Benign Lesions: Types, Symptoms, Causes and Treatment Options

A benign lesion refers to non-cancerous, non-malignant tissue changes that occur in the body and generally do not carry a risk of cancer. These types of lesions exhibit limited growth, do not spread to surrounding tissues, and do not metastasize. In most cases, monitoring is sufficient, although surgical intervention may be required in some situations.

Benign lesions can develop on the skin, in organs, or within internal tissues. Moles on the skin, fibroids, lipomas, or cysts fall into this category. These lesions usually grow slowly, changes in shape and color are rare, but depending on their size, they may cause symptoms.

The symptoms of benign lesions vary depending on the type and location of the lesion. Those seen on the skin are generally painless, round, and have well-defined borders. Lesions in internal organs, on the other hand, may cause pain, swelling, or functional impairment by exerting pressure on the area where they are located.

During the diagnostic process, the structure of the lesion is evaluated through physical examination, ultrasound, MRI, and, if necessary, biopsy. While most benign lesions do not require treatment, some may be removed for cosmetic or functional reasons. Regular follow-up is important for monitoring possible changes.

What Does a Benign Lesion Mean?

When my patients come to the outpatient clinic with an ultrasound or MRI report in their hands, I immediately notice the concern on their faces. When they see words like “lesion,” “nodule,” or “mass” in the report, the first question that comes to their minds is naturally, “Could this be cancer?” The diagnosis of a benign lesion is, at this point, a reassuring piece of news that allows them to take a deep breath and lifts that heavy burden off their shoulders. From a medical perspective, benign lesions generally closely resemble normal tissue cells and, in a sense, mimic the body’s own tissue.

You can think of these structures like an orange. Just as an orange has a peel and its inside remains within the boundaries of that peel, benign lesions are usually surrounded by a capsule or membrane. Their borders are clear and well-defined. Unlike malignant tumors, they do not spread like the roots of a tree, nor do they invade and destroy neighboring tissues. They grow in place.

The growth rate of these lesions is much slower compared to malignant tumors. In fact, some may remain the same size for years and exist without change for a lifetime. They can appear almost anywhere in the body; on your skin, in your liver, kidneys, bones, or thyroid gland. Although we say “not cancer,” these lesions are not inert structures. They can grow under the influence of hormonal changes, trauma, or inflammatory processes in the body. We especially observe that some benign lesions grow rapidly during periods when hormones peak, such as pregnancy. Therefore, knowing that you have a benign lesion does not mean ignoring it, but managing it with the right strategy.

What Symptoms Do Benign Lesions Cause in the Body?

The fact that a lesion is not cancerous does not mean it will not cause any problems in your body. In my clinical practice, the main factor requiring treatment of benign lesions is usually what we call the “mass effect.” In our body, each organ has its own place, its own space, and a limited volume. Even if it is benign, a growing mass can compress neighboring organs in this limited space, put pressure on vital vessels, or compress sensitive nerves.

The most common general symptoms of benign lesions are as follows:

• Pain
• Swelling
• Feeling of pressure
• Limited mobility
• Loss of function
• Bleeding
• Aesthetic deformities
• Fatigue

For example, a growing hemangioma in your liver, which is a cluster of blood vessels, may stretch the abdominal lining and cause a constant feeling of fullness or a dull pain on your right side. A fibroid in the uterus may press on the bladder, forcing you to urinate frequently, or it may press on the intestines from behind, leading to chronic constipation. A large nodule in the thyroid gland may create a visible swelling in your neck, affecting your social life, or it may push the windpipe and cause shortness of breath. In addition, some benign tumors, such as liver adenomas, can even pose a life-threatening risk due to the possibility of spontaneous bleeding.

What Are the Types and Symptoms of Benign Lesions Seen in the Liver?

The liver is the body’s factory and is also an organ where benign lesions are frequently seen. These lesions usually grow silently and are often detected incidentally during an ultrasound or CT scan performed for another reason. However, when they reach a certain size, they become symptomatic.

