Focal Lesions in the Liver Flashcards
solid liver lesions
older patients = malignant with metastases
chronic liver disease = primary liver cancer
non cirrhotic patients = haemangioma
benign
haemangioma
focal nodular hyperplasia
adenoma
liver cysts
malignant
primary liver cancers - hepatocellular carcinoma, cholangiocarcinoma
metastases
haemangioma
female>males
commonest liver tumour
hypervascualr
usually asymptmatic
haemangioma - diagnosis
US - echogenic spot
CT - venous enhancement from periphery to centre
MRI - high intensity area
no need for FNA
haemangioma - treatment
no need for treatment
focal nodular hyperplasia (FNH)
benign nodule formation of normal liver tissue
congenital vascular anomaly - associated with Osler-weber-rendu and liver haemangioma
central scar containing a large artery, radiating branches to the periphery
hyperplastic response to abnormal arterial flow
sinusoids, bile ductules and kupffer cells present on histology
minimal pain
focal nodular hyperplasia (FNH) - diagnosis
US - nodule with varying echogenicity
CT - hyper vascular mass with central scar
MRI - iso or hypo intense
FNA - normal hepatocytes and kupffer cells with central core
focal nodular hyperplasia (FNH) - treatment
no treatment necessary
hepatic adenoma
benign neoplasm composed of normal hepatocytes no portal tract, central veins or bile ducts
female>male
associated with contraceptive hormones
RUQ pain
rupture, haemorrhage or malignant transformation
transformation risk higher in males
hepatic adenoma - diagnosis
US - filling defect
CT - diffuse arterial enhancement
MRI - hypo or hyper intense lesion
FNA - may be needed
hepatic adenoma - treatment
stop hormones, weight loss
surgical excision
imaging after 6 months
simple cyst
liquid collection lined by an epithelium
no biliary tree communication
solitary and uniloculated
asymptomatic
intracystic haemorrhage, infection, rupture, compression
simple cyst - management
no follow up necessary
doubt = image in 3-6months
surgical intervention
hydatid cyst
echinoccocus granulosus
endemic regions - Eastern Europe, central america, South America, Middle East and North Africa
disseminated disease or erosion of cyst into adjacent structures and vessels
hydatid cyst - diagnosis
detection of anti-echinoccus antibodies
hydatid cyst - mangement
surgery
conservative
radical
risks
medical = albendazole
percutaneous drainage
polycystic liver disease
embryonic ductal plate malformation of the intrahepatic biliary tree
numerous cysts throughout liver parenchyma
Von meyenburg complexes (VMC)
polycystic liver disease
autosomal dominant polycystic kidney disease
Von meyenburg complexes (VMC)
benign cystic nodules throughout the liver
cystic bile duct malformations, originating form the peripheral biliary tree
remanants develop into small hepatic cysts and usually remain silent during life
not gremlin genetically driven
incidental finding
polycystic liver disease
liver function preserved renal failure rare
symptoms = size dependent
PPKCSH and SEC63
autosomal dominant polycystic kidney disease
renal failure due to polycystic kidneys and non-renal extra-hepatic features are common in ADPKD
potential massive hepatic enlargement
PKD1 and PKD2
liver abscess
high fever
leukocytosis
abdominal pain
complex liver lesion
history
abdominal or biliary infection
dental procedure
liver abscess - management
initial empiric broad spectrum antibiotics
aspiration/drainage percutaneously
echocardiogram
operation if no clinical improvement
4 weeks antibiotic therapy with repeat imaging
hepatocellular carcinoma (HCC)
most common primary liver cancer
men>female
risk factor = cirrhosis
hepatocellular carcinoma (HCC)
weight loss and RUQ pain
asymptomatic
worsening of pre-exisiting chronic liver disease
acute liver failure
signs of cirrhosis
hard enlarger RUQ mass
liver bruit
hepatocellular carcinoma (HCC) - labs
AFP (alpha fetoprotein)
>100mg/ml
elevation seen in 60-80%
hepatocellular carcinoma (HCC) - diagnosis
presentation elevated AFP US triphasic CT scan - very early arterial perfusion MRI biopsy
hepatocellular carcinoma (HCC) - prognosis
tumour size
extrahepatic spread
underlying liver disease and patient performance
hepatocellular carcinoma (HCC) - LIVER TRANSPLANTATION
best available treatment
removes tumour and liver
only if single tumour less than 5cm or less than 3 tumours less than 3 cm each
recurrence rate is low
hepatocellular carcinoma (HCC) - RESECTION
feasible for small tumours with preserved liver function (no jaundice or portal HTN)
recurrence rate is high
hepatocellular carcinoma (HCC) - LOCAL ABLATION
for non resectable
advanced liver cirrhosis
alcohol injection
radio-frequency ablation
temporary measure only
hepatocellular carcinoma (HCC) - chemoembolization
TransArterialChemoEmbolization
TACE
inject chemotherapy selectively in hepatic artery
inject an embolic agent
only in patients with early cirrhosis
no role for systemic chemotherapy
fibro-lamellar carinoma
presents in young patients
not related to cirrhosis
AFP is normal
CT shows typical stellate scar with radial septa showing persistent enhancement
surgical resection or transplantation is the standard of care for fibrolamellar carcinoma
TACE for patients with unresectable tumour
secondary liver metastases
common site for blood born metastases
mild cholestatic picture (ALP) with preserved liver function
Dx imaging for FNA
treatmetn depends on the primary cancer
resection or chemoebolization is possible
