Liver benign/malignant Flashcards
(57 cards)
1
Q
Liver Granulomas?
A
Asymptomatic
Appear as calcification within the liver parenchyma
May be solitary or multiple
May be related to scarring or an underlying disorder-such as an infection ie-hepatitis or sarcoidosis
2
Q
A
liver granuloma
3
Q
Hamartomas?
A
- Small, focal ,solid appearing, hypoechoic
- Benign malformations-cells go haywire and hypertrophy
- <6% of population on autopsy
- Often confused with metastatic disease-CTis needed for clarification
- Single or multiple
4
Q
cavernous hemangioma?
A
- Benign, congenital tumor consisting of large, blood-filled cystic spaces.
- most common benign tumor of the liver
- Found more frequently in women
- Patients are usually asymptomatic, although a small percentage may bleed, causing right upper quadrant pain.
5
Q
what is the most common benign tumor of the liver?
A
cavernous hemangioma
6
Q
cavernous hemagioma on u/s?
A
- Homogenous and hyperechoic-tangle of tiny blood vessels
- Extremely low blood flow-avascular on sonography
- May appear hypoechoic-atypical
- Well circumscribed
- Enlarges slowly and undergoes degeneration, fibrosis, and calcification.
- Found in the subcapsular hepatic parenchyma or in the posterior right lobe more than the left lobe of the liver.
7
Q
A
cavernous hemangioma
8
Q
A
hepatic adenoma
9
Q
hepatic adenoma?
- seen less commonly than
- more common in
- linked to
A
Seen less commonly than FNH
More common in women-linked to OC use
10
Q
Hepatic Adenoma s/s?
- increased incidence with what?
A
- May be symptomatic-RUQ mass felt if large
- Bleeding within lesion causes pain
- Risk of malignant degeneration
- Incidence is increased in patients with type I glycogen storage disease or von Gierke disease.
- Resection is recommended
11
Q
Hepatic adenomas-sonographic appearance?
A
- hetergeneous
- multiple feeding hepatic arteries seen supplying the adenoma from its periphery
- exhibit a capsule
12
Q
A
FNH
13
Q
What is FNH?
A
More common in women, 2nd most commonly seen tumor
Hormonal influences may be a factor-seen in childbearing years and OC use
Incidental & asymptomatic finding
14
Q
FNH on u/s?
A
Exhibits a central scar sometimes -vascular malformation
Solitary, isoechoic, well circumscribed
Contour abnormality of liver surface –displaces vessels -may be subtle
Hypervascular, stellate pattern
Spoke wheel pattern
15
Q
Fatty tumors?
- associated with
A
Extremely rare
Associated with renal angiomyolipomas
16
Q
fatty tumors s/s?
A
Asymptomatic
Well defined echogenic mass
Indistinguishable from hemangioma, metastasis or focal fat on US
CT confirms diagnosis
17
Q
broken diaphragm sign is seen with?
A
fatty tumors
18
Q
A
fatty tumor
19
Q
2 Tumors occurring with hormonal influence?
A
- FNH
- adenoma
20
Q
Hepatomegaly?
A
Enlargement of the liver
Frequent indication for sonography of the liver
On P/E physician can feel the liver edge below the rib cage
21
Q
hepatomegly causes? measurement? classified as?
A
Alcohol abuse
RL measurement >14 cm (normal range 13 to 17)
Classified as mild ,moderate and severe as size increases
22
Q
Reidel’s lobe?
A
Frequently misinterpreted as enlarged liver
Found more often in women
Tongue shaped process of the liver
Normal variant
23
Q
hepatomegly causes?
A
alcohol use Fatty liver Viral infections-Hepatitis A&B &C Mononucleosis Hemochromatosis Primary liver cancer Leukemia Lymphoma
24
Q
Symptoms of hepatomegaly? (4)
A
Abdominal pain
Swelling
Feeling of fullness
Jaundice
25
Other cause of enlargement- Passive Liver Congestion?
Caused by stasis of the blood within liver parenchyma
- Hepatic venous drainage is compromised
- Common complication of congestive heart failure
Central venous pressure is directly transmitted from the right atrium to the hepatic veins
Liver appears tensely swollen - sinusoids dilate to accommodate backflow of blood
26
Hepatocellular Carcinoma (HCC)?
- 3 etiology
- Most common primary malignant neoplasm
- Its pathogenesis is related to cirrhosis (80% of patients with preexisting cirrhosis develop hepatocellular carcinoma), chronic hepatitis B virus infection, and hepatocarcinogens in foods.
- Occurs more frequently in men
27
HCC clinical presentation? (5)
```
a previous history of cirrhosis or hepatitis B and C
a palpable mass
hepatomegaly
appetite disorder
fever
```
28
Hepatocellular Carcinoma (Cont.)- presentation is in one of 3 patterns?
Solitary massive tumor
Multiple nodules throughout the liver
Diffuse infiltrative masses in the liver
29
HCC- Pathologically, the tumor may present as a
Focal lesion
Invasive lesion with necrosis and hemorrhage
Poorly defined lesion
30
HCC- signs?
Can be very invasive
Has been known to invade the hepatic veins to produce Budd-Chiari syndrome
The portal venous system may also be invaded with tumor or thrombosis.
Has a tendency to destroy the portal venous radicle walls, with invasion into the lumen of the vessel
31
Fibrolamellar carcinoma?
```
Subtype of HCC
Found in adolescents and young adults
Without coexisting liver disease
Alphafetoprotein levels are normal
Advanced disease at diagnosis
Surgical resection of tumor is recommended
Echogenicity is variable
Calcification-central echogenic scar distinguishes it from hepatomas of HCC
```
32
Hemangiosarcoma?
