15. Liver Lesions

Question 1

What are the three benign primary liver lesions?

Answer 1

1. Hemangioma
2. Focal nodular hyperplasia (FNH)
3. Adenoma

Question 2

What are the two malignant primary lesions of the liver?

Answer 2

1. Hepatocellular carcinoma (HCC)

2. Cholangiocarcinoma (CCA)

Question 3

What lesion does oral contraceptive use increase the risk for?

Answer 3

Hepatic adenoma

Question 4

What lesion does a hx of extrahepatic malignancy increase the risk for?

Answer 4

Metastatic disease

Question 5

What lesion does underlying liver disease increase the risk for?

Answer 5

Hepatocellular carcinoma

Question 6

What lesion does a hx of primary sclerosing cholangitis (PSC) increase risk for?

Answer 6

Cholangiocarcinoma (CCA)

Question 7

Malignant lesions in a noncirrhotic liver are primarily:

Answer 7

Metastases from the GI tract

**also from the lung, UG tract, breast

Question 8

Malignant lesions in a cirrhotic liver are primarily:

Answer 8

Primary liver lesions (77%)

Question 9

What is the most common benign liver lesion? What kind of liver gets these?

Answer 9

Hemangioma

Non-cirrhotic

Question 10

What are hemangiomas?

Answer 10

Congenital vascular malformations–blood filled cavities lined by endothelium

Question 11

When are the majority of hemangiomas diagnosed? Size?

Answer 11

Third to fifth decade (asymptomatic)

1-20 cm (over 10 called giant hemangioma)

Question 12

Hemangiomas are multiple in __% of cases

Answer 12

30%

Question 13

Do hemangiomas have malignant potential?

Answer 13

NO

Question 14

When is the only time that a hemangioma or focal nodular hyperplasia will cause sx?

Answer 14

When the lesion is close to the surface and stretches the capsule, which has higher innervation

Question 15

What is characteristic of focal nodular hyperplasia (FNH) on imaging

Answer 15

Central stellate scar

Question 16

What is the second most common benign liver lesion?

Answer 16

Focal nodular hyperplasia

Question 17

What kind of liver gets FNH?

Answer 17

Non-cirrhotic liver

Question 18

What causes FNH?

Answer 18

Anomolous artery develops, leading to hyperperfusion

Hyperperfused area enlarges until it outgrows the blood supply

Question 19

Who usually gets FNH?

Answer 19

Women between the ages of 20 and 50

Question 20

What is the typical size of FNH?

Answer 20

<5 cm, rarely exceeds 10 cm

Question 21

How often is FNH multiple?

Answer 21

10-20% of cases

Question 22

What is growth of a hepatic adenoma associated with?

Answer 22

Estrogen

Question 23

What type of liver is an adenoma found in? Benign proliferation of:

Answer 23

Non-cirrhotic

Hepatocytes

Question 24

Who typically gets hepatic adenomas?

Answer 24

Women of childbearing age

Question 25

Hepatic adenomas are associated with the use of:

Answer 25

Contraceptives

Question 26

What are two situations that may give rise to multiple hepatic adenomas?

Answer 26

Glycogen storage disease | Diabetes mellitus

Question 27

What is there a risk for with hepatic adenomas?

Answer 27

Hemorrhage | Malignant transformation

Question 28

Treatment for hepatic adenoma?

Answer 28

Avoid contraceptives Avoid pregnancy Surgical resection if recommended to avoid risk of cancer and tumor rupture

Question 29

What is the #1 cause of HCC worldwide? In the US?

Answer 29

HBV | HCV

Question 30

Why is HCC on the rise in the US right now?

Answer 30

Lots of HCV infection occured in the 70s-80s, takes about 20-30 years to develop cirrhosis, and cirrhosis much come before transformation to HCC in HCV infection

Question 31

What is the most common cause of HCC in Asian americans? Non-asians?

Answer 31

HBV | HCV

Question 32

What is characteristic of blood flow in HCC?

Answer 32

Usually, 70% of blood flow is venous | HCC leads to a predominance of arterial blood flow, visualize by infusing contrast into the arteries

Question 33

What produces alpha fetoprotein (AFP)

Answer 33

Fetal liver Placenta **malignant liver cells

Question 34

Alpha fetoprotein is elevated in ___% of patients wtih HCC

Answer 34

60-70% | **can also be elevated with hepatic inflammation in the absence of HCC and with cirrhosis

Question 35

Values of AFP over ___ ng/ml in conjugation with liver lesion on imaging is consistent with HCC

Answer 35

200

Question 36

Prevention of HCC

Answer 36

HBV vaccination Treatment of viral hepatitis Coffee (decreased liver enzymes, cirrhosis, and HCC)

Question 37

Multiple liver lesions in a non-cirrhotic liver without arterial enhancement on imaging should make you think of:

Answer 37

Metastatic disease

Question 38

What will the AFP level be with metastatic carcinoma in the liver?

Answer 38

Normal (not over 200)

Question 39

What are common sources of metastatic carcinoma?

Answer 39

``` GI: colon, pancreas, eso, gastric Lung UG Breast Melanoma ```