Flashcards in Focal Liver Lesions Deck (57)
A solid liver lesion in older patients in the absence of liver disease is most likely to be?
A malignant metastases
A solid liver lesion in chronic liver disease patients is most likely to be?
Primary liver cancer
What is the most common solid liver tumour in non cirrhotic patients?
What are the four kinds of benign liver tumours?
Focal nodular hyperplasia
What are the two types of malignant liver tumours?
Primary liver cancers
What are the three kinds of primary liver cancer?
What are the clinical features of Haemangioma?
More common in females
Usually single small
Well demarcated capsule
How do you diagnose a Haemangioma?
Ultrasound = Echogenic spot, well demarcated
CT = venous enhancement from periphery to centre
MRI = High intensity area
What is the treatment for Haemangioma?
Benign incidental fining which does not go on to develop into anything else
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
What would you see on histology of Focal Nodular Hyperplasia?
Sinusoids, bile ductules and Kupffer cells present
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
What is the treatment of Focal Nodular Hyperplasia?
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
In which part of the liver are most Hepatic Adenomas found?
What is a Hepatic Adenoma?
Most are solitary fat containing lesions
What is Adenomatosis?
A rare condition of multiple adenomas associated with Glycogen Storage Disease
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
How do you diagnose Hepatic Adenoma?
US = Filling defect
CT = Diffuse arterial enhancement
MRI = Hypo or hyper intense lesion
What is the treatment for Hepatic Adenomas?
Observe every 6m for 2y
If no regression, then surgical excision
What types of cyclic lesions can occur?
Pyogenic or amoebic
What are the clinical features of a simple cyst?
Liquid collection lined by epithelium
No biliary tree communication
Solitary and uniloculated
What are the symptoms of a simple cyst?
Symptoms can be related to:
Compression on adjacent structures
How do you manage a simple cyst?
No follow up necessary
If in doubt, imaging in 3-6 months
If symptomatic, consider surgical intervention
What is the cause of a Hydatid Cyst?
How might a patient with a Hydatid Cyst present?
erosion of cysts into adjacent structures and vessels
How do you diagnose a Hydatid Cyst?
Serological testing detection of anti-Echinococcus antibodies
What treatment is available for Hydatid Cysts?
Surgery = Conservative or Radical
Medical = Albendazole
Percutaneous Drainage = PAIR
What types of surgery are available to treat Hydatid Cysts?