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GI > 4- liver tumours investigation & management > Flashcards

4- liver tumours investigation & management Flashcards

1
Q

what are examples of benign liver tumours?

A
  • haemangioma
  • focal nodular hyperplasia
  • adenoma
  • liver cysts
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2
Q

what are examples of malignant liver tumours?

A
  • primary liver cancers (hepatocellular carcinoma & cholangiocarcinoma)
  • metastases
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3
Q

what is haemangioma?

A
  • commonest benign liver tumour
  • hypervascular well demarcated capsule tumour
  • usually asymptomatic
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4
Q

what is used for diagnosis of haemoangioma?

A
  • ultrasound →echogenic spot, well demarcated
  • CT →venous enhancement from periphery to centre
  • MRI →high intensity
  • no need for biopsy or treatment
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5
Q

what is focal nodular hyperplasia?

A
  • benign liver tumour that forms in normal liver tissue = usually asymptomatic
  • congenital vascular anomaly with central scar containing large artery radiating branches to periphery
  • hyperplastic response to abnormal arterial flow
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6
Q

what does focal nodular hyperplasia look like on histology?

A

sinusoids, bile ductules, kupffer cells

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7
Q

what is diagnosis investigations for focal nodular hyperplasia?

A
  • ultrasound →nodule with varying echogenicity
  • CT →hypervascular mass with central scar
  • MRI →iso ir hypo intense
  • fine needle aspiration (for biopsy) →normal hepatocytes and kupffer cells with central core
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8
Q

what is hepatic adenoma?

A

= benign neoplasm composed of normal hepatocytes but no portal veins, central veins or bile ducts
- solitary fat containing lesion usually found on right lobe

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9
Q

what are risks of hepatic adenoma?

A

rupture, hemorrhage or malignant transformation →VERY RARE

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10
Q

what is common presentation of hepatic adenoma?

A
  • asymptomatic or RUQ pain
  • associated with contraceptive pill or anabolic steroids (driven by oestrogen)
  • female
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11
Q

what do you do if someone has hepatic adenoma and on oral contraceptive pill?

A

you discontinue the oral contraceptive pill if develop adenoma →usually digresses
- then continue to do check up ultrasound/CT every 6 months

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12
Q

what investigations would you do for hepatic adenoma?

A
  • ultrasound →filling defect
  • CT →diffuse arterial enhancement
  • MRI →hypo or hyper lesion
  • fine needle aspiration (biopsy) →may be needed
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13
Q

what is treatment of male with adenocarcinoma?

A

surgical incision - as more likely to become malignant than female

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14
Q

what is important differences between adenoma and focal nodular hyperplasia?

A

adenoma = purely hepatocyte tumour & malignant degeneration

focal nodular hyperplasia = all liver ultrastructure including RES & bile ducts & no malignant risk

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15
Q

what is a simple cyst?

A
  • Liquid collection lined by an epithelium
  • No biliary tree communication
  • Solitary and uniloculated
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16
Q

what is symptoms of simple cyst?

A
  • Most of the time asymptomatic
  • Symptoms can be related to
    • Intracystic haemorrhage
    • Infection
    • Rupture (rare)
    • Compression
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17
Q

what are hydatid cysts?

A

also fluid-filled sac that may present having spread or eroded into adjacent structures
- diagnosis includes & history and serological testing detection of anti-echinococcus

18
Q

what is treatment of hydatid cysts?

A

surgery most common
- conservative = open cystectomy, marsupialization
- Radical = Pericystectomy, lobectomy

medical = albendazole
percutaneous drainage

19
Q

what is polycystic liver disease?

A
  • embryonic ductal plate malformation of intrahepatic biliary tree
  • numerous cysts throughout liver parenchyma
20
Q

what are 3 types of polycystic liver disease?

A
  1. Von Meyenburg complexes (VMC)
  2. Polycystic Liver disease
  3. Autosomal dominant Polycystic Kidney disease
21
Q

what is von meyenburg complexes?

