Benign Focal Lesions of the Liver Flashcards
benign lesions include Haemangioma
Focal nodular hyperplasia
Adenoma
Liver cysts
with ____ being the most common benign tumour which is usually asymptomatic
Haemangioma
haemangioma is more common in males, true/false?
false
what is a haemangioma
a mass of atypical blood vessels
what investigations are done for haemangioma?
USS, CT (venous enhancement from periphery to center) , MRI
no need to biopsy
what is focal nodular hyperplasia?
it is a nodule formation of normal liver tissue caused by congenital problems in arterial flow which leads to a hyperplastic response.
what is focal nodular hyperplasia associated with?
osler-Weber-Rendu and liver haemangioma
histologically do FNH nodules show all types of cells in the liver (e.g. sinusoids, bile ductules and kupffer cells) or just hepatocytes?
all types of cells
does FNH have a relation with sex hormones?
no
which group is FNH more common in ?
young and middle aged women
how is FNH diagnosed?
US, CT, MRI, FNA
what would be seen on CT for FNH?
Classically (but not always) – central scar containing a large artery, radiating branches to the periphery
histologically do hepatic adenomas show all types of cells in the liver (e.g. sinusoids, bile ductules and kupffer cells) or just hepatocytes?
no - These are benign neoplasm composed of normal hepatocytes
no portal tract, central veins or bile ducts
adenomas are more common in females?
yes
do hepatic adenomas have a relation with sex hormones?
yes - contraceptive hormone associations
what may patients with hepatic adenoma present with?
assymptomatic
May present with rupture, hemorrhage, or malignant transformation (very rare)
how is hepatic adenoma diagnosed?
UC, CT, MRI, FNA - may be needed
how is hepatic adenoma treated?
Stop hormones
and observe
Male patients more prone to develop malignant adenoma than female so it is now thought that the adenoma should be resected rather than monitored
what are the 5 types of cystic lesions
Simple, Hydatid, Atypical, Polycystic lesion, Pyogenic or Amoebic abscess
____ ___ - a Liquid collection lined by an epithelium with no biliary tree communication
simple cyst
mostly simple cysts are ____ but symptoms can be due to ______, ______, ___ and ____
assymptomatic
haemorrhage, infection, rupture and compression
___ ___ - This is a common complication of tapeworm parasite echinoccocus granulosus
hydatid cyst
how is hydatid cyst diagnosed?
history and serologic testing - anti echinoccocus antibodies
what are the management options for hydatid cyst ?
surgery
medical - albendazole
percutaneous drainage: PAIR
what is polycystic liver disease?
Embryonic ductal plate malformation of the intrahepatic biliary tree
what are the three types of PLD?
Von Meyenburg complexes (VMC)
Polycystic Liver disease
Autosomal dominant Polycystic Kidney disease
what are the symptoms of PLD/
abdominal pain, abdominal distension, atypical symptoms due to voluminous cysts resulting in compression of adjacent tissue or failure of the affected organ
VMC are Cystic bile duct malformations, originating from the ______ biliary tree
Cystic bile duct malformations, originating from the peripheral biliary tree
are there predisposing genes to VMC?
no
____ ____ ____ ____Liver function preserved and renal failure rare
Symptoms depend on size of cysts
Polycystic Liver disease
are there predisposing genes to PCLD?
yes - PRKCSH and SEC63
Renal failure due to polycystic kidneys and non-renal extrahepatic features are _____ in ADPKD
common
are there predisposing genes to ADPKD?
yes– PKD1 and PKD2
what are the features of ADPKD?
Hypertension
Abdominal aneurysms
Cardiac valve abnormalities
what are the clinical features of liver abscess?
High fever
Leukocytosis
Abdominal Pain
Complex liver lesion
what is important to find out in the history for liver abscess?
if they have had a recent abdo or biliary infection
dental procedure
what is the management in liver abscess?
empirical antibiotics initially
aspiration/drainage percutaneously
ecg
