Focal Lesions of the Liver Flashcards
what are solid liver lesions in older patients likely to be?
Malignant metastases
what are solid liver lesions in chronic liver disease patients likely to be?
Primary liver cancer
What are solid tumours in non chronic liver patients likely to be?
Haemangioma
Is haemangioma benign or malignant?
Benign
What kind of tumour is an haemangioma?
Hyprevascular
How many lesions are typical of an haemangioma ?
one single (small) lesion
How do haemangiomas present on an US?
Echogenic spot, well demarcated
How do haemangiomas present on a CT?
Venous enhancement from peripherally to centre
How do haemangiomas present on an MRI?
High intensity area
what is the treatment for a haemangioma?
No treatment needed
what is focal Nodular Hyperplasia?
Benign nodule formation of normal liver tissue
what is focal nodular hyperplasia associated with?
Osler-Weber-Rendu and liver haemangioma
what is the common presentation of focal nodular hyperplasia?
Central scar containing a large artery, radiating branches to the periphery
what is present in the histology of focal nodular hyperplasia?
Sinusoids, bile ductules and Kupffer cells
what kind of mass is a focal nodular hyperplasia?
Hypervascular
what is a hepatic adenoma?
Benign neoplasm composed of normal hepatocytes o there is no involvement of the portal tract, central veins or bile ducts
how do people with hepatic adenomas present?
Usually asymptomatically but can have RUQ pain (due to rupture, haemorrhage, malignant transformation)
what is the usual appearance of a hepatic adenoma?
Solitary fat containing lesion
what are hepatic adenomas associated with?
Oral contraception and androgenic steroids
How should a hepatic adenoma be treated?
Stop hormones ans observe every 6 months for two years
what should be done if a hepatic adenoma doesn’t regress?
Surgical excision
what is a simple cyst?
Liquid collection lined by an epithelium with no biliary tree communication
Most of the time it is asymptomatic, but what can symptoms be related to?
Intracystic haemorrhage
Infection
Rupture
Compression of surrounding organs
what is a hydatid cyst?
Echinoccocus granulosus
what are the surgical options for a hydatid cyst?
copen cystectomy
Marsupialization
Pericystectomy
Lobectomy
what medication can be used to treat a hydatid cyst?
Albendazole
what is polycystic Liver disease?
Enbryonic ductaal plate malformation of the intrahepatic biliary tree - many cysts throughout the parenchyma
what are the 3 types of polycystic liver disease?
Von Meyenburg complexes (VMC)
Polycystic Liver disease
Autosomal dominant Polycystic Kidney disease
What are von meyenburg complexes?
Benign cyst nodules throughout the liver
where do cystic bile duct malformations originate in von meyenburg complexes?
from the peripheral biliary tree
which genes are involved in Polycystic liver disease?
PCLD gene – PRKCSH and SEC63
which genes are involved in Dominant Polycystic Kidney disease?
ADPKD genes – PKD1 and PKD2
what are the clinical features of liver abscesses?
High fever
Leukocytosis - increased number of white cells
Abdominal Pain
Complex liver lesion
what is important in the history for liver abscesses?
abdominal/biliary infection or recent dental treatment
what is the initial treatment for liver abscesses?
Empire broad spectrum antibiotics
what are the surgical options for liver abscess treatment?
aspiration/drainage percutaneously
open drainage
resection
what is the most common primary liver cancer?
Hepatocellular carcinoma
what are the risk factors for hepatocellular carcinoma?
Cirrhosis of any cause:
Hep B or C
Alcohol
Aflatoxin
what are the clinical features of hepatocellular carcinomas?
Wt loss and RUQ pain
Asymptomatic
Worsening of pre-existing chronic liver disease
Acute liver failure
where are hepatocellular carcinomas likely to metastasise to?
portal vein, lymph nodes, lung, bone, brain
what is Alfa Fetoprotein
AFP is an HCC tumour marker
what values of AFP suggests HCC as a likely diagnosis?
100ng/ml or greater
what investigations are used in the diagnosis of hepatocellular carcinoma?
Ultrasound
CT scan
MRI
Biopsy
what is the criteria for liver transplant in hepatocellular carcinoma?
Single tumour less than 5cm or 3 tumours less than 3cm each
when can resection be used?
For small tumours with preserved liver function
when can local ablation be used?
when resection can’t - those who have advanced liver cirrhosis
what are the two forms of ablation used in HCC?
Alcohol injection
Radiofrequency ablation
what does TACE stand for?
Transarterial Chemoablation
for which patients can TACE be used?
In patients with early cirrhosis
In which patients does Fibre-Lamellar Carcinoma present?
Young patients
What would a CT show in Fibre-Lamellar Carcinoma?
stellate scar with radial septal showing persistent enhancement
what is the treatment for Fibre-Lamellar Carcinoma?
resection or transplantation - TACE if unresectable
What are the common primary sites for secondary liver metastases?
colon, breast, lung, stomach, pancreas and melanoma
