hepatomegaly and focal liver lesions

Question 1

what would solid liver lesions in older patients suggest ?

Answer 1

malignancy

with mets more common than primary liver cancer in the absence of liver disease

Question 2

what would solid liver lesions in chronic liver disease patients suggest ?

Answer 2

more likely to be primary liver cancer than mets or benign tumours

Question 3

in non-cirrhotic patients what is the most common solid liver tumour ?

Answer 3

haemangioma

Question 4

what are the benign liver lesions ?

Answer 4

haemangioma

focal nodular hyperplasia

adenoma

liver cysts

Question 5

what are the malignant liver lesions ?

Answer 5

1. primary liver cancer
   - hepatocellular carcinoma
   - cholangiocarcinoma (fibrolamellar carc, hepatoblastoma)
2. mets

Question 6

what are the 2 types of hepatoblastomas ?

Answer 6

angiosarcoma

haemangioendothelioma

Question 7

what are the clinical features of haemangioma ?

Answer 7

most common liver tumour

females > male

it is a hypervascular tumour

asymptomatic

Question 8

how do you diagnose a haemangioma ?

Answer 8

Ultrasound - echogenic spot that is well demarcated

CT - venous enhancement from periphery to centre

MRI - high intensity area

Question 9

treatment for haemangioma ?

Answer 9

no need for treatment

benign

Question 10

what is focal nodular hyperplasia (FNH) ?

Answer 10

a benign nodule formation of normal liver tissue

it is a hyper plastic response to abnormal arterial flow

more common in young women and middle age women

associated with Osler-Weber-Rendu and haemangiomas

usually asymptomatic but may cause minimal pain

Question 11

how to diagnose FNH?

Answer 11

US - nodule with varying echogenicity
CT - hypervascular mass with central scar
MRI - iso or hypo intense
FNA - normal hepatocytes and kupffer cells

Question 12

treatment for FNH ?

Answer 12

none necessary

Question 13

what are hepatic adenomas ?

Answer 13

benign neoplasm composed of normal hepatocytes, no portal tract, central veins or bile ducts

women more likely to get it

usually asymptomatic but may have RUQ pain

*can have malignant transformation but is very rare and more common in men

Question 14

what drugs are hepatic adenomas associated with ?

Answer 14

oral contraceptives

androgenic steroids

*thankfully regression can occur after discontinuation

Question 15

how to diagnose hepatic adenomas ?

Answer 15

US - filling defect
CT - diffuse arterial enhancement
MRI - hypo or hyper intense lesion

Question 16

how to treat hepatic adenomas ?

Answer 16

-stop any hormones (oestrogen)
-weight loss
-surgical excision for males (regardless of size)
-females = <5cm is an annual MRI
>5cm is surgical excision

Question 17

what solid liver lesions do young people get ?

Answer 17

FNH

hepatic adenoma

Question 18

what are the different types cystic lesions ?

Answer 18

simple

hydatid

atypical

polycystic lesion

pyogenic or amoebic abscess

Question 19

what are the clinical features of a simple cyst ?

Answer 19

liquid collection lined by an epithelium

most of the time asymptomatic

*symptoms may be related to intracystic haemorrhage, infection, rupture or compression

Question 20

treatment for a simple cyst ?

Answer 20

none necessary

Question 21

what is a hydatid cyst ?

Answer 21

‘echinoccocus granulosus’

ethnicities such as central and south america, eastern Europeans and north africa are more at risk

patients may present with disseminated disease

can be serologically tested for anti-echinococcus antibodies