Neoplasms-Benign

Question 1

What is a neoplasm?

Answer 1

Tumour/lesion, abnormal tissue growth, diffuse or focal, benign or malignant, distinct or ill-defined

Question 2

Describe benign neoplasms.

Answer 2

Asymptomatic, well-defined, encapsulated, slow growing, no mets, hypo or avascular

Question 3

What is the most common benign liver tumour?

Answer 3

Hemangioma

Question 4

How do hemangiomas look on U/S?

Answer 4

small (<3cm), well defined, homogeneous and hyperechoic

Question 5

What population (M or F) do hemangiomas affect more?

Answer 5

Females > males (5:1)

Question 6

What is Focal Nodular Hyperplasia (FNH)?

Answer 6

Hyperplastic (increase in cell number) lesion containing all elements of normal liver tissue.

Question 7

What population (male or female) develops FNH and what causes this?

Answer 7

Females- due to hormones

Question 8

What is another name for FNH and how does it look on U/S?

Answer 8

“Stealth lesion”

On U/S- subtle, less than 8cm, area of decreased echogenicity, central Doppler flow

Question 9

What does it mean when the FNH is “hot” or “warm”?

Answer 9

Nuclear medicine exam called Sulphur Colloid scan looks for Kupffer cells (which perform phagocytosis) and because FNH has kupffer cells, it shows up “hot”.

Question 10

What medication is linked to Adenomas?

Answer 10

Oral contraceptives

Question 11

What other disease are adenomas related to? (SC)

Answer 11

Type 1 Glycogen Storage Disease (GSD, von Gieke’s disease).

Type 1 GSD is a genetic disorder (enzyme deficiency) causing them to store increased glycogen in the liver.

Question 12

What can happen to adenomas?

Answer 12

They can hemorrhage or infarct causing severe pain.

Question 13

Is FNH or are adenomas more common?

Answer 13

FNH

Question 14

What is the U/S appearance of adenomas?

Answer 14

• Usually hyperechoic but variable
• 8 to 15 cm
• Solid, solitary and well encapsulated
• Doppler shows central area of colour

Question 15

How do adenomas show on sulphur colloid scan- hot or cold?

Answer 15

Cold

Question 16

Compare FNH and adenomas- vascularity and sulphur colloid scans.

Answer 16

Vascularity- both have central vascularity

Sulphur colloid- FNH is hot, adenomas are cold

Question 17

Lipomas:

• how often do they occur?
• symptoms?
• sonographic appearance?

Answer 17

• very rare
• asymptomatic
• hyperechoic (like hemangioma)

Question 18

Other tests to confirm benign liver neoplasms.

Answer 18

• contrast CT/MRI
• RBC scintigraphy (hemangioma)
• sulphur colloid scans (FNH and adenomas)
• micro bubble enhanced U/S
• biopsy

Question 19

Treatment for hemangioma

Answer 19

Repeat ultrasound after 3-6 months

Question 20

Treatment for FNH

Answer 20

Conservative (keep checking), depending on size

Question 21

Treatment for adenoma

Answer 21

Surgery recommended due to potential hemorrhage

Question 22

Treatment for lipomas

Answer 22

Conservative