[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Liver and gallbladder](https://durgical.com/en/general-pathology/areas/liver/) › Benign liver masses

# Benign liver masses

- Lesion

Most liver masses found by chance in healthy livers are harmless, such as hemangiomas and focal nodular hyperplasia.

Updated Nov 12, 2026

## Key points

- Cavernous hemangioma: most common benign liver tumour; blood-filled vascular channels; avoid needle biopsy.
- Focal nodular hyperplasia: mostly women; central stellate scar with a large abnormal artery; polyclonal hyperplasia, not a neoplasm.
- FNH has no malignant potential and rarely bleeds; contrast imaging often makes the diagnosis.
- Nodular regenerative hyperplasia: diffuse small nodules without fibrosis; presinusoidal portal hypertension; linked to vascular and immune disorders and drugs.
- Bile duct adenoma and von Meyenburg complexes: tiny white subcapsular nodules, easily mistaken for metastases at surgery.

## What it is

Many liver masses are not neoplasms. Focal nodular hyperplasia is a hyperplastic response of hepatocytes to an abnormal artery, with a central stellate scar. Cavernous hemangioma, the most common benign liver tumour, is a vascular lesion. Nodular regenerative hyperplasia, large regenerative nodules, bile duct adenomas, von Meyenburg complexes, abscesses, granulomas and inflammatory pseudotumours can all mimic a tumour. Correct naming avoids needless surgery.

## Step by step

- FNH: a congenital or acquired arterial malformation sends excess arterial flow to one area.
- Hepatocytes respond by polyclonal hyperplasia, forming nodules around the artery.
- Fibrous septa radiate from the abnormal vessel: the central stellate scar.
- Hemangioma: a vascular malformation grows slowly by filling and dilating channels.
- Altered blood flow also explains nodular regenerative hyperplasia: alternating atrophy and regeneration.

## Benign liver masses

| Lesion | Gross and microscopy | Key point |
| --- | --- | --- |
| [Cavernous hemangioma](https://durgical.com/en/conditions/benign-liver-lesions/) | Well-defined red-blue soft mass; vascular spaces lined by endothelium, fibrous walls | Most common; usually incidental |
| [Focal nodular hyperplasia](https://durgical.com/en/conditions/benign-liver-lesions/) | Tan nodule with central stellate scar; hepatocyte nodules, thick-walled arteries, ductular reaction in septa | Not neoplastic; map-like glutamine synthetase staining |
| Nodular regenerative hyperplasia | Diffuse small nodules without fibrous septa | Portal hypertension; reticulin stain shows it |
| Bile duct adenoma or hamartoma | Small subcapsular white nodules of bland ductules | Mimics metastasis at surgery |
| Inflammatory pseudotumour, abscess, granuloma | Inflammatory masses | Clinical and biopsy correlation |

## Markers

- Glutamine synthetase (map-like in FNH)
- Reticulin
- CD34 and CD31 (vessels)

## Memory aid

FNH is the liver's 'star with a scar': a central star of fibrous tissue with a big artery, harmless and not a tumour.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the most common benign tumour of the liver?

Cavernous hemangioma.

## What is the characteristic gross feature of focal nodular hyperplasia?

A central stellate fibrous scar containing large abnormal arteries, with radiating septa.

## Why is nodular regenerative hyperplasia easy to miss on H&E?

Nodules have no fibrous septa; a reticulin stain is needed to see the compressed plates around regenerating nodules.

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## Connections

## Related 5

- [Hepatocellular adenoma: the molecular subtypes and their risks](https://durgical.com/en/general-pathology/hepatocellular-adenoma-the-molecular-subtypes-and-their-risks/)
- [Hepatocellular carcinoma](https://durgical.com/en/general-pathology/hepatocellular-carcinoma/)
- [Metastases to the liver: the most common liver malignancy](https://durgical.com/en/general-pathology/metastases-to-the-liver-the-most-common-liver-malignancy/)
- [Choledochal cysts and fibropolycystic disease](https://durgical.com/en/general-pathology/choledochal-cysts-and-fibropolycystic-disease/)
- [Hyperplasia: physiologic and pathologic](https://durgical.com/en/general-pathology/hyperplasia-physiologic-and-pathologic/)

## Related conditions 2

- [Benign liver lesions (haemangioma, focal nodular hyperplasia, adenoma)](https://durgical.com/en/conditions/benign-liver-lesions/)
- [Budd-Chiari syndrome](https://durgical.com/en/conditions/budd-chiari-syndrome/)

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Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Hepatic hemangioma: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000243.htm) (MedlinePlus, US National Library of Medicine, 2026).

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