Hepatomegaly and focal lesions in the liver Flashcards
What are the two classifications of liver lesions?
Benign
Malignant
Name 4 Benign liver lesions
Haemangioma
Focal nodular hyperplasia
Adenoma
Liver cysts
Name 2 Malignant liver lesions
Primary liver cancers - hepatocellular carcinoma or cholangiocarcinoma
Metastases
What are the clinical features of a Haemangioma?
The commonest liver tumour More common in females Hypervadcular tumour Usually single/small Asymptomatic
How is a Haemangioma diagnosed?
US
CT
MRI
What are the clinical features of Focal Nodular Hyperplasia?
Benign nodule formation of normal liver tissue
Congenital vascular anomaly; associated with Osler-Weber-Rendu and liver haemangioma (in up to 20%)
Classically (but not always) – central scar containing a large artery, radiating branches to the periphery (Hub & spoke)
Hyperplastic response to abnormal arterial flow
Sinusoids, bile ductules and Kupffer cells present on histology
More common in young and middle age women
No relation with sex hormones
Usually asymptomatic, may cause minimal pain
How is FNH diagnosed?
US
CT
MRI
FNA
What are the clinical features of a Hepatic Adenoma?
Benign neoplasm composed of normal hepatocytes no portal tract, central veins or bile ducts
More common in women - female: male ratio 10:1
Associated with contraceptive hormones and anabolic steroids
Usually asymptomatic but may have RUQ pain
May present with rupture, hemorrhage, or malignant transformation (very rare)
Malignant transformation risk higher in males
Most Hepatic adenomas are solitary fat containing lesions. True/False?
True
What lobe are Hepatic adenomas usually in?
Right
What is adenomatosis associated with?
Glycogen Storage Diseases
What is the treatment for Hepatic adenoma?
Stop Hormones Weight Loss Males:Surgical excision Females: Imaging after 6 months <5cm - annual MRI >5cm - surgical excision
