Benign Lesions in the Liver Flashcards
Solid liver lesions in older patients are more likely to be what?
Malignant with metastases more common than primary liver cancer in the absence of liver disease
WHat are solid liver lesions in patients with chronic liver disease more likely to represent?
Primary Liver Cancer rather than metastases or benign tumour
What is the most common solid liver tumour in non cirrhotic patients
Hemangioma (benign)
Name 4 benign liver tumours
Hemangioma
Focal nodular hyperplasia
Adenoma
Liver cysts
Name the 2 main types of malignant tumours
Primary liver cancers
Metastases
What are the 2 types of Primary liver cancers
Hepatocellular carcinoma
Cholangiocarcinoma
What is the commonest liver tumour
Hemangioma
Describe a hemangioma
A vascular tumour
Usually single and small
Well demarcated capsule
Usually asymptomatic
How do we diagnose a Hemangioma
Ultrasound is key
CT
MRI
What is the treatment for hemangioma
No treatment
Describe a focal nodular hyperplasia
enign nodule formation of normal liver tissue
congenital anomaly
What is the classic appearance of a focal nodular hyperplasia
A central scar through the middle of the mass
Who is more likely to have a focal nodular hyperplasia
Young and middle aged women
What type of response is a focal nodular hyperplasia?
A hyperplastic response to abnormal arterial flow
How can we diagnose a focal nodular hyperplasia
Ultrasound
CT
MRI
Fine needle aspiration
What is the treatment for Focal nodular hyperplasia
No treatment
No change is required for pregnancy or hormones
What is a hepatic adenoma
Benign neoplasm composed of normal hepatocytes with no portal tract, central veins or bile ducts
Who is more likely to get hepatic adenomas?
Women
What are hepatic adenomas associated with
The contraceptive hormones - mostly oestrogen
What are the symptoms of hepatic adenoma
Usually asymptomatic but may have RUQ pain
How might hepatic adenomas present
Rupture, haemorrhage or malignant transformation
Where are hepatic adenomas most commonly found
In the right lobe in young women
How can regression of hepatic adenomas occur
If the oral contraceptive is discontinued
How can we diagnose hepatic adenoma
US
CT
MRI
FNA
What is the treatment for hepatic adenomas
Stop the hormones and observe every 6 months for 2 years
If there is no regression then surgical incision may be appropriate
What liver structures do adenomas contain
Purely hepatocyte tumours
What liver structures do focal nodular hyperplasias contain
All of the liver ultrastructure - RES and bile ductules
What type of benign tumour imay bleed
Adenoma
What type of benign tumour has the risk of developing into a malignant tumour
Adenoma
How can you describe both adenomas and focal nodular hyperplasia
Hypervascular
What is a simple cyst
A liquid collection lined by an epithelium
What do simple cysts look like on US
Black holes
How common are simple cysts in the liver
2nd most common to hemangiomes
When would we consider surgical intervention in a simple cyst
If the patient was symptomatic
What is the cause of hydatid cysts
Sheep born parasite
What can hydatid cysts erode into?
The IVC
What is the treatment of a hydatid cyst
Marsupialisation or resection
Albendazole (also used for tapeworms)
What is polycystic liver disease a result of
Embryonic ductal plate malformation of the intrahepatic biliary tree
What are the 3 types of polycystic liver disease
Von Meyenburg complexes
Polycystic liver disease
Autosomal dominant polycystic kidney disease
What is the most common form of PLD
Autosomal recessive
What are Von Meyenburg complexes
Benign cystic nodules throughout the liver
When do Von Meyenburg complexes occur
During liver development
What do the symptoms of PCLD depend on
The size of the cysts
What is the main What does autosomal dominant polycystic kidney disease result in
Renal failure
What is the main method of managing polycystic liver disease
Conservative treatment
What drug is used in PLD for symptom relief and liver volume reduction
Somatostatin
What are the 3 common symptoms of a liver abscess
high fever
Leukocytosis
Abdominal Pain
Who tends to appear more unwell a patient with a liver abscess or a patient with metastasis?
Liver abscess
What is the common history of a patient with liver abscess
Abdominal or biliary infection Dental procedure (rare)
What is the treatment for a liver abscess treatment
Initial broad spectrum antibiotics
Aspiration/ drainage
Why do we do an ECHO on patients with a liver abscess
To rule out bacterial endocarditis
What do we do for a patient if there is no clinical improvement?
Open drainage and resection
What is the minimum number of weeks of atibiotic therapy for a liver abscess patient
4 weeks