The most common benign lesions we encounter in the liver are hemangiomas. These are essentially clusters of blood vessels. When they are small, they cause no problems and are simply monitored. However, when they exceed 5 cm, which we call giant hemangiomas, they begin to occupy space within the abdomen.

The complaints caused by giant hemangiomas include:

• Abdominal pain
• Early satiety
• Nausea
• Bloating
• Shortness of breath

Another group of benign lesions includes adenomas and masses called Focal Nodular Hyperplasia (FNH). Adenomas can be seen especially in women who have used birth control pills for a long time and, unlike other benign lesions, they carry a risk of bleeding. Therefore, we remain more vigilant when we detect an adenoma. FNH is generally harmless, but if it grows too large, it can press on the stomach and make eating difficult.

Does a Benign Lesion in the Breast Carry a Risk of Cancer?

Breast tissue is one of the most sensitive areas to hormonal changes and is among the organs that women worry about the most throughout their lives. Every woman who feels a lump understandably experiences great fear. However, I can confidently say that not every lump felt in the breast is cancer.

Especially in young women, between the ages of 20 and 40, the most common benign lesions we see are fibroadenomas. These are masses that move under the hand during examination, have smooth borders, a rubbery consistency, and are generally painless. They are also called “breast mice” because they are very mobile. Fibroadenomas usually do not turn into cancer, but they can increase in size. Especially during pregnancy or breastfeeding, they may grow rapidly under the influence of hormones, leading to asymmetry and shape distortion in the breast.

Another common condition is breast cysts. These fluid-filled sacs can cause tension and pain depending on the menstrual cycle.

The aspects we monitor in the follow-up of benign breast lesions are:

• Increase in size
• Change in shape
• Presence of pain
• Degree of firmness

Is a Thyroid Nodule a Benign Lesion?

Thyroid nodules are so common in our society that if we performed an ultrasound on every two or three people on the street, we would likely find a nodule. The vast majority of these nodules are benign in nature. The thyroid gland is a very important organ located at the front of the neck, shaped like a butterfly, and it regulates our metabolism. When nodules here grow, they can cause both cosmetic and functional problems.

As the nodule grows, it not only creates a visible swelling from the outside but also exerts pressure on vital structures nearby. Right behind it is the esophagus, next to it is the windpipe, and there are nerves leading to the vocal cords:

Symptoms caused by large thyroid nodules include:

• Difficulty swallowing
• Feeling of something stuck
• Hoarseness
• Shortness of breath
• Cough
• Neck pain

If the nodule is of the type we call a “hot nodule” or “toxic adenoma,” the situation is somewhat different. These nodules do not obey signals from the brain and produce excessive thyroid hormone on their own. In this case, a condition called hyperthyroidism develops in the patient.

Additional symptoms seen in these patients include:

• Palpitations
• Tremors in the hands
• Excessive sweating
• Weight loss
• Irritability
• Insomnia

What Are the Problems of Benign Lesions in the Uterus and Prostate?

The reproductive systems in both women and men are also areas where benign lesions are frequently seen, and these lesions can significantly reduce quality of life.

In women, uterine fibroids are benign tumors originating from the muscle layer of the uterus. They are seen in almost half of women of reproductive age. Most women are not even aware that they have fibroids, but the location and size of the fibroid change everything. If the fibroid is close to the inner layer of the uterus or very large, it can turn life into a nightmare.

The main complaints caused by fibroids include:

• Heavy bleeding
• Prolonged menstrual periods
• Anemia
• Pelvic pain
• Frequent urination
• Constipation
• Lower back pain
• Pain during intercourse
• Infertility

In men, the most common problem with age is Benign Prostatic Hyperplasia (BPH), that is, benign enlargement of the prostate. The prostate gland is an organ located just at the exit of the bladder, surrounding the urinary canal like a ring. When this organ enlarges, it compresses the urinary canal and prevents urine from being expelled comfortably.

