Liver Lesions

Question 1

Name 5 types primary liver cancers

Answer 1

• Hepatocellular carcinoma
• fibrolamellar HcC
• epitheloid haemangioepithelioma
• angiosarcoma
• lymphoma
• hepatic neuro endocrine tumours

Question 2

Name 6 risk factors hepatocellular carcinoma

Answer 2

• male
• hepatitis b! in sa, and hep c
• alcoholic cirrhosis
• non -alcoholic fatty liver disease Nafld.
• non - alcoholic steatohepatitis Nash
• alpha 1 antitrypsin deficiency , haemochromatosis, Wilson’s…

Basically any cause cirrhosis

Question 3

Clinical presentation hepatocellular carcinoma? (4)

Answer 3

• Liver mass
• worsening liver failure
• Paraneoplastic phenomena
• jaundice

Question 4

Blood results of hepatocellular carcinoma ?

Answer 4

Raised alpha feto protein AFP! >400
Deranged LFT

Question 5

Diagnosis hepatocellular carcinoma ? (5)

Answer 5

• Raised AFP > 400
• imaging!
- Ultrasound: solid lesion but may be iso-echoic and may contain hypo-echoic areas. Ill defined borders with coarse margins and may contain internal echoes
- contrast ct: early arterial enhancement with venous phase washout pathognomonic!
- MRI if can’t do CT
• never biopsy! Will rupture capsule and upstage.

Question 6

Name the 5 most common origins of liver metastasis

Answer 6

• Colorectal cancer
• breast cancer
• neuroendocrine tumour metastasis
• upper gi: stomach, esophagus
• pancreas ‘

First 3 have good prognosis

Question 7

Contrast CT features liver metastasis?

Answer 7

• Pre-contrast isOdense
• arterial phase not enhancing!
• venous phase: mildly enhancing compared to liver
• portovenous phase: hypodense!

Question 8

Diagnosis neuroendocrine metastasis to liver?

Answer 8

• Ct: light bulb sign with arterial phase enhancement and delayed washout
• chromogranin A serology or urine/serum metanephrines
• nuclear medicine pet scan

Question 9

Name 4 benign solid liver lesions

Answer 9

• Haemangiona (most common): sinusoidal malformation, no malignant risk
• focal nodular hyperplasia: second most common, no risk malignancy, hepatocytes bigger
• hepatic adenoma: benign hepatocyte proliferation (more), pre-malignant
• regenerative nodules:hepatocyte hypertrophy in cirrhosis,no malignant risk but look like HCC ( do MRI)

Question 10

Name 3 benign cystic liver lesions

Answer 10

• Simple congenital cyst
• polycystic liver disease
• Caroli’s disease (biliary origin)

Question 11

CT features liver haemangioma?

Answer 11

Asymmetrical nodular peripheral enhancement with centripedal filling in venous phone

Question 12

Treatment liver haemangioma?

Answer 12

Only if symptomatic ( bleeding, compression surrounding) or rupture:
• enucleation and inflow control
• embolisation of feeding vessels
• formal liver resection

Question 13

CT features focal nodular hyperplasia?

Answer 13

Well circumscribed with central scar
Hyperdense in arterial phase, isodense venous phase

Question 14

Treatment hepatic adenoma? (6)

Answer 14

Stop estrogen use! This lesion is premalignant.. Diagnose with MRI.

Do surgical resection if:
• before planned pregnancy or second trimester
• > 5 cm
• documented increase in size.

If <5cm, resect if
• symptomatic ( RUq pain, rupture, bleed)
• healthy young female with estrogen use

Question 15

Clinical presentation polycystic liver disease? (9)

Answer 15

• Kidney cysts first!
• asymptomatic when small < 2cm
When larger
• renal dysfunction or failure
• abdominal pains
• Early satiety
• RUQ or renal flank mass
• shortness of breath (diaphramatic splinting)
Complications
• bleeding, anemia, pain
• large, mass effect, rupture, secondary infection

Question 16

Name 6 conditions associated with polycystic liver disease

Answer 16

• Kidney cysts!
• pancreatic cysts
• cerebral aneurysm
• inguinal hernia
• mitral valve regurgitation
• diverticulosis