Lesson 1.3 - Malignant Hepatic Neoplasms Flashcards
4 malignant hepatic neoplasms
HCC
Fibrolamellar carcinoma
Angiosarcoma
Hepatic epitheloid hemangioendothelioma
Most common malignant tumour and occurs most commonly in males or females
HCC/hepatoma
males (5:1)
Causes of HCC
Hep B&C (world)
Fatty liver, Steatohepatitis, Cirrhosis (western)
Fungi or toxins (developing)
HCC symptoms (3)
RUQ pain
weight loss
abdo swelling - ascites
3 forms of HCC pathologically
Solitary tumour
Multiple nodules
Diffuse infiltration
Budd-Chiari syndrome
HCC invades hepatic venous system
HCC appearance
Variable - hypoechoic, complex or echogenic
T/F calcification is uncommon with HCC
true
What is HCC indistinguishable from (3)
focal fat
hemangiomas
lipomas
A thin hypo halo-fibrous capsule may indicate
HCC
T/F
US is useful to distinguish between steatosis and hemangiomas
false
Smaller HCC nodules appearance
hypoechoic without necrosis
Larger HCC mass appearance
inhomogenous - necrosis and fibrosis
What is a subtype of HCC that shows calcifications
Fibrolamellar carcinoma
T/F
AFP levels are normal with fibrolamellar carcinoma
True
Fibrolamellar carcinoma most commonly found in what population
adolescents and young adults without coexisting liver disease
What are the two rare malignant liver tumours
Hemangiosarcoma (more rare)
Hepatic epitheliod
Of hemangiosarcoma and
hepatic epitheliod, what population(s) do these occur in and what is the echogenecity of each?
Hemangiosarcoma - older adults (60-70 yrs)
mixed echogenicity
Hepatic epitheliod -
adults
multiple hypoechoic nodules - large masses
Most common primary tumours resulting in liver mets are from
Breast* Lung* Colon* Stomach Panc GB
Sono appearance of mets (3)
Single or multifocal lesions
Diffuse
Lesion size varies
An echogenic metastases generally arises from
GI tract or HCC (or other carcinomas)
Hypovascular mets tend to show what echogenicity
Hypoechoic
Hypervascular mets tend to show what echogenicity
Hyperechoic
Echogenic mets may mimic what on US
Hemangioma
Untreated breast, lung, gastric, panc and esophageal cancer mets to liver are generally what echogenecity
Hypoechoic
Lymphoma of the liver show as
multiple hypoechoic masses
Lung cancer with mets to liver typically show what sono appearance
Bulls eye/target - hypoechoic peripheral halo
Calcified mets
Marked echogenicity with distal acoustic shadowing
Shadowing in the liver is most often due to (4)
calcifications
air
stones
fat-containing lesions
A clean shadow vs a dirty shadow
Clean shadow: calcifications
Dirty shadow: air
What is the most common cause of a calcified liver tumour
Metastases
Sono appearance of cystic mets (distinguishable from simple cysts) (5)
Mural nodules Thick walls Fluid-filled Internal septations Extensive necrosis
Cystic mets seen with
cystadenocarcinoma (ovary & panc) Mucinous carcinoma (colon) necrosis - sarcomas
same as metastatic sarcomas but the last
Infiltrative mets seen with
breast
lung
malignant melanoma
Infiltrative metastatic disease may be confused with (2)
cirrhosis or fatty liver
T/F infiltrative metastatic disease is difficult to appreciate on US
true
Infiltrative metastatic disease sono app
diffuse, inhomogenous liver hard to delineate
sarcomas
rare
arise from connective tissue but can spread to liver
metastatic sarcomas
primary cystadenocarcinoma
mucinous carcinoma
neuroendocrine and carcinoid tumours
(same as cystic mets except last)
CEUS contrast enhanced US
Non-nephrotoxic
No ionizing radiation
Determines vascularity in metastases
Aurora sign
“ring down artifact”
not in liver - caused by lung parenchymal disease but may be seen when scanning liver
One of the most common causes of hepatomegaly
alcohol abuse
T/F
Reidels lobe happens more commonly in men
False
Reidel’s lobe most commonly happens in women
Causes of hepatomegaly (7)
Fatty liver Hep ABC Mono Hemochromatosis primary liver cancer leukemia lymphoma hepatic trauma passive liver congestion
Purpose of US for hepatic trauma
used for serial monitoring
How does hepatic trauma change and time frame
Fresh hemorrhage is echogenic After 1 week - hypo
After -3 weeks - indistinct
What occurs post-surgery
hematoma
Passive liver congestion is caused by
stasis of the blood - HV drainage compromised increasing venous pressure due to backflow
