Liver Lesions

Question 1

What types of Primary Liver Lesions are benign? malignant?

Answer 1

• Benign
  
  • Hemangioma
  • Focal Nodular Hyperplasia (FNH)
  • Adenoma
• Malignant
  
  • Hepatocellular Carcinoma (HCC)
  • Cholangiocarcinoma (CCA)

Question 2

What do the following history findings suggest in terms of the type of liver lesion?

Oral contraceptives:

A history of extrahepatic malignancy:

Underlying liver disease:

History of primary sclerosing cholangitis:

Answer 2

• Oral contraceptives:
  
  • Hepatic adenoma
• A history of extrahepatic malignancy:
  
  • Metastatic disease
• Underlying liver disease:
  
  • Hepatocellular carcinoma
• History of primary sclerosing cholangitis:
  
  • Cholangiocarcinoma

Question 3

Most lesions in non-cirrhotic livers originate from which two organs?

Answer 3

The GI tract (45%) and the lungs (24%)

Question 4

77% of lesions in a cirrhotic liver are due to…

Answer 4

Hepatocellular carcinoma

Question 5

How does a hemangioma (normally painless) lead to pain?

Answer 5

Glissm’s capsule surrounds the liver and has nerve endings

Expansion of liver and subsequent stretch of the capsule leads to pain and is an indication for surgery

Question 6

What is the most common benign liver lesion and what type of liver is it associated with (Cirrhotic/Non-cirrhotic)?

Answer 6

Hemangioma found in Non-cirrhotic liver

Question 7

• What is a hemangioma?
• Age of diagnosis?
• Range in size and number?
• Malignant potential?

Answer 7

• What is a hemangioma?: congenital vascular malformations
• Age of diagnosis: third to fifth decade
• Range in size and number: 1-20cm (multiple in 30%)
• Malignant potential: None

Question 8

What is the second most common benign liver lesion and what type of liver is associated with it?

Answer 8

Focal Nodular Hyperplasia in Non-cirrhotic livers

Question 9

What is a Focal Nodular Hyperplasia?
Gender and age and of diagnosis?
Range in size and number?
Malignant potential?

Answer 9

• What is a FCH: A reaction to intrahepatic amolous artery leading to hyperperfusion
• Gender and age and of diagnosis: Women (20-50yrs)
• Range in size and number: <5cm (Rarely > 10cm)
• Malignant potential: None

Question 10

What is the third most common benign liver lesion what type of liver is it associated with?

Answer 10

Hepatic adenoma found in non-cirrhotic liver

Question 11

Hepatic adenoma is a proliferation of ______

What other disorders is it associated with?

Answer 11

Hepatic adenoma is a proliferation of hepatocytes

• Associated with contraceptive use
• Multiple adenomas also seen with
  
  • Glycogen storage disease
  • Diabete Mellitus

Question 12

In what population are hepatic adenomas usually found?

What are its symptoms?

Answer 12

Majority in women of childbearing age

Usually asymptomatic

Question 13

Hepatic adenoma differs from hemangiomas and FNH because there its risk for _______ and _________ ________

Answer 13

Hepatic adenoma differs from hemangiomas and FNH because there its risk for Hemorrhage and Malignant Transformation

Question 14

What treatment is used for Hepatic Adenoma?

Answer 14

• Contraceptives should be discontinued
• Avoid pregnancy
• Surgical resection is recommended to avoid the risk of cancer and tumor rupture

Question 15

What is the leading cause of hepatocellular carcinoma worldwide? In the US?

Answer 15

Worldwide: Hepatitis B

US: Hepatitis C cirrhosis

Question 16

What is the most rapidly rising carcinoma in the US?

Answer 16

Hepatocellular carcinoma

Question 17

Why is there an recent increase in prevalence of HCV infection?

Answer 17

Patients who were infected 20 years ago (before current treatment capabilities) are now starting to have cirrhosis so levels appear to be increasing

Question 18

What is the most frequent cause of HCC in non-Asians?

In Asians?

Answer 18

HCV

HBV

Question 19

What happens to arterial flow and portal blood flow as HCC progresses?

Answer 19

Portal blood flow decreases and Arterial blood flow increases

Question 20

What is “washout” in a radiograph of HCC?

Answer 20

Contrast in the radiograph will show early arterial enhancement followed by “washout” of venous flow (decreased presence of contrast)

Question 21

What protein is elevated in 60%-70% of patients with HCC?

Answer 21

Alpha Fetoprotein (AFP) - normally produced by the fetal liver and the placenta

Question 22

AFP levels greater than _____ ng/ml in conjunction with ______ _____ on imaging is consistant with HCC

Answer 22

200ng/ml; liver lesion

Question 23

How is HCC prevented?

Answer 23

HBV vaccination

Treatment of viral hepatitis

Coffee

Question 24

What are the primary sites of metastatic carcinoma?

Answer 24

• Gastrointestinal
• Lung
• Urogenital
• Breast
• Melanoma