Abdomen

Question 1

Fibrosis is not seen in: (September 2013, March 2017)
a. Budd-Chiari
b. Cirrhosis
c. Haemochromatosis
d. Wilson disease
e. Alpha 1

Answer 1

Probably Budd-Chiari (periportal, not generalised/parenchymal)

A. BCS - centrilobular congestion, necrosis then fibrosis (not cirrhosis) - Robbins
B. Cirrhosis - bridging parenchymal fibrosis
C. HCT → fibrosis → cirrhosis
D. Wilson’s - fatty → hepatitis → cirrhosis (Robbin’s)
E. A1AT - childhood OR adult cirrhosis

Question 2

Heamangioma:
-Definition
-Vascular supply
-Cells in the tumor
-Does it have a capsule?

Answer 2

-Def: benign tumor composed of large cavernous vascular channels, lined by single layer of endothelial cells, supported by thin fibrous stroma.

-Vascular supply: hepatic artery

-Cells: endothelial cells. No hepaticyte, no bile ducts.

-No capsule; only pseudocapsule.

Question 3

Haemangioma:
Morphology

Answer 3

-Frequently sub capsular in location
-Usually solitary and slow growing; 50 % multiple (syndrome)
-90% no Ca + (be aware 10% YES Ca+) (making this difficult DD for fibrolamellar HCC)
-Giant haemangiomas: can have a central scar, never enhances (no vascularity, of mixoid tissue)

Question 4

Haemangioma:
Dx morphology
Ways of Dx (methods)

Answer 4

-CT/MR
-Peripheral nodular discontinuous enhancement.
-From outside to inside as time progress (centripetal)
-Always follows density/intensity to portal veins.
-Eovist/Primovist: haemangioma will not uptake.

-US:
-Echogenic (unless background liver is w/steatosis, in that case, could be hypoechoic)
-Posterior acoustic enhancement.

-NM:
TC-99m labeled RBC:
-Initially defect/less uptake (DD from other entities)
-Delay: 30-50min: persistent uptake.

-Angio:
Cotton wool appearance.
Normal size feeding vessels.

-Final diagnosis: Biopsy
Needs to be a core (FNA not enough)

Question 5

Haemangioma:
main DD

Answer 5

-Small HCC
-Met w/ central necrosis
-Peripheral cholangioCa (mimic due to delay persistent enhancement)

Question 6

Haemangioma:
Subtypes

Answer 6

-Typical

-Giant:
>4cm (or >6cm or > 10cm, poor agreement)
-Central non enhancing scar (no vascularity)
-Associated w/Kasabach Merritt syndrome

-Capillary Flash filling haemangiomas
Rapid flash filled on arterial phase.
Retains in delay
Does not wash out (DD tumor)

-Sclerosing haemangioma
Contains fibrous tissue + thrombosed vascular channels.
Poor gad enhancement.
T2 not as bright.

-Atypical haemangiomas
Enhances from center to periphery.

-Pedunculated exophytic haemangiomas
Most frequently in left hepatic lobe. Complications: torsion, infarc.