Liver Lesions

Question 1

Benign liver lesions

Answer 1

Hemangioma
Focal Nodular Hyperplasia (FNH)
Adenoma

Question 2

Malignant liver lesions

Answer 2

Hepatocellular carcinoma (HCC)
Cholangiocarcinoma (CCA)

Question 3

Most common benign liver lesion
Found in NON-CIRRHOTIC LIVER
Diagnosed in 34rd-5th decade
NO MALIGNANT POTENTIAL

Answer 3

Hemangioma

Question 4

2nd most common benign liver lesion
Found in NON-CIRRHOTIC LIVER
Reaction to intrahepatic anomolous artery leading to hyper perfusion -- area enlarges 
Women between 20 & 50 
NO MALIGNANT POTENTIAL

Answer 4

Focal Nodular Hyperplasia

Question 5

3rd most common benign liver lesion
Found in NON-CIRRHOTIC LIVER
Benign proliferation of hepatocytes
Majority in women of childbearing age
Associated with contraceptive use 
Usually asymptomatic 
Multiple may be seen with Glycogen storage disease, DM

Answer 5

Hepatic Adenoma

Question 6

What is one big difference between hepatic adenomas and the other two kinds of benign liver lesions?

Answer 6

Hepatic adenomas have a risk for HEMORRHAGE and MALIGNANT TRANSFORMATION
-Growth and rupture during pregnancy

Question 7

Treatment for Hepatic Adenomas

Answer 7

Contraceptives discontinued
Avoid pregnancy
Surgical resection recommended to avoid cancer/tumor rupture

Question 8

What has the fastest growing death rate in the US?

Answer 8

Hepatocelluar carcinoma

Question 9

What is a common indication of HCC?

Answer 9

Elevated alpha fetoprotein (AFP) – produced by fetal liver and placenta
Elevated in 60-70% of patients with HCC
But can also be elevated with hepatic inflammation or cirrhosis in the absence of HCC
But values > 200 ng/mL in conjunction with liver lesion on imaging is consistent with HCC

Question 10

Some ways to prevent HCC…

Answer 10

HBV vaccination
Treatment of viral hepatitis
Coffee?

Question 11

What are some possible cancer that can have metastases to the liver?

Answer 11

GI: colon, pancreas, esophagus, gastric
Lung
Urogenital
Breast
Melanoma

Question 12

What is the most common blood supply to HCC?

Answer 12

The hepatic artery – NOT the portal vein

With HCC there is a decrease in portal blood flow and increased in arterial blood flow