Lesson 1C (Part 1)

Question 1

What is one of the most common malignant tumours?

Answer 1

Hepatocellular carcinoma

- HCC

Question 2

Who is HCC more common in?

Answer 2

Men

- 5:1

Question 3

What are the causes of HCC? (4)

Answer 3

1. Alcoholic cirrhosis
2. Viral Hep B&C
3. Fatty liver-steatohepatitis-cirrhosis
4. Fungi and toxins in food

Question 4

What are symptoms of hepatocellular carcinoma?

Answer 4

1. RUQ pain
2. Weight loss
3. Abdominal swelling
   - ascites is present

Question 5

What are 3 pathological forms of HCC?

Answer 5

1. Solitary tumor
2. Multiple nodules
3. Diffuse infiltration

Question 6

What does HCC sometimes invade?

Answer 6

The portal vein

- 30-60% of cases

Question 7

Budd–Chiari syndrome

Answer 7

The condition is caused by occlusion of the hepatic veins that drain the liver
- is a very rare condition,

Question 8

What is the sonographic appearance of HCC? (4)

Answer 8

1. Hypoechoic, complex or echogenic
2. Smaller nodules
3. Thin peripheral hypoechoic halo
   - fibrous capsule
4. Becomes more complex over time

Question 9

What other testings can be done for HCC? (4)

Answer 9

1. CEUS
2. CT scan
3. MRI
4. Doppler

Question 10

What is a subtype of HCC?

Answer 10

Fibrolamellar carcinoma

Question 11

Who are fibrolamellar carcinoma more common in? (2)

Answer 11

1. Adolescents

2. Young adults

Question 12

What does fibrolamellar carcinoma coexist without?

Answer 12

A liver disease

Question 13

What is recommended treatment for fibrolamellar carcinoma?

Answer 13

Surgical resection of the tumour

Question 14

What is the sonographic appearance of fibrolamellar carcinoma? (2)

Answer 14

1. Echogenicity is variable
2. Calcification
   - central echogenic scar distinguishes it from hepatomas of HCC

Question 15

Hemagiosarcoma

Answer 15

Extremely rare malignant tumor

Question 16

Who is more common to get hemagiosarcoma?

Answer 16

Adults 60-70 years of age

Question 17

What is hemagiosarcoma associated with?

Answer 17

Carcinogens

Question 18

What is the sonographic appearance of hemagiosarcoma?

Answer 18

Large mass of mixed echogenicity

Question 19

Hepatic epitheloid

Answer 19

Rare malignant tumour of vascular origin

Question 20

Who is more common to get hepatic epitheloid?

Answer 20

Adults

Question 21

What are affected with hepatic epitheloid? (3)

Answer 21

1. Soft tissues
2. Lungs
3. Liver

Question 22

What is the sonographic appearance of hepatic epitheloid?

Answer 22

Multiple hypoechoic nodules

- large masses

Question 23

Where are the most common primary tumours resulting in liver metastases from? (6)

Answer 23

1. Gallbladder
2. Colon
3. Stomach
4. Pancreas
5. Breast
6. Lung

Question 24

What are 2 blood borne routes?

Answer 24

1. Hepatic artery

2. Portal vein

Question 25

What do lymphatics spread through? (4)

Answer 25

1. Stomach 2. Pancreas 3. Ovary 4. Uterus

Question 26

Where do the tumour cells from the GI tract drain through to get to the liver?

Answer 26

Portal system

Question 27

What is the sonographic appearance of mets? (5)

Answer 27

1. Single or multifocal liver lesions 2. All with identical sonographic morphology 3. Diffuse liver involvement - varied sized lesions 4. Geographic infiltration - rarely 5. Hypoechoic halo - strongly associated with malignancy

Question 28

What is strongly associated with malignancy?

Answer 28

Hypoechoic halo

Question 29

What are common echogenic sonographic patterns of metastatic disease? (7)

Answer 29

1. GI tract 2. HCC 3. Vascular primaries 4. Islet cell carcinoma 5. Carcinoid 6. Choriocarcinoma 7. Renal cell carcinoma

Question 30

What are common hypoechoic sonographic patterns of metastatic disease? (6)

Answer 30

1. Breast 2. Lung 3. Lymphoma 4. Esophagus 5. Stomach 6. Pancreas