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4. GASTROINTESTINAL > GI Section III: Liver Masses > Flashcards

GI Section III: Liver Masses Flashcards

(67 cards)

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1
Q

The most common benign liver neoplasm

A

Hemangioma

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2
Q

Hemangioma facts

A

Favors women 5:!
Enlarge with pregnancy.

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3
Q
A

Hemangioma

Hyperechoic (dark in fatty liver)
Vessels adjacent to the lesion, NOT in the lesion

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4
Q
A

Hemangioma

tends to match the aorta in signal and have

“peripheral nodular discontinuous enhancement”.

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5
Q

can be used to diagnose hemangiomas - bigger than 2 cms

A

Tc-99m-labeled RBCs

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6
Q

Typical Hemangioma

A
  • Classically Hyperechoic (bright) on ultrasound
  • Enhanced thru transmission is common
  • NO Doppler flow inside the lesion itself
  • Calcifications are extremely rare
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7
Q

Giant Hemangioma

A

> 5 cm

Similar CT findings to regular hemangioma

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8
Q

Potential complication complication of Hemangioma

A

Kasabach-Merritt syndrome - consumptive coagulopathy

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9
Q

Flasii Filling
Hemagioma

A

< 2 cm

Technically not a hemangioma, but historically referred to as one. - Rapid flash filling

They otherwise retain contrast and remain isodense to blood pool. They do not washout the way an HCC would.

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10
Q

The second most common benign liver neoplasm.

A

Focal nodule hyperplasia

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11
Q

FNH start in utero as an?

A

AVM

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12
Q

FNH composistion

A

Normal hepatocytes abdnomally arranged ducts and Kupffer cells (reticuloendothelial cells)

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13
Q
A

FNH

“spoke wheel” US Doppler

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14
Q
A

FNH

“Homogeneous” on arterial phase - Same to the IVC (not aorta)

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15
Q
A

FNH

Can be a “Stealth” lesion on MRI - T1 and T2 isointense. Can have acentralscar.

Scar will demonstrate delayed enhancement (like scars do).

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16
Q

FNH biopsy rule

A

You have to hit the scar, otherwise path results will say normal hepatocytes.

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17
Q

Can develop after chemotherapy treatment with oxaliplatin (chemo for bowel cancer)

A

FNH

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18
Q

What other test is used to confirm FNH

A

Sulfur Colloid - Hot

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19
Q

Usually a solitary lesion seen in a female on OCPs

A

Adenomas

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20
Q

Alternatively could be seen in a man on anabolic steroids.

A

Adenomas

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21
Q

Associated with glycogen storage disease (von Gierke) or liver adenomatosis

A

Adenomas

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22
Q

Big fat diabetic girl named Von Gierke + hepatic mass?

A

Adenomas

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23
Q

What imaging methods can reliably differentiate hepatic adenoma from hepatocellular carcinoma?

A

NONE

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24
Q
A

Adenomas

Chemical-shift imaging showing loss of signal on out-of-phase images can confirm the presence of fat.

