Liver Lesions Flashcards
what are solid liver lesions in older patients more likely to be
malignant- metastases more common that primary when no liver disease
what are solid liver lesions in chronic liver disease patients (cirrhosis or active hep b) more likely to be
primary liver cancer- more than metastases or benign tumours
in non cirrhotic patients what is the most common solid liver tumour
haemangioma
what are cirrhotic patients screened for
hepatoma
when should imaging be done
when abdo pain, deranged LFT’s, resp problems
what are 4 benign liver lesion
haemangioma, focal nodular hyperplasia, adenoma, liver cysts
what are 2 primary liver cancers
hepatocellular carcinoma, cholangiocarcinoma
what are two types of cholangiocarcinoma
fibrolamellar carcinoma, hepatoblastoma
what is the most common liver tumour
benign- haemangioma
haemangioma more/less commen in males than females
more common in females
what are the clinical features of haemangioma
usually asymptomatic, usually single and small hypervascular tumour
how do you diagnose haemangioma
US: echogenic spot, well demarcated
CT: venous enhancement from periphery to centre
MRI: high intensity area
No need for FNA
what is the treatment for haemangioma
no treatment needed
what is an FNH, describe it
focal nodular hyperplasia
- benign nodule formation of normal liver tissue
- congenital vascular anomaly
what does a FNH classically look like
central scar containing a large artery, radiating branches to the periphery
what is FNH associated with
with Osler-Weber-Rendu and liver haemangioma
what causes FNH
hyperplastic response to abnormal arterial flow
what is present in histology of FNH
sinusoids, bile ductules and kupffer cells
what are the symptoms of FNH
usually asymptomatic, may cause minimal pain
who is FNH more common in
young/ middle aged women
how is FNH diagnosed
US: Nodule with varying echogenicity
CT: Hypervascular mass with central scar
MRI: Iso or hypo intense
FNA: Normal hepatocytes and Kupffer cells with central core
what is the treatment for FNH
no treatment needed
describe a hepatic adenoma
benign neoplasm composed of normal hepatocytes, no portal tract, central veins or bile ducts
are hepatic adenomas more common in males or females
females 10:1
what are hepatic adenomas associated with
contraceptive hormones and anabolic steroids
how might hepaic adenomas present
usually asymptomatic but may have RUQ pain
present with rupture, haemorrhage or malignant transformation (rare)
are males or females at a higher risk of malignant transformation of hepatic adenomas
men
what is adenomatosis
multiple adenomas, a rare condition associated with glycogen storage disease
how is hepatic adenoma diagnosed
US: Filling defect
CT: Diffuse arterial enhancement
MRI: Hypo or hyper intense lesion
FNA: May be needed
how are hepatic adenomas treated
Stop hormones, weight loss
Males (irrespective of size) : surgical excision
Females : imaging after 6months
<5cm or reducing in size - annual MRI
>5cm or increase in size - for surgical excision
what are the two benign solid liver lesions found in young patients
adenoma, focal nodular hyperplasia
what are the different types of cystic lesions
simple, hydrated, atypical, polycystic lesion, pyogenic or amoebic abscess
what is a simple cyst, describe
liquid collection lined by an epithelium- no biliary tree communication, solitary and uniloculated
when does a simple cyst cause symptoms
intracystic haemorrhage, infection, rupture (rare), compression
how is a simple cyst managed
no follow up needed- if doubt/ symptomatic consider imaging in 3/6 months or surgical intervention
what is a hydatid cyst
multiple cysts caused by the parasite enchinococcus granulosus
how does echinococcus granulosus present
disseminated disease, erosion of cysts into adjacent structures and vessels (IVC)
how is hydatid cyst managed
conservative (most common)- open cystectomy, marcupialization
radical pericystectomy, lobectomy
medical: albendazole
percutaneous drainage
what are the risks of hyatid cyst surgery
operative mortality, anaphylaxis, dissemination of infection
what is polycystic liver disease
when an embryonic ductal plate malformation of the intrahepatic biliary tree causes numerous cysts throught liver parenchyma
what are the three types of polycystic liver disease
- von meyeburg complexes (VMC)
- polycystic liver disease
- autosomal dominant polycystic kidney disease
what are von meyenburg complexes
(aka microhamartomas)
bengin cyst nodules throughout the liver
cystic bile duct malformations originating from the peripheral biliary tree
what is the outcome of autosomal dominant polycystic kidney disease
renal failure due to polycystic kidneys and non renal extra hepatic features
in what disease is potential massive hepatic enlargement a threat
autosomal dominant polycystic kidney disease
how is polycystic liver disease managed
management of; abdo pain, abdo distention and atypical symptoms caused by voluminous cysts compressing adjacent tissues or failure of affected organ
conservative treatment to halt cyst growth
invasive porcedures (aspiration/ transplant) in advanced cases
somatostatin can relieve symptoms and reduce liver volume
what are the clinical features of liver abcess
high fever, leukocytosis,
abdo pain,
complex liver lesions
what is the usual history of a liver lesion
abdo or biliary infection or dental procedure
how are liver abscesses managed
initial empiric broad spectrum antibiotics
aspiration/ drainage percutaneously
echocardiogram
open drainage/ resection if no clinical improvement
4 weeks antibiotic therapy with repeat imaging
what are the 5 main types of malignant liver tumours
hepatocellular, fibro-lamellar carcinoma of the liver, hepatoblastoma, intrahepatic cholangiocarcinoma, metastases
is hepatocellular carcinoma more common in men or women
men
cirrhosis is the most important risk factor of HCC, what can cause cirrhosis
hepatitis B and C, alcohol, aflatoxin
what are the clinical features of HCC
Wt loss and RUQ pain (most common)
Asymptomatic
Worsening of pre-existing chronic liver disease
Acute liver failure
what might be found on examination of HCC
signs of cirrhosis,
hard enlarged RUQ mass,
liver bruit (rare)
where is HCC likely to metastasise to
Rest of the liver Portal vein Lymph nodes Lung Bone Brain
what is AFP (alpha fetoprotein)
HCC tumour marker, values >100ng/ml highly suggestive
what does a HCC prognosis depend on
tumour size, extrahepatic spread, underlying liver disease, patient performance
what is the requirement for liver transplantation in HCC
single tumour less than 5cm or less than 3 tumours each smaller than 3cm
what are the treatment options for HCC
liver transplant, resection, percutaneous ethanol injections/ radio-frequency ablation, transarterial chemoembolism, sorafenib, palliative
when is resection possible and what is the downfall
for small tumour with preserved liver function
recurrence rate is high
when is local ablation done
when non resectable or advanced liver cirrhosis
what is trans arterial chemoembolization (TACE)
inject chemotherapy in hepatic artery with embolic agent- only in patients with early cirrhosis
what is sorafenib
systemic therapy for HCC
who does fibro-lamellar carcinoma present in
young patients 5-35
is fibro lamellar carcinoma associated with cirrhosis
no
what is the AFP like in fibro lamellar carcinoma
AFP
what is the management for fibro-lamellar carcinoma
surgical resection or transplantation
TACE for unresectable tumours
what is the most common site for blood born metasteses
liver
what are the common metastases of the liver
colon, breast, lung, stomach, pancreas and melanoma