A

= type of polycystic liver disease

  • on Meyenburg complexes (micro hamartomas) benign cystic nodules throughout the liver
  • Cystic bile duct malformations, originating from the peripheral biliary tree
  • Remnants develop into small hepatic cysts and usually remain silent during life
22
Q

what is polycystic liver disease?

A

= type of polycystic liver disease
- liver function preserves, renal failure rare
- symptoms depend on size

23
Q

what is autosomal dominant polycystic kidney disease?

A

= type of polycystic disease
- renal failure due to polycystic kidneys & non-renal extrahepatic features
- potential massive hepatic enlargement

24
Q

what is management of polycystic liver disease?

A
  • abdominal pain, abdominal distension, atypical symptoms due to voluminous cysts resulting in compression of adjacent tissue or failure of affected organ
  • conservative treatment recommended to halt cyst growth to allow abdominal decompression
  • pharmacological therapy = somatostatin (benefit for symptom relief & liver volume reduction)
25
Q

what is presentation of liver abscess?

A
  • high fever
  • leukocytosis
  • abdominal pain
  • complex liver lesion

history →abdominal or biliary infection, dental procedure

26
Q

what is management of liver abscess?

A
  • intrinsic empiric broad spectrum antibiotics
  • aspiration/drainage percutaneously
  • echocardiogram
  • operation if no clinical improvement →open drainage, resection
  • 4 weeks antibiotic therapy repeat image
27
Q

what are common malignant liver lesions?

A
  1. Hepatocellular carcinoma (HCC)
  2. Fibro-lamellar carcinoma of the liver
  3. Hepatoblastoma
  4. Intrahepatic cholangiocarcinoma
  5. Others
  6. METASTASES
28
Q

what are clinical features of hepatocellular carcinoma?

A
  • weight loss and RUQ pain
  • asymptomatic
  • worsening of pre existing chronic liver disease
29
Q

what is AFP?

A

alfa fetoprotein = hepatocellular carcinoma tumour marker

30
Q

what helps diagnosis of hepatocellular carcinoma?

A
  • clinical presentation
  • elevated AFP
  • combination of ultrasound & CT (MRI and biopsy can then be used if needed)
31
Q

what is important for prognosis hepatocellular carcinoma?

A
  • tumour size
  • extrahepatic spread
  • underlying liver disease
  • pt performance status (important)
32
Q

what is treatment of hepatocellular carcinoma?

A

early stages think about resection or transplant but as worses then move onto palliative options

33
Q

when is resection a feasible treatment option hepatocellular carcinoma?

A
  • feasible if small tumour with preserved liver function but recurrence rate is higher than liver transplant
34
Q

what is local ablation treatment option?

A
  • for non resectable pt or advanced liver cirrhosis
  • alcohol injection
  • radiofrequency ablation
  • temporary measure
35
Q

what is chemoembolization treatment option?

A

→trans arterial chemoembolization = TACE

  • inject chemo in hepatic artery
  • inject embolic agent
  • in patients with early cirrhosis
  • no role for systemic chemo
36
Q

what are fibrolamellar carcinoma?

A
  • not related to cirrhosis
37
Q

what are diagnostic findings of fibrolamellar carcinoma?

A
  • AFP normal
  • CT shows typical stellate scar with radial septal showing persistent enhancement
38
Q

what are treatment options for fibrolamellar carcinoma?

A
  • surgical resection or transplantation is standard of care
  • TACE if unresectable tumour
39
Q

what are second liver metastases?

A
  • common site for blood borne metastases
  • common primaries →colon, breast, lung, stomach, pancreas
  • preserved liver function
40
Q

what are malignant primary liver cancers?

A
  • hepatocellular carcinoma
  • fibrolamellar carcinoma
  • hepatoblastoma

GI (56 decks)

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