Flashcards in 15. Liver Lesions Deck (39):
What are the three benign primary liver lesions?
2. Focal nodular hyperplasia (FNH)
What are the two malignant primary lesions of the liver?
1. Hepatocellular carcinoma (HCC)
2. Cholangiocarcinoma (CCA)
What lesion does oral contraceptive use increase the risk for?
What lesion does a hx of extrahepatic malignancy increase the risk for?
What lesion does underlying liver disease increase the risk for?
What lesion does a hx of primary sclerosing cholangitis (PSC) increase risk for?
Malignant lesions in a noncirrhotic liver are primarily:
Metastases from the GI tract
**also from the lung, UG tract, breast
Malignant lesions in a cirrhotic liver are primarily:
Primary liver lesions (77%)
What is the most common benign liver lesion? What kind of liver gets these?
What are hemangiomas?
Congenital vascular malformations--blood filled cavities lined by endothelium
When are the majority of hemangiomas diagnosed? Size?
Third to fifth decade (asymptomatic)
1-20 cm (over 10 called giant hemangioma)
Hemangiomas are multiple in __% of cases
Do hemangiomas have malignant potential?
When is the only time that a hemangioma or focal nodular hyperplasia will cause sx?
When the lesion is close to the surface and stretches the capsule, which has higher innervation
What is characteristic of focal nodular hyperplasia (FNH) on imaging
Central stellate scar
What is the second most common benign liver lesion?
Focal nodular hyperplasia
What kind of liver gets FNH?
What causes FNH?
Anomolous artery develops, leading to hyperperfusion
Hyperperfused area enlarges until it outgrows the blood supply
Who usually gets FNH?
Women between the ages of 20 and 50
What is the typical size of FNH?
<5 cm, rarely exceeds 10 cm
How often is FNH multiple?
10-20% of cases
What is growth of a hepatic adenoma associated with?
What type of liver is an adenoma found in? Benign proliferation of:
Who typically gets hepatic adenomas?
Women of childbearing age
Hepatic adenomas are associated with the use of:
What are two situations that may give rise to multiple hepatic adenomas?
Glycogen storage disease
What is there a risk for with hepatic adenomas?
Treatment for hepatic adenoma?
Surgical resection if recommended to avoid risk of cancer and tumor rupture
What is the #1 cause of HCC worldwide? In the US?
Why is HCC on the rise in the US right now?
Lots of HCV infection occured in the 70s-80s, takes about 20-30 years to develop cirrhosis, and cirrhosis much come before transformation to HCC in HCV infection
What is the most common cause of HCC in Asian americans? Non-asians?
What is characteristic of blood flow in HCC?
Usually, 70% of blood flow is venous
HCC leads to a predominance of arterial blood flow, visualize by infusing contrast into the arteries
What produces alpha fetoprotein (AFP)
**malignant liver cells
Alpha fetoprotein is elevated in ___% of patients wtih HCC
**can also be elevated with hepatic inflammation in the absence of HCC and with cirrhosis
Values of AFP over ___ ng/ml in conjugation with liver lesion on imaging is consistent with HCC
Prevention of HCC
Treatment of viral hepatitis
Coffee (decreased liver enzymes, cirrhosis, and HCC)
Multiple liver lesions in a non-cirrhotic liver without arterial enhancement on imaging should make you think of:
What will the AFP level be with metastatic carcinoma in the liver?
Normal (not over 200)