Benign liver lesions Flashcards
How are benign liver lesions classified?
Solid
Cystic
Name solid benign liver lesions
Haemangioma
Focal nodular hyperplasia
Hepatic adenoma
Regenerative nodules
What is the most common benign liver lesion?
Haemangioma
What is the second most common benign liver lesion?
Focal nodular hyperplasia
Discuss the epidemiology of haemangioma
20% of population
F:M 3:1 at 45yo
Discuss morphological features of a haemangioma
Congenital large endothelial vascular space
Average 5cm (<25cm)
Solitary
No malignant risk
Discuss the presentation of liver haemangiomas
Incidental finding
RUQ mass
Rarely symptomatic
How do liver haemangiomas present on CT?
Assymetrical nodular peripheral enhancement in arterial phase with centripetal filling
How do liver haemangiomas present on MRI?
T1 hypointense
T2 hyperintense
Contrast enhanced
Discuss the management of liver haemangiomas
Only if symptomatic/rupture
- Enucleation and inflow control
- Embolization of feeding vessels
- Formal liver resection
Discuss the epidemiology of focal nodular hyperplasia liver lesions
Young females
Discuss the morphology of focal nodular hyperplasia liver lesions
<5cm No true capsule No malignant risk Chords of benign hepatocytes combined by fibrous septa from central scar Atypical biliary epithelium
Discuss investigations for focal nodular hyperplasia liver lesions
AFP (normal)
CT
MRI
How do focal nodular hyperplasia liver lesions appear on CT scan?
Well circumscribed with central scar
Hyperdense in arterial phase
Isodense in venous phase
How do focal nodular hyperplasia liver lesions appear on MRI?
T1 hypointense
T2 hyper/isointense
Fibrous central scar
Discuss the management of focal nodular hyperplasia liver lesions
No management required
Reassure patient
Stop oestrogen use
Resect if unsure diagnosis
Discuss the morphology of hepatic adenomas
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
Discuss the presentation of hepatic adenomas
Incidental on U/S
RUQ pain/mass
How do hepatic adenomas appear on CT?
Sharp borders
Arterial enhancement
Iso/hypo-dense in venous phase
How do hepatic adenomas appear on MRI?
T1 hyperintense
Gadobenate dimeglumine causes no enhancement (excreted via bile ducts and kidneys)
Discuss the management of hepatic adenoma
Stop oestrogen use Surgical resection if >5cm OR if - symptomatic - unsure diagnosis - low risk area - high risk patient
Discuss the morphology of regenerative nodules
Hepatocyte hypertrophy and cirrhosis
Multiple
Small
Not premalignant
Name cystic benign liver lesions
Congenital cyst
Polycystic liver disease
NET metastases
Caroli’s disease
Discuss the morphology of congenital cysts
Simply cyst No septa Thin wall Clear contents (non-bilious, serous fluid) No malignant risk
Name clinical features of congenital cysts
Accidental finding RUQ mass Early satiety Pain Intra-cystic bleeding
Discuss the management of congenital cysts
If symptomatic
- laparoscopic enucleation
- arterial embolization
- aspiration and sclerotherapy
- resection
Name clinical features of polycystic liver disease
First kidney cysts Asymptomatic Renal dysfunction Abdominal pain Early satiety RUQ mass SOB
Name investigations in polycystic liver disease
Bloods (GGT, UKE)
Imaging
Genetics (PCKD 1/2)
Name conditions associated with polycystic liver disease
Pancreatic cysts Cerebral aneurysm Inguinal hernia MR Diverticulosis
Discuss the management of polycystic liver disease
Involve nephrology Surgical - aspiration and sclerotherapy - enucleation - resection - hepato-renal transplant
