Focal Liver Lesions and Hepatomegaly Flashcards
describe liver lesions in the elderly
more likely to be malignant - metastases more common than primary liver cancer in absence of liver disease
describe liver lesions in chronic liver disease
more likely to be a primary liver cancer than metastases or benign tumours
describe liver tumours in non-cirrhotic patients
most common tumour is haemangioma
bengin liver lesions
haemangioma
focal nodular hyperplasia
adenoma
liver cysts
malignant liver lesions
primary liver cancers
metastaes
primary liver cancers
hepatocellular carcinoma (HCC) cholangiocarcinoma
types of cholangiocarcinoma
fibrolamella carcinoma
hepatoblastoma
types of hepatoblastoma
angiosarcoma
haemangioendothelioma
epidemiology of haemangioma
most common liver tumour
female
pathology of haemangioma
hyper vascular tumour (attached to lots of blood vessels)
single and small
well demarcated capsule
symptoms of haemangioma
asymptomatic
complications of haemangioma
bleeding (due to hypervascularity)
tests for haemangioma
ultrasound
CT
MRI
treatment for haemangioma
none
pathology of focal nodular hyperplasia (FNH)
nodule formation
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
epidemiology of FNH
young and middle aged woman - no relation with sex hormones
symptoms of FNH
asymptomatic
minimal pain
histology of FNH
sinusoid
bile ductules
kupffer cells
tests for FNH
ultrasound
CT
MRI
fine needle aspiration (FNA)
treatment for FNH
none
no change in pregnancy or hormones
pathology of hepatic adenoma
neoplasm composed of normal hepatocytes, no portal tract, central veins or bile ducts
solitary fat containing lesions
hypervascular
usually right lobe
epidemiology of hepatic adenoma
female
contraceptive hormones
androgenic steroids
malignant transformation risk is higher in males
symptoms of hepatic adenoma
asymptomatic
right upper quadrant pain
rare signs of hepatic adenoma
size related;
rupture
haemorrhage
malignant transformation
what is multiple adenomas
rare conditions associated with glycogen storage disease
tests for hepatic adenoma
ultrasound
CT
MRI
FNA
treatment for hepatic adenoma
stop hormones
weight loss
males - surgical excision
females - imaging in 6 months, surgical incision then dependent on size (>5 cm - remove)
types of cystic lesions
simple hydatid atypical polycystic lesion pyogenic or amoebic abscesses
pathology of simple cyst
liquid collection lined by epithelium
no biliary tree communication
solitary and uniloculated
symptoms of simple cyst
asymptomatic
symptoms due to complications
complications of simple cyst
intracystic haemorrhage
infeciton
rupture (rare)
compression
treatment for simple cyst
no follow up necessary
if doubt - imaging 3-6 months
surgical intervention - symptomatic or uncertain diagnosis
pathology of hydatid cyst
echinoccocus granulosus (Cestoda)
signs of hydatid cyst
disseminated disease
erosion of cysts into adjacent structures and vessels (IVC)
detection of anti-echinococcus antibodies
treatment for hydatid cyst
surgery
drug - albendazole
percutaneous drainage
pathology of polycystic liver disease (PLD)
embryonic ductal plate malformation of the intrahepatic biliary tree
numerous cysts throughout liver parenchyma
types of PLD
von meyenburg complexes (VMC)
polycystic liver disease (PCLD)
autosomal dominant polycystic kidney disease (ADPKD)
pathology of VMC
benign cystic nodules throughout liver
cystic duct malformation originating from peripheral biliary treee
remnants develop into small hepatic cysts and remain asymptomatic
aetiology of VMC
not germline genetically driven
incidental finding
aetiology of PCLD
mutation in PCLD gene - PRKCSH and SEC63
pathology of PCLD
liver function preserved
renal failure is rare
symptoms of PCLD
dependent on size of cysts;
abdominal pain
abdominal distension
atypical symptoms
pathology of ADPKD
renal failure due to polycystic kidneys
non-renal extra hepatic features
potential massive hepatic enlargement
aetiology of ADPKD
mutation in ADPKD genes - PKD1 and PKD2
treatment of polycystic liver disease
conservative
invasive (only in those with advanced PCLD, ADPKD or liver failure) - defenestration/aspiration, liver transplantation
somatostatin
action of somatostatin in polycystic liver disease management
symptom relief
liver volume reduction
symptoms/signs of liver abscess
high fever
leukocytosis
abdominal pain
complex liver lesion
aetiology of liver abscess
abdominal or biliary infection
dental procedure
treatment of liver abscess
empiric broad spectrum antibiotics
aspiration/drianinage
surgery (no improvement)
4 weeks antibiotic therapy with repeat imaging
epidemiology of HCC
men
risk factors for HCC
cirrhosis from any cause; HBV (integrates DNA) HCV alcohol aflatoxin other
symptoms/signs of HCC
weight loss right upper quadrant pain asymptomatic worsening of pre-existing chronic liver disease acute liver failure
signs of HCC
signs of cirrhosis
hard enlarged right upper quadrant mass
liver bruit (rare)
elevated alfa fetoprotein (AFP)
metastases of HCC
rest of the liver portal vein lymph nodes lung bone brain
describe AFP
HCC tumour marker
>100ng/ml - high probability of HCC
tests for HCC
AFP ultrasound triphasic CT MRI biopsy
treatment for HCC
liver transplantation resection local ablation chemoembolization - TACE systemic therapies
describe local ablation treatment in HCC
ethanol injection
radiofrequency ablation
liver transplantaiton in HCC
low recurrence rate
resection in HCC
small tumours with preserved liver function, high recurrence rate
local ablation in HCC
non resectable tumour
TACE in HCC
inject chemotherapy selectively in hepatic artery
then inject embolic agent
only in patients with early cirrhosis
systemic therapies in HCC
sorafenib
action of sorafenib
multikinase inhibitor of vascular endothelial gf receptor, platelet derived gf receptor and Raf
common side effects but increased survival
epidemiology fibro-lamellar carcinoma
young patients
not related to cirrhosis
pathology of fibro-lamellar carcinoma
AFP normal
stellate scar with radial septa showing persistent enhancement
treatment for fibro-lamellar carcinoma
surgical resection
transplantation
TACE - unresectable tumour
describe secondary liver metastases
most common site for blood born metastases
common primaries for secondary liver metastases
colon breast lung stomach pancreas melanoma
pathology of secondary liver metastases
mild evaluated ALP
preserved liver function
tests for secondary liver metastases
ultrasound
CT
MRI
FNA
treatment for secondary liver metastases
dependent on primary cancer
resection or TACE may be possible
