Liver Lesions Flashcards by Jonas Repkewitz

What is a hepatocellular adenoma?

Benign neoplasm composed of normal hepatocytes

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Hepatocellular adenomas are more common in?

Females

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Hepatocellular adenomas are associated with?

Contraceptive hormones and anabolic steroids

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Hepatocellular adenomas may increase in size, and there is a risk of?

Rupture of bleed

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Where are hepatocellular adenomas usually found?

Right lobe

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Multiple adenomas is known as?

Adenomatosis

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What is adenomatosis?

Rare condition associated with Glycogen storage disease

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How do hepatocellular adenomas present?

Most asymptomatic
may have RUQ pain
May present with rupture, haemorrhage or malignant transformation

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How do you investigate hepatocellular adenomas?

USS (filling defect)
CT (diffuse atrial enhancement)
MRI (hypo-/hyper-intense lesions)
+/- FNA

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What does FNA stand for?

Fine needle aspiration

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How do you treat hepatocellular adenomas?

Stop hormones
Weight loss
Males - surgical excision
Females - surgical excision if >5cm (otherwise annual imaging)

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What is the most common primary liver cancer?

Hepatocellular carcinoma (HCC)?

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HCC is associated with?

HBV, HCV, and cirrhosis

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On diagnosis HCC is usually _____ unless incidental finding?

advanced

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What are the histopathological types of HCC?

hepatocytic

Cholangiocytic

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What are risk factors for HCC?

Cirrhosis of any origin

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HCC metastasises to the?

Liver
Portal vein
Lymph nodes
Lung 
Bone 
Brain

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How does a HCC present?

Usually as a mass, pain, obstruction
Weight loss
Worsening pre-existing liver disease
Acute liver failure

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What would be found on examination for HCC?

Signs of cirrhosis, hard enlarged RUQ

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How do you investigate HCC?

AFP
USS
Triphasic CT

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What is AFP?

Alfa-feroprotein

HCC tumour marker

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How do you treat?

Transplant 
Resection
Local ablation
Ethanol injection, chemoembolisation
Systemic therapies

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What are systemic therapies for HCC?

Sorafenib (multikinase inhibitor - side effects common)

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When do you chose transplant as a possible treatment option for HCC?

If tumour <5 cm

or more than 3 <3cm lesions

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Fibrolamellar Carcinoma presents in?

Young patients

Fibrolamellar carcinoma is not related to?

Cirrhosis

In fibrolamellar carcinoma the AFP is?

Normal

What does the CT show for fibrolamellar carcinoma?

typical stellate scar with radial septa showing persistent enhancement

What is the standard care for fibrolamellar carcinoma?

Surgical resection

If un-resectable how do you treat fibrolamellar carcinoma?

TACT (trans arterial chemoembolisation)

What is a hepatoblastoma?

Rare malignant liver cancer occurring in infants and children

A hepatoblastoma is composed of?

Tissue resembling foetal liver cells

Hepatoblastoma presents with?

Abdominal mass and increased AFP

What is a haemangioma?

Commonest benign liver tumour of mesenchymal origin

What do haemangiomas looks like?

Usually small | Well distinguished capsule

Haemangiomas have a risk of?

Malignant degeneration

How does a haemangioma present?

Asymptomatic

How do you investigate haemangiomas?

US CT MRI Nuclear colloid scna

What is seen on USS for haemangioma?

Echogenic spot, well demarcated

What is seen on CT for heamangioma?

venous enhancement from periphery to centre

What is seen on MRi for haemangioma?

High intense area

What is seen on nuclear colloid scan for haemangioma?

Cold

How do you treat a haemangioma?

usually not needed ?radiological follow up Resection if it causes any problems

What is focal nodular hyperplasia?

Benign nodular formation of normal liver tissue

Focal nodular hyperplasia is believed to be in response to?

Underlying congenital atriovenous malformation causing a hpyerplastic response to abnormal blood flow

Focal nodular hyperplasia is more common in?

Young-middle aged women

What is seen on histology for focal nodular hyperplasia?

Sinusoids Bile ductules Kupffer cells with a central core

Focal nodular hyperplasia has ____ malignant risk

How does focal nodular hyperplasia present?

typically asymptomatic | may cause minimal pain

How do you investigate focal nodular hyperplasia?

``` US CT MRI FNA Sulfur colloid scna ```

What is seen on US for Focal nodular hyperplasia?

Nodule with varying echogenicity

What is seen on CT for Focal nodular hyperplasia?

Hypervascular mass with central scar

What is seen on MRI for focal nodular hyperplasia?

Iso/hypo intense)

What is seen on FNA for focal nodular hyperplasia?

Normal hepatocytes + Kupffer cells with central core

What is seen on sulfur colloid scan for focal nodular hyperplasia?

Isotense

How do you treat focal nodular hyperplasia?

Treatment not needed

What is a simple cystic lesion?

Liquid collection lined by epithelium without any biliary tree communication (solitary and uniloculated (single) sac)

How does a simple cystic lesion present?

usually asymptomatic | Can be related to intracystic haemorrhage, infection, rupture (rare), compression

How do you treat a simple cystic lesion?

No follow up | Symptomatic/uncertain - consider surgery

What causes a Hydatic cyst?

parasitic infection tapeworm - Echinocus granuloso)

Where is Echinocus granuloso endemic?

``` Eastern Europe CA SA ME North Africa ```

patients with hydatid cysts may present with?

Disseminated disease or erosion of cysts into adjacent structures and vessels

How do you investigate hydatid cysts?

Serology to detect anti-echinoccus antibodies

How do you treat Hydatid cysts?

Surgery | Medical: albendazole or percutaneous drainage

What causes polycystic liver disease?

Embryonic ductal plate malformation of intrahepatic biliary tree

In PCLD the liver function is _____ and renal failure is?

preserved | rare

What are clinical features of PCLD?

Abdominal pain and distension | Atypical symptoms due to voluminous cyst resulting in compression of adjacent tissue or failure of affected organ

Clinical features of PCLD are dependent on?

Size of cyst

How do you treat PCLD?

Conservative Rarely invasive procedures required (only in advanced) Somatostatin analogues (symptom relief and liver volume reduction

What is a liver abscess?

Pus-filled mass

What are clinical features of liver abscesses?

``` High fever (continuous or swinging) Abdominal pain History of abdominal biliary infection, dental procedure ```

How do you investigate liver abscesses?

Increased WCC Complex liver lesion ECHo

How do you manage liver abscesses?

Broad-spectrum antibiotics (4 weeks with repeat imaging) Aspiration drainage percutaneously Surgery if no improvement (open drainage/resection)