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25
Most common location for hepatic adenoma (75%)
Right Lobe liver
26
Adenoma Managment
* Stop the OCPs and re-image, they should get smaller. * Smaller than 5cm, watch them. * Larger than 5cm they often resect because (1) they can bleed and (2) they can rarely turn into cancer.
27
What are teh adenoma subtypes?
Inflammatory * Most common * Highest bleed rate HNF-1 alpha mutated * Second most common * Multiple masses Beta catenin mutated * Least common * Anabolic steroids * Glycogen storage disease * Familial adenomatous polyposis
28
HCC occurs typically in what setting?
Cirrhosis and chronic liver disease; Hep B, Hep C, hemachomatosis, glycogen storage disease, Alpha 1 antitrypsisn
29
What is elevated in HCC
AFP (80-95%)
30
HCC invades what vessles?
Portal vein Hepatic vein invation - more specific finding
31
What is the average doubling time of HCC?
3 - 4.5 months
32
Early HCC You will only see them in the arterial phase Sometimes there is rim enhancement - mistaken for hemangioma RIM enhancement is NEVER hemangioma
33
Large HCC with mozaic pattern in a non cirrhotic patient. - LATE appearance PVP: Hypodense - due to fast washout Delayed: Prolonge capsule and septal enhancement very large with a mozaic pattern, a capsule, hemorrhage, necrosis and fat evolution. HCC is a silent tumor, so if patients do not have cirrhosis or hepatitis C, you will discover them in a late stage.
34
LEFT: Diffusely enhancing tumor thrombus in HCC with portal vein invasion. RIGHT: Tumor thrombus with vessels within the thrombus.
35
Classic HCC vs FL HCC
Fibrolamellar HCC
36
Classic HCC vs FL HCC
Classic HCC
37
Central Scars of FNH and Fibrolamellar HCC
Focal Nodular Hyperplasia
38
Central Scars of FNH and Fibrolamellar HCC
FL HCC
39
NECT, arterial and portal venous phase in a patient with Hepatitis C with two lesions in the liver (arrows).
Hypervascular lesions in the right and left lobe Upper images NECT: isodense AP: enhancement (not as dense as the bloodpool) PVP: Isodense Lower Images NECT/AP/PVP: as dense as the blood pool UPPER: Right lobe HCC LOWER: Hemangioma
40
cancer of the bile duct
Cholangiocarcinoma Cholangiocarcinoma believes in nothing Lebowski. It flicks you up, it takes the money (prognosis is poor).
41
Cholangiocarcinoma. Who gets it?
Classic: 80 y.o. man + Primary sclerosis cholangitis (PSC, main risk factor in the west) + recurrent pyogenic "oriental" cholangitis (main risk factor in the east) + Caroli disease (Type V) + Hepatitis + HIV + Hx of cholangitis + Liver worms (clonorchis)
42
Non enhanced, arterial, portal venous and equilibrium phase.
Cholangiocarcinoma. AP: Hypodense PVP: Hypodense + peripheral enhancement Equilibirum phase: Hyperdense + Liver capsule retraction infiltrating mass with capsular retraction and delayed persistent enhancement is very typical for
43
What does cholangiocarcinoma look like?
Scar generating cancer + Delayed enhancement + desmoplastic pulling of the scar (capsular retration and ductal dilatation)
44
Cholangiocarcinoma Only on the delayed images at 8-10 minutes after contrast injection a relative hyperdense lesion is seen. This is the fibrous component of the tumor.
45
"Painless jaundice"
CholangioCA (Just like pancreatic head CA)
46
Invades the Portal Vein
HCC
47
Encases the Portal Vein
CholangioCA
48
Cholangiocarcinoma that occurs at the bifurcation of the right and left hepatic ducts
Klatskin tumor
49
Klatskin tumor Mass at the bifurcation fo the right and left hepatic ducts
50
Klatskin Tumor small mass causing biliary obstruction "Shoulder/abrupt tapering"
51
Delayed Enhancement Peripheral Biliary Dilation Liver Capsular Retraction NO tumor capsule
Cholangiocarcinoma
52
key factor for surgical candidacy for cholangioCA
Proximal extent of involvement
53
Implies biliary +/- vascular involvment of the hepatic lobe in Cholangiocarcinoma?
Atrophy of a lobe
54
Tumor markers: A. Increased CEA and CA19-9 B. Normal CEA INC CA19-9 C. INC CEA Normal CA19-9
A. CholangioCA B. Pancreatic CA C. Colon CA
55
the most common primary sarcoma o f the liver
Angiosarcoma Very rare
56
Associated with Toxic exposure - Aresnic Plyvinyl Cl Radiation Thorotrast
Hepatic Angiosarcoma
57
Assoc with Hemochomatosis and NF1 patients
Hepatic Angiosarcoma
58
Uncommon benign cystic neoplasm of the liver + middle aged women + Pain + jaundice Solid + Nodular enhancing + capsule
Biliary Cystadenoma
59
This is way more common than a primary liver cancer
Hepatic metastasis (20-40x)
60
If you see mets in the liver, first think:
Colon
61
Calcified mets are usually the result of what mucinous neoplasms?
Colon Ovary Pancreas
62
Hepatic metastasis Calcified metastasis in a patient with colon cancer. Hyperechoic + hypervascular (renal, melanoma, carcinoid, choriocarcinoma, thyroid, islet cell)
63
Hypoechoic mets on usd =
Hypoechoic mets are often hypovascular -> more common look Colon Lung Pancrease
64
Hepatic metastasis Hypoechoic halo (target) - classic description
65
Mass on CT scan
low density masses with a continuous rim of enhancement discontinueous = hemangioma A background fatty liver may result in the lesions looking bright (higher density).
66
What type of lymphoma involves the liver 60% of the time
HL
67
Kaposi sarcoma Causes diffuse periportal hypoechoic infiltration. Similar to biliary duct dilatation

4. GASTROINTESTINAL (47 decks)

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