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Flashcards in Focal Liver Lesions Deck (57)
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1

A solid liver lesion in older patients in the absence of liver disease is most likely to be?

A malignant metastases

2

A solid liver lesion in chronic liver disease patients is most likely to be?

Primary liver cancer

3

What is the most common solid liver tumour in non cirrhotic patients?

Haemangioma

4

What are the four kinds of benign liver tumours?

Haemangioma
Focal nodular hyperplasia
Adenoma
Liver cysts

5

What are the two types of malignant liver tumours?

Primary liver cancers
Metastases

6

What are the three kinds of primary liver cancer?

Hepatocellular carcinoma
Fibrolamelar carcinoma
Hepatoblastoma

7

What are the clinical features of Haemangioma?

More common in females
Hypervascular tumour
Usually single small
Well demarcated capsule
Usually asymptomatic

8

How do you diagnose a Haemangioma?

Ultrasound = Echogenic spot, well demarcated
CT = venous enhancement from periphery to centre
MRI = High intensity area

9

What is the treatment for Haemangioma?

None needed
Benign incidental fining which does not go on to develop into anything else

10

What are the clinical features of Focal Nodular Hyperplasia?

Benign nodule foramen of normal liver tissue
Congenital vascular abnormality
Classically appears as a central scare contain a large artery with branches radiating to the periphery
Hyper plastic response to abnormal arterial flow
More common in young and middle age women
Usually asymptomatic, may cause minimal pain

11

What would you see on histology of Focal Nodular Hyperplasia?

Sinusoids, bile ductules and Kupffer cells present

12

How do you diagnose Focal Nodular Hyperplasia?

US = Nodule with varying echogenicty
CT = Hypervascular mass with central scar
MRI = Iso- or hypo- intense
FNA = Normal hepatocytes and Kupffer cells with central core

13

What is the treatment of Focal Nodular Hyperplasia?

None needed

14

What are the clinical features of Hepatic Adenoma?

Benign neoplasm composed of normal hepatocytes with NO portal tract, central vein or bile ducts
More common in women
Associated with contraceptive hormones
Usually asymptomatic, with possible RUQ pain
rarely presents with rupture, haemorhhage or very rarely malignant transformation

15

In which part of the liver are most Hepatic Adenomas found?

Right lobe

16

What is a Hepatic Adenoma?

Most are solitary fat containing lesions

17

What is Adenomatosis?

A rare condition of multiple adenomas associated with Glycogen Storage Disease

18

How does use of OC contribute to Hepatic Adenomas?

Risk related to duration of use
The oestrogen component causes the adenoma
Regression can occur on stopping the OC

19

How do you diagnose Hepatic Adenoma?

US = Filling defect
CT = Diffuse arterial enhancement
MRI = Hypo or hyper intense lesion

20

What is the treatment for Hepatic Adenomas?

Stop hormone
Observe every 6m for 2y
If no regression, then surgical excision

21

What types of cyclic lesions can occur?

Simple
Hydatid
Atypical
Polycystic
Pyogenic or amoebic

22

What are the clinical features of a simple cyst?

Liquid collection lined by epithelium
No biliary tree communication
Solitary and uniloculated

23

What are the symptoms of a simple cyst?

Mostly asymptomatic
Symptoms can be related to:
Intracystic haemorrhage
Infection
Rupture (rare)
Compression on adjacent structures

24

How do you manage a simple cyst?

No follow up necessary
If in doubt, imaging in 3-6 months
If symptomatic, consider surgical intervention

25

What is the cause of a Hydatid Cyst?

Echinoccocus granulosus
TAPEWORM

26

How might a patient with a Hydatid Cyst present?

Disseminated disease
erosion of cysts into adjacent structures and vessels

27

How do you diagnose a Hydatid Cyst?

History
Appearance
Serological testing detection of anti-Echinococcus antibodies

28

What treatment is available for Hydatid Cysts?

Surgery = Conservative or Radical
Medical = Albendazole
Percutaneous Drainage = PAIR

29

What types of surgery are available to treat Hydatid Cysts?

Conservative =
Open cystectomy
Marsupialisation

Radical =
Pericystectomy
Lobectomy

30

What risks are associated with Hydatid Cysts?

Operative morbidity
Anaphylaxis
Dissemination of infection