Symptoms seen in BPH patients include:

• Weak stream
• Intermittent urination
• Difficulty starting urination
• Frequent nighttime urination
• Feeling of incomplete emptying
• Sudden urgency
• Dribbling

Is Biopsy Necessary for the Diagnosis of a Benign Lesion?

Imaging technologies have reached an incredible level today. High-resolution ultrasounds, multi-slice CT scans, and multiparametric MRI devices provide us with detailed information about the internal structure, vascularity, and stiffness of the lesion. However, in order to name the lesion with 100% accuracy and say “yes, this is definitely benign,” sometimes a tissue diagnosis, that is, a biopsy, may be required. Biopsy is the “gold standard” of diagnosis.

My patients are usually frightened when they hear the word “biopsy.” Unfortunately, misconceptions such as “if it is cut, it will spread” or “if it is disturbed, it will worsen” are still common among the public. However, in modern medicine, especially in interventional radiology, we perform biopsies without surgical incisions, using only special needles and imaging guidance. These methods do not cause the spread of cancer; on the contrary, if there is suspicion, early diagnosis saves lives, and if it is benign, it provides peace of mind.

The biopsy methods we use are:

• Fine Needle Aspiration Biopsy
• Core Biopsy
• Vacuum-Assisted Biopsy

Fine Needle Aspiration Biopsy (FNAB): We generally prefer this method for thyroid nodules and cysts. We enter the lesion with a needle much thinner than even the needles used for drawing blood and take cell samples. It is such a delicate procedure that anesthesia is usually not even required; it feels like a mosquito bite.

Core (Tru-cut) Biopsy: We use this method when we need to see not only the cells but also the architectural structure of the tissue in breast, liver, or soft tissue masses. Millimetric tissue cylinders are taken with special spring-loaded needles. Since it is performed under local anesthesia, the patient does not feel pain during the procedure.

Vacuum-Assisted Biopsy (VAB): Especially in the breast, it is a highly advanced method that extracts suspicious lesions using vacuum power. This method not only diagnoses but also treats by completely removing benign fibroadenomas smaller than 3-4 cm from the body. In other words, diagnosis and treatment occur simultaneously.

Is Non-Surgical Treatment of Benign Lesions Possible?

This is where modern medicine, especially Interventional Radiology, truly shines. In the past, for a “benign but large” mass, our patients had to undergo open surgery, have part of their organs removed, and endure long recovery periods. Carrying a surgical scar on the neck for a nodule or having the uterus removed for a fibroid were difficult decisions for patients.

Interventional radiology has fundamentally changed this approach with its “minimally invasive” philosophy. Now, we can treat these lesions without surgery, without scalpels, without sutures, entering only through needle punctures. Our basic principle is this: to visualize the problematic area with imaging devices, perform a targeted procedure directly at the source, and cause minimal damage to healthy tissue. Our goal is not only to eliminate the disease but also to preserve the patient’s comfort and the function of the organ.

How Are Benign Lesions Treated by Ablation?

The term ablation refers to the destruction of tissue using energy. Instead of surgically removing the mass, we render it inactive in place using heat or cold. The lesion, which turns into dead tissue, is gradually cleared by phagocytic cells, and the mass shrinks over time.

• Radiofrequency and Microwave Ablation:

In these methods, we use heat energy. We frequently apply them especially in thyroid nodules, bone tumors (osteoid osteoma), and liver lesions. We clearly see the nodule on the ultrasound screen. Through the area numbed with local anesthesia, we enter the exact center of the nodule with a special needle. By delivering radiofrequency or microwave energy to the tip of this needle, we generate high heat. This heat thermally destroys only the diseased tissue at the tip of the needle.

In thyroid nodule ablation, for example, we destroy the nodule millimeter by millimeter using a method we call the “moving shot” technique. During the procedure, the patient remains alert and can communicate with us. When the procedure is finished, your healthy thyroid tissue remains intact, and only the nodule turns into dead tissue. In this way, our patients do not have to use thyroid medication for life as they would after surgery. Additionally, there is no risk of hoarseness or a permanent neck scar.

