4: Hepatomegaly and focal liver lesions Flashcards
Elderly patients are more likely to have (primary liver cancer / secondary metastases).
secondary metastases from other cancers
Patients with chronic liver disease are likely to have (primary liver cancer / secondary metastases).
primary liver cancer
due to the chronic inflammation - constant replenishing of cells makes DNA errors more likely, and chronic inflammation puts cells under oxidative stress which may damage their DNA
What is the most common tumour found in non-cirrhotic patients?
Is it benign or malignant?
Haemangioma
How are liver lesions found?
Usually through imaging / screening for other diseases
Name four types of benign liver lesion.
Haemangioma
Focal nodular hyperplasia
Adenoma
Cysts
Name the two broad classes of malignant tumour found in the liver.
Primary (originating from the liver - hepatocellular carinoma or cholangiocarcinoma)
Metastases from elsewhere
What is the most common liver tumour?
Haemangioma
Haemangiomas are more common in (males / females).
females
Characteristic of benign tumours
What do haemangiomas look like?
Small, singular, encapsulated
Do haemangiomas cause symptoms?
No
Is any treatment required for a haemangioma?
No
How are liver lesions investigated?
Imaging - ultrasound, MRI, CT scan
Biopsy
What is focal nodular hyperplasia?
A benign nodule made of normal liver tissue
What causes the formation of focal nodular hyperplasia?
Congenital abnormal blood flow
What does focal noduar hyperplasia look like?
Central scar running to the periphery of the liver
Focal nodular hyperplasia is more common in (males / females).
females
Which immune cell can be seen in benign FNH biopsies?
Kupffer cells
(liver phagocytes)
Adenomas look like normal hepatocytes with one major difference - what is this difference?
No vessels
(portal vein, ducts or hepatic vein)
What drug is associated with liver adenomas in females?
Contraceptive pill
i.e hormone pills
Why may athletes develop liver adenomas?
Hormone therapy
e.g steroids
Benign liver adenomas rarely become ___.
malignant
What is the general treatment for adenomas in both males and females?
Weight loss
Stop hormone therapy
What surgical management for adenomas is undergone in males?
Excision
due to malignant potential
Adenomas may ___ and cause haemorrhage if they get too big.
rupture
What is the most common malignant liver cancer?
Hepatocellular carcinoma
Hepatocellular carcinoma commonly occurs in (men / women).
men
Hepatocellular carcinoma is associated with which chronic liver disease?
Cirrhosis
What are some symptoms of hepatocellular carcinoma?
RUQ pain
Hard RUQ mass
Weight loss
Jaundice
What are some signs of hepatocellular carcinoma?
Hard mass in RUQ
Jaundice
What is the marker used to detect hepatocellular carcinoma?
AFP
(alpha fetoprotein)
What investigations are undergone to detect hepatocellular carcinoma?
Imaging - US/CT/MRI
Biopsy
Hepatocellular carcinoma can potentially ___ to other areas of the body.
metastasize
What is the only surgical procedure which cures hepatocellular carcinoma?
Liver transplant
What surgical procedure can be done to palliate hepatocellular carcinoma?
Resection
What is a rare malignant liver tumour found in young patients?
Fibro-lamellar carcinoma
In fibro-lamellar carcinoma, the AFP is (normal / elevated).
normal
What would be seen on images of fibro-lamellar carcinoma?
Long stellate scar
