6 cm): Diagnóstico Diferencial, Trabalho e Opções de Tratamento

A liver lesion measuring 17.6 cm is classified as "giant" (generally >10 cm). Its size alone warrants thorough investigation to distinguish benign from malignant causes and guide appropriate management.

Differential Diagnosis

Benign etiologies (most common):

• Giant hemangioma: The most frequent benign liver tumor; often asymptomatic.
• Hepatic adenoma: Associated with oral contraceptive use; carries bleeding and rare malignant transformation risk.
• Focal nodular hyperplasia (FNH): Typically benign, often incidental.
• Simple cyst: Rarely reaches this size.

Malignant considerations:

• Hepatocellular carcinoma (HCC): Risk factors include cirrhosis, chronic hepatitis B/C.
• Cholangiocarcinoma: Bile duct origin.
• Metastasis: Common primaries include colorectal, breast, neuroendocrine, and melanoma.

Infectious causes:

• Pyogenic abscess
• Hydatid cyst (Echinococcus)

Diagnostic Workup

1. Cross-sectional imaging: Contrast-enhanced MRI with liver-specific protocol or triphasic CT for characterization.
2. Tumor markers: AFP (HCC), CA19-9 (cholangiocarcinoma), CEA (metastatic disease).
3. Biopsy: Reserved for imaging-indeterminate lesions; avoided if HCC is likely due to seeding risk.

Management

A multidisciplinary tumor board guides therapy: surgical resection, liver transplant, ablation, transarterial chemoembolization (TACE), or systemic therapy. Benign, asymptomatic lesions may be safely observed with serial imaging.