• Cryoablation (Freezing):

In some cases, we prefer freezing instead of heating. This method works wonders in breast fibroadenomas and some bone tumors. The probe placed inside the lesion cools the tissue down to -40 to -80 degrees. An ice ball forms inside the lesion, and these ice crystals break apart the tumor cells. The best part of freezing is that extreme cold has a natural anesthetic effect on nerves; therefore, almost no pain is felt during the procedure. In addition, since the healing tissue is very smooth, the cosmetic results are excellent.

What Is Embolization (Shrinking Benign Lesions by Blocking Blood Supply)?

For a tumor or mass to grow and remain alive, it needs blood supply, that is, nourishment. If you cut off this supply route, meaning the vessel feeding it, the lesion starves, shrinks, and becomes smaller. The embolization procedure is based on this principle: intravascular occlusion therapy.

• Uterine Artery Embolization (UAE):

It is a revolutionary method in the treatment of fibroids. It is the strongest alternative especially for women who are recommended to have their uterus removed (hysterectomy) but do not want to lose their organ. Through very thin catheters inserted from the groin or wrist, similar to a heart angiography, we reach the main vessels feeding the uterus. From here, we send very small particles (microparticles) only into the vessel branches feeding the fibroids, blocking these pathways.

Fibroids whose blood flow is cut off cannot be nourished and undergo infarction, turning into dead tissue. Over time, they shrink and reduce in size. In our patients, complaints of bleeding and pain disappear completely in 90% of cases. Most importantly, the uterus remains in place, there is no incision scar on the abdomen, and the patient can preserve fertility potential.

• Prostate Artery Embolization (PAE):

In men with benign prostate enlargement, we find and block the very thin arteries feeding the prostate. The prostate gland, whose blood supply is reduced, softens and shrinks. Thus, the pressure on the urinary canal is relieved. The biggest difference of this method compared to classical prostate surgeries (such as TUR-P) is that there is no risk of sexual dysfunction. Many male patients avoid treatment due to fear of “dry ejaculation” (retrograde ejaculation) or erectile problems that may occur after surgery. PAE eliminates this risk and ends this concern for men. In addition, the risk of urinary incontinence is almost negligible.

What Is the Approach to Benign Lesions in Cyst Treatment?

Simply draining simple fluid-filled cysts (in the liver, kidney, or thyroid) with a needle usually does not provide a permanent solution. Because as long as the cyst wall, that is, the membrane producing that fluid, remains inside, the cyst will refill with fluid shortly after it is emptied. This is similar to inflating a punctured tire. For a permanent solution, we apply sclerotherapy.

After completely draining the fluid inside the cyst, we inject sterile pure alcohol or special adhesive agents through the same needle. These substances chemically destroy the cells on the cyst wall. The walls adhere to each other, and the cyst becomes unable to accumulate fluid again.

In the treatment of Hydatid Cyst (dog cyst), which is unfortunately still common in our country and is caused by parasites, we use the “PAIR” method. We enter the cyst under imaging guidance, administer drugs that kill the live parasites inside, wait, and then drain all the contents. This method is much more comfortable than surgery, carries less risk, and requires a much shorter hospital stay.

What Are the Advantages of Interventional Radiology in the Treatment of Benign Lesions?

The general trend in modern medicine is now to provide the highest benefit with the least harm to the patient. Interventional radiology is the point where this “first, do no harm” principle meets technology. The advantages we offer compared to surgery in the treatment of benign lesions are quite clear.

These advantages are:

• Procedures are performed through a needle puncture
• No scalpel or suture scars
• Organ-preserving
• General anesthesia is usually not required
• Hospital stay is very short
• Low risk of infection
• Fast return to normal life
• Minimal psychological trauma

Especially in areas with high aesthetic concern such as the neck and breast, the absence of scars is an invaluable advantage for our patients. In addition, for elderly individuals or patients with heart disease who are at risk with general anesthesia, these procedures performed under local anesthesia open a life-saving door. Our patients can come in the morning, undergo the procedure, and return home to their loved ones in the evening or the next morning. The recovery process takes days, not weeks.

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