Liver Lesions - Franco

Question 1

How liver lesions categorized?

Which are more common?

Answer 1

Primary or Metastatic

Metastatic (in the US)

Question 2

What are 3 benign liver lesions?

What are 2 malignant liver lesions?

Answer 2

• Benign
  
  • Hemangioma
  • Focal Nodular Hyperplasia
  • Adenoma
• Malignant
  
  • Hepatocellular Carcinoma
  • Cholangiocarcinoma

Question 3

What are some risk factors for liver lesions?

Answer 3

• Oral contraceptives (Hepatic adenoma)
• Extrahepatic malignancy (Metastatic disease)
• Liver Disease (Hepatocellular Carcinoma)
• Primary Sclerosing Cholangitis (Cholangiocarcinoma)

Question 4

What is an hemangioma?

What is the treatment for a hemangioma?

Answer 4

Essentially a dilated blood vessel; it is completely benign

Does not usually require treatment; replace estrogen contraceptives to see if it shrinks, otherwise surgical resection

Question 5

What is a focal nodular hyperplasia?

Who gets it?

Answer 5

overgrowth of cells surrounding an artery due to a bounty of nutrients

Typically women between 20-50

Question 6

What is a hepatic adenoma?

Who gets it?

Answer 6

Benign proliferation hepatocytes

Women of child-bearing age who use contraceptives

(glycogen storage disease, diabetes mellitus)

Question 7

What risks are associated with hepatic adenoma?

How are hepatic adenomas treated?

Answer 7

hemorrhage or maligant transformation

Discontinuation of contraceptives, avoid pregnancy, surgical resection

Question 8

What is the worldwide incidence of hepatocellular carcinoma?

What does HCC incidence mirror?

Answer 8

Widespread in south-east asia and africa

Hepatitis B infection rates

Question 9

What is the biggest cause of hepatocellular carcinoma in the United States?

What percentage of HCC is caused by hepatitis?

Answer 9

Hepatitis C, cirrhosis

2/3 of all cases

Question 10

How do blood flow patterns change in HCC?

How can this be used to diagnose HCC?

Answer 10

Arterial flow is increased, while portal flow is decreased

HCC will show washout with contrast during the venous phase and light-up during the arterial phase

Question 11

What is AFP?

What is it a marker for?

How specific is it?

Answer 11

alpha fetoprotein, a produced by the liver and the placenta

Marker for HCC

Not very specific, can be elevated with hepatic inflammation or cirrhosis

Question 12

What are three ways HCC can be prevented?

Answer 12

1. HBV vaccination
2. Prompt treatment of hepatitis
3. Coffee?

Question 13

What sites are metastatic disease most likely to come from?

Answer 13

1. GI
   
   1. colon
   2. pancreas
   3. esophageal
   4. gastric
2. Lung
3. Urogenital
4. Breast
5. Melanoma