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Gastroenterology > Liver mass > Flashcards

Liver mass Flashcards

Differential/management

1
Q

What to do with a patient presenting w/ fever + neutropenia?

A

Start empiric antibiotic tx ASAP for potential sepsis, continue until an infectious bacterial process has been r/o

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2
Q

MC liver masses in infants <1 y?

A

Hemangioma, Hamartoma

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3
Q

What liver masses require a confirmatory biopsy?

A

Hepatoblastoma, Hepatocellular carcinoma

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4
Q

Potential infectious etiologies for liver mass?

A

Abscess, viral hepatitis, Entamoeba Hystolytica (if Hx international travel)

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5
Q

MC cause of febrile neutropenia?

A

viral suppression of bone marrow function

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6
Q

What are inflammatory pseudotumors (IPT)?

A

Rare, benign, solitary and well demarcated lesions caused by proliferation of inflammatory cells

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7
Q

IPT synonyms

A 
Inflammatory myofibroblastic tumor
Plasma cell granuloma
Fibrous Histiocytoma
Fibroxanthoma
Xanthogranuloma
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8
Q

IPT locations

A 
MC: Lungs
Extrapulmonary sites: 
Head/neck, orbit, salivary glands, lymph nodes, breast
Kidney, GU tract
Pancreas, retroperitoneum
Liver, spleen, GI tract
Soft tissue
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9
Q

IPT clinical manifestations

A

Usually asymptomatic, incidental findings

In extremely rare cases they can cause mass effect

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10
Q

IPT laboratory findings?

A

Elevated WBC count, elevated acute phase reactants (ESR, CRP), abnormal LFTs
Uncommonly: cytopenias (Anemia, Leukopenia/Neutropenia/Thrombocytopenia)

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11
Q

IPT imaging tests

A

US, CT, MRI, PET (positron emission tomography)

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12
Q

if Dx unknown, what to do?

A

Fine-needle aspiration (FNA) or open biopsy/resection

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13
Q

IPT pathogenesis

A
  • Cellular insult –> aberrant inflammatory response
  • Activation inflammatory cells –> release of Cytokines –> activation: neutrophils, eosinophils, lymphocytes, plasma cells, Histiocytes, multinucleated giant cells, myofibroblasts and spindle-shaped cells –> cellular damage + IPT formation
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14
Q

IPT etiology

A

Unknown, but 3 possibilities have been considered:
*Postinfectious, *Autoimmune, *Neoplastic (IPT > postradiation tx for malignant neoplasms, Some IPTs w/ + genetic testing for malignancy, suggesting some could be: low grade mesenchymal neoplasms + secondary inflammatory component)

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15
Q

IPT (immune etiology

A

Due to IgG4-related disease: an immune mediated condition characterized by:
lymphoplasmacytic infiltration
Predominant IgG4 + plasma cells
Elevation of IgG4
Dramatic response to glucocorticoids when adm

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16
Q

Viral Neutropenia

A

Transient, usually mild to moderate, rarely leads to superimposed bacterial infections, improves in 3-8 days
MC viruses (mild to moderated N): Influenza A and B, RSV, Parvovirus, Measles, Rubella, Varicella
However, Viruses causing greater suppression include:
EBV, CMV, Human herpesvirus 6 (HHV-6), Hepatitis, HIV
–> superimposed bacterial infections

17
Q

Autoimmune Neutropenia (AIN)

A

By granulocyte-specific antibodies
Typically detected incidentally btw 7-9 months of age
ANC ranging 0.5-1.0 K/mcL
Dx confirmation:
Autoantibody detection
Indirect-GIFT (Indirect granulocyte immunofluorescence test)
GAT (Granulocyte agglutination test)
Tx: Close monitoring, spontaneous remission and disappearance of autoantibodies

18
Q

Neutropenia causing recurrent or severe infections, or Pt needing a surgical procedure

A

Filgrastim-G-CSF (Granulocyte colony stimulating factor)

19
Q

Refractory cases of Neutropenia, management?

A

Intravenous immunoglobulin (IVIG)
CS
Monoclonal antibodies

20
Q

IPT Tx

A

-Usually conservative, if no clinical improvement –> surgical (full) resection
1st line: outpatient monitoring –> serial imaging and labs
>surgery, most IPT cases do not recur
-Antibiotics, NSAIDs (varying degrees of success)
-If IgG4-related disease suspected: Glucocorticoids to help tumor regression

21
Q

Differential Dx Liver mass in infants

A
  • Hematologic
  • Oncologic
  • GI
  • Infectious
22
Q

Hematologic causes of liver mass in infants

A

IgG4-related disease
Autoimmune neutropenia
Kostmann Syndrome
Congenital neutropenia

23
Q

Oncologic causes liver mass infants

A 
Hepatoblastoma
Hepatocellular adenoma
Hepatocellular carcinoma
Focal nodular hyperplasia
IPT
24
Q

GI causes liver mass infants

A 
Hepatic hemangioma
Hepatic hamartoma
Simple hepatic cyst
Polycystic liver disease
Hydatid cyst
25
Q

Infectious causes liver mass infants

A 
Hepatic abscess
Viral hepatitis
Epstein Barr Virus
CMV
Entamoeba Hystolytica

Gastroenterology (2 decks)

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