Benign liver lesions

Question 1

How are benign liver lesions classified?

Answer 1

Solid

Cystic

Question 2

Name solid benign liver lesions

Answer 2

Haemangioma
Focal nodular hyperplasia
Hepatic adenoma
Regenerative nodules

Question 3

What is the most common benign liver lesion?

Answer 3

Haemangioma

Question 4

What is the second most common benign liver lesion?

Answer 4

Focal nodular hyperplasia

Question 5

Discuss the epidemiology of haemangioma

Answer 5

20% of population

F:M 3:1 at 45yo

Question 6

Discuss morphological features of a haemangioma

Answer 6

Congenital large endothelial vascular space
Average 5cm (<25cm)
Solitary
No malignant risk

Question 7

Discuss the presentation of liver haemangiomas

Answer 7

Incidental finding
RUQ mass
Rarely symptomatic

Question 8

How do liver haemangiomas present on CT?

Answer 8

Assymetrical nodular peripheral enhancement in arterial phase with centripetal filling

Question 9

How do liver haemangiomas present on MRI?

Answer 9

T1 hypointense
T2 hyperintense
Contrast enhanced

Question 10

Discuss the management of liver haemangiomas

Answer 10

Only if symptomatic/rupture

1. Enucleation and inflow control
2. Embolization of feeding vessels
3. Formal liver resection

Question 11

Discuss the epidemiology of focal nodular hyperplasia liver lesions

Answer 11

Young females

Question 12

Discuss the morphology of focal nodular hyperplasia liver lesions

Answer 12

<5cm
No true capsule
No malignant risk 
Chords of benign hepatocytes combined by fibrous septa from central scar
Atypical biliary epithelium

Question 13

Discuss investigations for focal nodular hyperplasia liver lesions

Answer 13

AFP (normal)
CT
MRI

Question 14

How do focal nodular hyperplasia liver lesions appear on CT scan?

Answer 14

Well circumscribed with central scar
Hyperdense in arterial phase
Isodense in venous phase

Question 15

How do focal nodular hyperplasia liver lesions appear on MRI?

Answer 15

T1 hypointense
T2 hyper/isointense
Fibrous central scar

Question 16

Discuss the management of focal nodular hyperplasia liver lesions

Answer 16

No management required
Reassure patient
Stop oestrogen use
Resect if unsure diagnosis

Question 17

Discuss the morphology of hepatic adenomas

Answer 17

Benign hepatocyte proliferation
Solitary
10-25% malignancy risk
Well-vascularised by hepatic aa (risk to rupture and bleed)
Congested hepatocytes with glycogen deposits, no bile ducts, no Kupffer cells, no lobules

Question 18

Discuss the presentation of hepatic adenomas

Answer 18

Incidental on U/S

RUQ pain/mass

Question 19

How do hepatic adenomas appear on CT?

Answer 19

Sharp borders
Arterial enhancement
Iso/hypo-dense in venous phase

Question 20

How do hepatic adenomas appear on MRI?

Answer 20

T1 hyperintense

Gadobenate dimeglumine causes no enhancement (excreted via bile ducts and kidneys)

Question 21

Discuss the management of hepatic adenoma

Answer 21

Stop oestrogen use 
Surgical resection if >5cm OR if
- symptomatic
- unsure diagnosis
- low risk area
- high risk patient

Question 22

Discuss the morphology of regenerative nodules

Answer 22

Hepatocyte hypertrophy and cirrhosis
Multiple
Small
Not premalignant

Question 23

Name cystic benign liver lesions

Answer 23

Congenital cyst
Polycystic liver disease
NET metastases
Caroli’s disease

Question 24

Discuss the morphology of congenital cysts

Answer 24

Simply cyst
No septa
Thin wall
Clear contents (non-bilious, serous fluid) 
No malignant risk

Question 25

Name clinical features of congenital cysts

Answer 25

``` Accidental finding RUQ mass Early satiety Pain Intra-cystic bleeding ```

Question 26

Discuss the management of congenital cysts

Answer 26

If symptomatic - laparoscopic enucleation - arterial embolization - aspiration and sclerotherapy - resection

Question 27

Name clinical features of polycystic liver disease

Answer 27

``` First kidney cysts Asymptomatic Renal dysfunction Abdominal pain Early satiety RUQ mass SOB ```

Question 28

Name investigations in polycystic liver disease

Answer 28

Bloods (GGT, UKE) Imaging Genetics (PCKD 1/2)

Question 29

Name conditions associated with polycystic liver disease

Answer 29

``` Pancreatic cysts Cerebral aneurysm Inguinal hernia MR Diverticulosis ```

Question 30

Discuss the management of polycystic liver disease

Answer 30

``` Involve nephrology Surgical - aspiration and sclerotherapy - enucleation - resection - hepato-renal transplant ```