Lesson 1.3 - Malignant Hepatic Neoplasms

Question 1

4 malignant hepatic neoplasms

Answer 1

HCC
Fibrolamellar carcinoma
Angiosarcoma
Hepatic epitheloid hemangioendothelioma

Question 2

Most common malignant tumour and occurs most commonly in males or females

Answer 2

HCC/hepatoma

males (5:1)

Question 3

Causes of HCC

Answer 3

Hep B&C (world)
Fatty liver, Steatohepatitis, Cirrhosis (western)
Fungi or toxins (developing)

Question 4

HCC symptoms (3)

Answer 4

RUQ pain
weight loss
abdo swelling - ascites

Question 5

3 forms of HCC pathologically

Answer 5

Solitary tumour
Multiple nodules
Diffuse infiltration

Question 6

Budd-Chiari syndrome

Answer 6

HCC invades hepatic venous system

Question 7

HCC appearance

Answer 7

Variable - hypoechoic, complex or echogenic

Question 8

T/F calcification is uncommon with HCC

Answer 8

true

Question 9

What is HCC indistinguishable from (3)

Answer 9

focal fat
hemangiomas
lipomas

Question 10

A thin hypo halo-fibrous capsule may indicate

Answer 10

HCC

Question 11

T/F

US is useful to distinguish between steatosis and hemangiomas

Answer 11

false

Question 12

Smaller HCC nodules appearance

Answer 12

hypoechoic without necrosis

Question 13

Larger HCC mass appearance

Answer 13

inhomogenous - necrosis and fibrosis

Question 14

What is a subtype of HCC that shows calcifications

Answer 14

Fibrolamellar carcinoma

Question 15

T/F

AFP levels are normal with fibrolamellar carcinoma

Answer 15

True

Question 16

Fibrolamellar carcinoma most commonly found in what population

Answer 16

adolescents and young adults without coexisting liver disease

Question 17

What are the two rare malignant liver tumours

Answer 17

Hemangiosarcoma (more rare)

Hepatic epitheliod

Question 18

Of hemangiosarcoma and

hepatic epitheliod, what population(s) do these occur in and what is the echogenecity of each?

Answer 18

Hemangiosarcoma - older adults (60-70 yrs)
mixed echogenicity

Hepatic epitheliod -
adults
multiple hypoechoic nodules - large masses

Question 19

Most common primary tumours resulting in liver mets are from

Answer 19

Breast*
Lung*
Colon*
Stomach
Panc
GB

Question 20

Sono appearance of mets (3)

Answer 20

Single or multifocal lesions
Diffuse
Lesion size varies

Question 21

An echogenic metastases generally arises from

Answer 21

GI tract or HCC (or other carcinomas)

Question 22

Hypovascular mets tend to show what echogenicity

Answer 22

Hypoechoic

Question 23

Hypervascular mets tend to show what echogenicity

Answer 23

Hyperechoic

Question 24

Echogenic mets may mimic what on US

Answer 24

Hemangioma

Question 25

Untreated breast, lung, gastric, panc and esophageal cancer mets to liver are generally what echogenecity

Answer 25

Hypoechoic

Question 26

Lymphoma of the liver show as

Answer 26

multiple hypoechoic masses

Question 27

Lung cancer with mets to liver typically show what sono appearance

Answer 27

Bulls eye/target - hypoechoic peripheral halo

Question 28

Calcified mets

Answer 28

Marked echogenicity with distal acoustic shadowing

Question 29

Shadowing in the liver is most often due to (4)

Answer 29

calcifications air stones fat-containing lesions

Question 30

A clean shadow vs a dirty shadow

Answer 30

Clean shadow: calcifications | Dirty shadow: air

Question 31

What is the most common cause of a calcified liver tumour

Answer 31

Metastases

Question 32

Sono appearance of cystic mets (distinguishable from simple cysts) (5)

Answer 32

``` Mural nodules Thick walls Fluid-filled Internal septations Extensive necrosis ```

Question 33

Cystic mets seen with

Answer 33

``` cystadenocarcinoma (ovary & panc) Mucinous carcinoma (colon) necrosis - sarcomas ``` same as metastatic sarcomas but the last

Question 34

Infiltrative mets seen with

Answer 34

breast lung malignant melanoma

Question 35

Infiltrative metastatic disease may be confused with (2)

Answer 35

cirrhosis or fatty liver

Question 36

T/F infiltrative metastatic disease is difficult to appreciate on US

Answer 36

true

Question 37

Infiltrative metastatic disease sono app

Answer 37

diffuse, inhomogenous liver hard to delineate

Question 38

sarcomas

Answer 38

rare | arise from connective tissue but can spread to liver

Question 39

metastatic sarcomas

Answer 39

primary cystadenocarcinoma mucinous carcinoma neuroendocrine and carcinoid tumours (same as cystic mets except last)

Question 40

CEUS contrast enhanced US

Answer 40

Non-nephrotoxic No ionizing radiation Determines vascularity in metastases

Question 41

Aurora sign

Answer 41

"ring down artifact" | not in liver - caused by lung parenchymal disease but may be seen when scanning liver

Question 42

One of the most common causes of hepatomegaly

Answer 42

alcohol abuse

Question 43

T/F | Reidels lobe happens more commonly in men

Answer 43

False | Reidel's lobe most commonly happens in women

Question 44

Causes of hepatomegaly (7)

Answer 44

``` Fatty liver Hep ABC Mono Hemochromatosis primary liver cancer leukemia lymphoma hepatic trauma passive liver congestion ```

Question 45

Purpose of US for hepatic trauma

Answer 45

used for serial monitoring

Question 46

How does hepatic trauma change and time frame

Answer 46

Fresh hemorrhage is echogenic After 1 week - hypo | After -3 weeks - indistinct

Question 47

What occurs post-surgery

Answer 47

hematoma

Question 48

Passive liver congestion is caused by

Answer 48

stasis of the blood - HV drainage compromised increasing venous pressure due to backflow