Benign Focal Lesions of the Liver

Question 1

benign lesions include Haemangioma
Focal nodular hyperplasia
Adenoma
Liver cysts

with ____ being the most common benign tumour which is usually asymptomatic

Answer 1

Haemangioma

Question 2

haemangioma is more common in males, true/false?

Answer 2

false

Question 3

what is a haemangioma

Answer 3

a mass of atypical blood vessels

Question 4

what investigations are done for haemangioma?

Answer 4

USS, CT (venous enhancement from periphery to center) , MRI

no need to biopsy

Question 5

what is focal nodular hyperplasia?

Answer 5

it is a nodule formation of normal liver tissue caused by congenital problems in arterial flow which leads to a hyperplastic response.

Question 6

what is focal nodular hyperplasia associated with?

Answer 6

osler-Weber-Rendu and liver haemangioma

Question 7

histologically do FNH nodules show all types of cells in the liver (e.g. sinusoids, bile ductules and kupffer cells) or just hepatocytes?

Answer 7

all types of cells

Question 8

does FNH have a relation with sex hormones?

Answer 8

no

Question 9

which group is FNH more common in ?

Answer 9

young and middle aged women

Question 10

how is FNH diagnosed?

Answer 10

US, CT, MRI, FNA

Question 11

what would be seen on CT for FNH?

Answer 11

Classically (but not always) – central scar containing a large artery, radiating branches to the periphery

Question 12

histologically do hepatic adenomas show all types of cells in the liver (e.g. sinusoids, bile ductules and kupffer cells) or just hepatocytes?

Answer 12

no - These are benign neoplasm composed of normal hepatocytes

no portal tract, central veins or bile ducts

Question 13

adenomas are more common in females?

Answer 13

yes

Question 14

do hepatic adenomas have a relation with sex hormones?

Answer 14

yes - contraceptive hormone associations

Question 15

what may patients with hepatic adenoma present with?

Answer 15

assymptomatic

May present with rupture, hemorrhage, or malignant transformation (very rare)

Question 16

how is hepatic adenoma diagnosed?

Answer 16

UC, CT, MRI, FNA - may be needed

Question 17

how is hepatic adenoma treated?

Answer 17

Stop hormones
and observe

Male patients more prone to develop malignant adenoma than female so it is now thought that the adenoma should be resected rather than monitored

Question 18

what are the 5 types of cystic lesions

Answer 18

Simple, Hydatid, Atypical, Polycystic lesion, Pyogenic or Amoebic abscess

Question 19

____ ___ - a Liquid collection lined by an epithelium with no biliary tree communication

Answer 19

simple cyst

Question 20

mostly simple cysts are ____ but symptoms can be due to ______, ______, ___ and ____

Answer 20

assymptomatic

haemorrhage, infection, rupture and compression

Question 21

___ ___ - This is a common complication of tapeworm parasite echinoccocus granulosus

Answer 21

hydatid cyst

Question 22

how is hydatid cyst diagnosed?

Answer 22

history and serologic testing - anti echinoccocus antibodies

Question 23

what are the management options for hydatid cyst ?

Answer 23

surgery

medical - albendazole

percutaneous drainage: PAIR

Question 24

what is polycystic liver disease?

Answer 24

Embryonic ductal plate malformation of the intrahepatic biliary tree

Question 25

what are the three types of PLD?

Answer 25

Von Meyenburg complexes (VMC) Polycystic Liver disease Autosomal dominant Polycystic Kidney disease

Question 26

what are the symptoms of PLD/

Answer 26

abdominal pain, abdominal distension, atypical symptoms due to voluminous cysts resulting in compression of adjacent tissue or failure of the affected organ

Question 27

VMC are Cystic bile duct malformations, originating from the ______ biliary tree

Answer 27

Cystic bile duct malformations, originating from the peripheral biliary tree

Question 28

are there predisposing genes to VMC?

Answer 28

no

Question 29

____ ____ ____ ____Liver function preserved and renal failure rare Symptoms depend on size of cysts

Answer 29

Polycystic Liver disease

Question 30

are there predisposing genes to PCLD?

Answer 30

yes - PRKCSH and SEC63

Question 31

Renal failure due to polycystic kidneys and non-renal extrahepatic features are _____ in ADPKD

Answer 31

common

Question 32

are there predisposing genes to ADPKD?

Answer 32

yes– PKD1 and PKD2

Question 33

what are the features of ADPKD?

Answer 33

Hypertension Abdominal aneurysms Cardiac valve abnormalities

Question 34

what are the clinical features of liver abscess?

Answer 34

High fever Leukocytosis Abdominal Pain Complex liver lesion

Question 35

what is important to find out in the history for liver abscess?

Answer 35

if they have had a recent abdo or biliary infection dental procedure

Question 36

what is the management in liver abscess?

Answer 36

empirical antibiotics initially aspiration/drainage percutaneously ecg