Tom Reeve Academic Surgical Clinic  ·  St Leonards

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Thomas J. HughSpecialist Hepato-Biliary & General Surgeon
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Research · Benign liver

Benign liver tumours and cysts

Not every liver lesion is cancer. Thomas J. Hugh has published on focal nodular hyperplasia, liver adenoma, liver cysts, and pyogenic liver abscess so Sydney patients know when benign liver conditions need surgery versus surveillance.

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This page explains focal nodular hyperplasia in plain language, alongside peer-reviewed work by Thomas J. Hugh and colleagues.

Plain-language patient guide→
/ 01Overview

What is focal nodular hyperplasia (FNH)?

Focal nodular hyperplasia is a benign liver growth, often found in young women on MRI. It rarely needs surgery when imaging is characteristic. FNH is not a precursor to cancer. Biopsy or resection is reserved for atypical scans or diagnostic uncertainty.

Nahm, Samra, and Hugh (2011) reviewed myths and truths about FNH, helping GPs reassure patients with classic imaging.

Tom Hugh emphasises MRI with liver-specific contrast when ultrasound findings are unclear.

/ 02Evidence

When does a liver adenoma need treatment?

Hepatocellular adenoma carries bleeding and malignant transformation risk, especially in larger lesions and certain subtypes. Stop or adjust oral contraceptives when advised. Surgery or embolization is considered for size thresholds, male patients, or growth on serial MRI.

Nahm et al. (2020) reported Hugh's single-institution adenoma management experience in ANZ Journal of Surgery, outlining when resection was chosen.

Thomas J. Hugh individualises adenoma pathways with hepatology and radiology input.

  • Monitor: small, typical adenoma in low-risk patient with serial MRI
  • Intervene: size above roughly 5 cm, β-catenin mutated subtype, or symptoms
  • Emergency: sudden pain may mean haemorrhage into the adenoma
/ 03Evidence

Should liver cysts be drained or removed?

Simple liver cysts are common and usually need no treatment. Symptomatic or enlarging cysts may be fenestrated laparoscopically. Polycystic disease is managed differently. de Reuver, Samra, and Hugh (2018) compared operative and non-operative outcomes and quality of life in benign liver cysts.

That Surgical Endoscopy study helps set expectations when cysts cause fullness or pain rather than cancer worry.

/ 04Evidence

How is pyogenic liver abscess treated?

Pyogenic liver abscess is a bacterial infection within the liver, often from biliary disease or portal spread. Treatment combines antibiotics and drainage (percutaneous or surgical). Delay increases sepsis risk. Underlying causes such as stones or diabetes must be addressed.

Pang, Samra, Hugh, and Smith (2011) audited ten years of pyogenic liver abscess care, reflecting North Shore experience with drainage and surgery.

Tom Hugh still applies those lessons when abscess care overlaps with biliary surgery.

/ 05Evidence

How do benign lesions differ from liver cancer on referral?

Multiphase MRI and expert radiology reporting separate benign liver conditions from hepatocellular carcinoma and cholangiocarcinoma. Hugh's benign liver publications support watchful waiting when safe, avoiding unnecessary hepatectomy.

When imaging remains indeterminate, Hugh discusses biopsy versus resection in MDT settings at Sydney HPB units.

/ 06Publications

Peer-reviewed publications by Thomas J. Hugh

The papers below are a selection of 66 papers from over 300 publications by Tom Hugh and collaborators, focused here on focal nodular hyperplasia. Where a DOI or publisher link is available, it opens in a new tab so you can read the original research.
/ 07About the author

Who writes and operates from this evidence base?

Thomas J. Hugh is a specialist Upper GI and hepato-biliary surgeon and Chair of Surgery at the University of Sydney Northern Clinical School. He operates at Royal North Shore Hospital and North Shore Private, with consultations at the Tom Reeve Academic Surgical Clinic in St Leonards.

Outcomes across his practice are tracked through the DASO audit unit. That combination of published research and prospective audit is intended to keep advice grounded in measured results, not marketing claims.

Read more about Tom Hugh→
/ 08Common questions

Classic FNH does not transform into HCC. Surgery is for diagnosis or symptoms, not routine cancer prevention.

Stable simple cysts often need no follow-up. Symptomatic or complex cysts get a personalised schedule after surgical review.

Biliary infection, appendicitis, or bloodstream spread are common. Your team searches for a source while treating the abscess.

/ 09Related reading