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MBChB Surgery > Benign liver lesions > Flashcards

Benign liver lesions Flashcards

1
Q

How are benign liver lesions classified?

A

Solid

Cystic

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2
Q

Name solid benign liver lesions

A

Haemangioma
Focal nodular hyperplasia
Hepatic adenoma
Regenerative nodules

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3
Q

What is the most common benign liver lesion?

A

Haemangioma

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4
Q

What is the second most common benign liver lesion?

A

Focal nodular hyperplasia

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5
Q

Discuss the epidemiology of haemangioma

A

20% of population

F:M 3:1 at 45yo

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6
Q

Discuss morphological features of a haemangioma

A

Congenital large endothelial vascular space
Average 5cm (<25cm)
Solitary
No malignant risk

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7
Q

Discuss the presentation of liver haemangiomas

A

Incidental finding
RUQ mass
Rarely symptomatic

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8
Q

How do liver haemangiomas present on CT?

A

Assymetrical nodular peripheral enhancement in arterial phase with centripetal filling

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9
Q

How do liver haemangiomas present on MRI?

A

T1 hypointense
T2 hyperintense
Contrast enhanced

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10
Q

Discuss the management of liver haemangiomas

A

Only if symptomatic/rupture

  1. Enucleation and inflow control
  2. Embolization of feeding vessels
  3. Formal liver resection
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11
Q

Discuss the epidemiology of focal nodular hyperplasia liver lesions

A

Young females

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12
Q

Discuss the morphology of focal nodular hyperplasia liver lesions

A 
<5cm
No true capsule
No malignant risk 
Chords of benign hepatocytes combined by fibrous septa from central scar
Atypical biliary epithelium
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13
Q

Discuss investigations for focal nodular hyperplasia liver lesions

A

AFP (normal)
CT
MRI

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14
Q

How do focal nodular hyperplasia liver lesions appear on CT scan?

A

Well circumscribed with central scar
Hyperdense in arterial phase
Isodense in venous phase

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15
Q

How do focal nodular hyperplasia liver lesions appear on MRI?

A

T1 hypointense
T2 hyper/isointense
Fibrous central scar

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16
Q

Discuss the management of focal nodular hyperplasia liver lesions

A

No management required
Reassure patient
Stop oestrogen use
Resect if unsure diagnosis

17
Q

Discuss the morphology of hepatic adenomas

A

Benign hepatocyte proliferation
Solitary
10-25% malignancy risk
Well-vascularised by hepatic aa (risk to rupture and bleed)
Congested hepatocytes with glycogen deposits, no bile ducts, no Kupffer cells, no lobules

18
Q

Discuss the presentation of hepatic adenomas

A

Incidental on U/S

RUQ pain/mass

19
Q

How do hepatic adenomas appear on CT?

A

Sharp borders
Arterial enhancement
Iso/hypo-dense in venous phase

20
Q

How do hepatic adenomas appear on MRI?

A

T1 hyperintense

Gadobenate dimeglumine causes no enhancement (excreted via bile ducts and kidneys)

21
Q

Discuss the management of hepatic adenoma

A 
Stop oestrogen use 
Surgical resection if >5cm OR if
- symptomatic
- unsure diagnosis
- low risk area
- high risk patient
22
Q

Discuss the morphology of regenerative nodules

A

Hepatocyte hypertrophy and cirrhosis
Multiple
Small
Not premalignant

23
Q

Name cystic benign liver lesions

A

Congenital cyst
Polycystic liver disease
NET metastases
Caroli’s disease

24
Q

Discuss the morphology of congenital cysts

A 
Simply cyst
No septa
Thin wall
Clear contents (non-bilious, serous fluid) 
No malignant risk
25
Q

Name clinical features of congenital cysts

A 
Accidental finding
RUQ mass
Early satiety
Pain 
Intra-cystic bleeding
26
Q

Discuss the management of congenital cysts

A

If symptomatic

  • laparoscopic enucleation
  • arterial embolization
  • aspiration and sclerotherapy
  • resection
27
Q

Name clinical features of polycystic liver disease

A 
First kidney cysts
Asymptomatic
Renal dysfunction
Abdominal pain
Early satiety
RUQ mass
SOB
28
Q

Name investigations in polycystic liver disease

A

Bloods (GGT, UKE)
Imaging
Genetics (PCKD 1/2)

29
Q

Name conditions associated with polycystic liver disease

A 
Pancreatic cysts
Cerebral aneurysm
Inguinal hernia
MR
Diverticulosis
30
Q

Discuss the management of polycystic liver disease

A 
Involve nephrology 
Surgical
- aspiration and sclerotherapy
- enucleation
- resection 
- hepato-renal transplant

MBChB Surgery (38 decks)

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