Liver SOL (Space Occupying Lesion)

A liver space occupying lesion (SOL) is a general term for any abnormal mass or focal lesion identified within the liver on imaging. Liver SOLs are broadly categorised as benign or malignant, and accurate characterisation is essential as management differs vastly between these groups. Common benign liver SOLs include haemangiomas (the most common benign liver tumour, composed of vascular channels and usually requiring no treatment), simple hepatic cysts, focal nodular hyperplasia (FNH), and hepatic adenomas (particularly relevant in women taking oral contraceptives, as large adenomas carry a small risk of rupture and malignant transformation). Malignant SOLs include hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma, and metastatic liver deposits from colorectal, breast, or neuroendocrine primaries.

The evaluation of a liver SOL begins with a detailed clinical history and laboratory investigations (liver function tests, AFP, CA 19-9, CEA) followed by high-quality imaging. Contrast-enhanced CT (CECT) of the abdomen and MRI with hepatobiliary contrast agents (gadoxetate disodium/Primovist) provide detailed characterisation of most lesions without the need for biopsy. Liver biopsy is reserved for lesions that remain indeterminate on imaging or when histological confirmation is needed to guide non-surgical treatment decisions. PET-CT may be employed in the staging workup of suspected malignant lesions.

Management of liver SOLs is highly individualised. Small, asymptomatic benign lesions (haemangiomas, simple cysts, FNH) in patients without cirrhosis can often be managed with watchful waiting and periodic imaging surveillance. Symptomatic lesions, those with uncertain malignant potential, or large hepatic adenomas typically require surgical intervention. For malignant SOLs, liver resection — ranging from minor non-anatomical wedge resection to major hepatectomy — offers the best chance of cure in resectable cases, while liver transplantation is considered for HCC within transplant criteria. Our surgical team is expert in the complete spectrum of liver surgery for SOLs of all types.