- age group?
Extremely rare malignant tumor
Seen in adults 60-70 yrs of age
Associated with specific carcinogens
Large mass of mixed echogenicity on US
33
Hepatic epitheliod?
Rare malignant tumor of vascular origin
Occurs in adults
Soft tissues ,lung and liver are affected
Multiple hypoechoic nodules-large masses
34
Lymphoma?
A malignant neoplasm involving lymphocyte proliferation in the lymph nodes
35
Lymphoma 2 main disorders?
Hodgkin lymphoma and non-Hodgkin lymphoma, are differentiated by lymph node biopsy
36
Lymphoma 2 main disorders?
Hodgkin lymphoma and non-Hodgkin lymphoma, are differentiated by lymph node biopsy
37
Lymphoma on u/s?
Patients with lymphoma have hepatomegaly with a normal or diffuse alteration of parenchymal echoes
38
Lymphoma on u/s?
Patients with lymphoma have hepatomegaly with a normal or diffuse alteration of parenchymal echoes
39
Lymphoma s/s? (8)
- Focal hypoechoic mass is sometimes seen.
Patient symptoms:
- enlarged
- nontender lymph nodes
- fever
- fatigue
- night sweats
- weight loss
- bone pain
- abdominal mass
Presence of splenomegaly or retroperitoneal nodes may help confirm a diagnosis of lymphadenopathy
40
lymphoma
41
lymphoma
42
Metastatic Disease?
- The most common form of neoplastic involvement of the liver
- Primary sites are the colon, breast, and lung
- Patients with short survival rate after initial detection of liver metastases are those with hepatocellular carcinoma and carcinoma of the pancreas, stomach, and esophagus
43
Metastatic Disease spreads?
- Patients with a longer survival rate are those with head and neck carcinoma and carcinoma of the colon.
- Metastatic spread to the liver occurs as the tumor erodes the wall and travels through the lymphatic system or through the bloodstream to the portal vein or hepatic artery to the liver.
44
Sonographic appearance-mets
Single or multifocal liver lesions
All with identical sonographic morphology
Diffuse liver involvement, varied sized lesions
Geographic infiltration rarely
Hypoechoic halo-strongly associated with malignancy
Prior knowledge of malignancy aids interpretation
45
Common sonographic patterns of metastatic disease? echogenic
```
GI tract
HCC
Vascular primaries
Islet cell carcinoma
Carcinoid
Choriocarcinoma
Renal cell carcinoma
```
hypervascular
46
Common sonographic patterns of metastatic disease? hypoechoic
```
Breast
Lung
Lymphoma
Esophagus
Stomach
Pancreas
```
hypovascular
47
Bull’s Eye or target?
typically seen with Lung cancer
Hypoechoic peripheral halo
Non specific and Common appearance
48
Calcified metastases?
```
Mucinous adenocarcinoma
Osteogenic sarcoma
Chondrosarcoma
Teratocarcinoma
Neuroblastoma
```
Marked echogenicity with Distal acoustic shadowing
49
Calcifications in the liver not always mets?
Shadowing in the liver is most often due to calcifications, air, stones and fat containing lesions
A clean shadow is caused by calcifications, while a dirty shadow is caused by air
Metastases are the most common cause of a calcified liver tumor
FNH only rarely has calcifications
50
Cystic mets ?
Necrosis-sarcomas
Cystadenocarcinoma of ovary & pancreas
Mucinous carcinoma of colon
51
Cystic metastases on u/s?
```
Uncommon
Distinguishable from simple cysts:
Mural nodules
Thick walls
Fluid-fluid levels
Internal septations
Extensive necrosis
```
52
Infiltrative Mets seen with?
Breast
Lung
Malignant melanoma
53
Infiltrative metastatic disease on u/s?
Diffuse disorganization of parenchyma
Difficult to appreciate on ultrasound
May be confused with cirrhosis or fatty liver
Chemotherapy may make liver fatty-nodules difficult to appreciate
CEUS,CT or MRI may be helpful
54
Metastatic - Kaposi sarcomas?
Neuroendocrine and carcinoid tumors
Primary cystadenocarcinoma
Mucinous carcinoma
Sarcomas -rare arise from connective tissue but can spread to liver
55
Diagnosis-CEUS Contrast Enhanced Ultrasound?
Major role diagnosis and detection of mets
Involves the use of microbubble contrast agents and specialized imaging techniques-
Tiny bubbles in an injectable gas
Shows sensitive blood flow and tissue perfusion
Are not nephrotoxic
No ionizing radiation
Similar results as CT and MRI
Determines vascularity in metastases
Biopsy establishes the primary tissue site
56
Portal venous gas ?
Accumulation of gas in the peripheral portal venous system
Similar in appearance to pneumobilia(air in bile ducts) which tends to be more central
In the adult -caused by GI issues:
Ischemic, necrotic, ulcerated bowel
Colorectal carcinoma
Inflammatory bowel disease
Perforated peptic ulcer
57
Hepatic Trauma
The liver is the third most commonly injured abdominal organ after the spleen and kidney.
Laceration of the liver occurs in 3% of trauma patients and is frequently associated with other injured organs.
Need for surgery is determined by the size of the laceration, the degree of hemoperitoneum, and the patient’s clinical status.
The right lobe is affected more often than the left.
The degree of trauma can vary, ranging from a small laceration, to a large laceration with a hematoma, to a subcapsular hematoma, or to capsular disruption.
