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Flashcards in Liver - focal liver lesions Deck (61)
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1

What are solid liver lesions in older patients most likely to be?

Malignant - usually metastases if the patient does not have liver disease (then it is more likely to be a primary liver cancer)

2

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

Haemangioma

3

What are the causes of a benign focal liver lesions? (4)

Haemangioma
Focal nodular hyperplasia
Adenoma
Liver cysts

4

What are the 2 causes of malignant focal lesions of the liver?

Primary liver cancers
Metastases

5

What are the types of primary liver cancers? (6)

Hepatocellular carcinoma
Cholangiocarcinoma
Fibrolamellar carcinoma
Hepatoblastoma
Angiosarcoma
Haemangioendothelioma

6

Clinical features of haemangioma:
-more common in M or F?
- blood supply?
- size/ number of them?
- border?
- symptoms?

Females
Hypervascular tumour
Usually single and small
Well demarcated capsule
usually asymptomatic

7

Diagnosis of haemangioma?

US: echogenic spot, well demarcated
CT: venous enhancement from periphery centre
MRI: high intensity area
No need for FNA

8

Treatment for haemangioma?

No need for treatment

9

What is a focal nodular hyperplasia?

Benign nodule formation of normal liver tissue (hyper plastic growth of normal hepatocytes)

10

What is usually the cause of a focal nodular hyperplasia?
What 2 other conditions is FNH therefore associated with?

Congenital vascular anomaly - hyperplastic response to abnormal arterial flow
Osler-Weber-Rendu
Liver haemangioma

11

What is the classical appearance of a focal nodular hyperplasia?

Central scar containing a large artery, radiating branches to the periphery (Hub and spoke) - not always

12

What 3 things are present on histology focal nodular hyperplasia?

Sinusoids
Bile ductules
Kupffer cells

13

What age groups and gender are focal nodular hyperplasia more common in?

Young and middle age women (no relation with sex hormones)

14

Symptoms of focal nodular hyperplasia?

Usually asymptomatic, amy cause minimal pain

15

Diagnosis of focal nodular hyperplasia?

US: nodule with varying echogenicity
CT: hypervascular scar with central scar
MRI: Iso or hypo intense
FNA: normal hepatocytes and cupful cells with central core

16

Treatment of focal nodular hyperplasia?

No treatment necessary
(no change required regarding pregnancy and hormones - some older texts give mixed message)

17

What is a hepatic adenoma?

Benign neoplasm composed of normal hepatocytes - most are solitary fat containing lesions
No portal tract, central veins or bile ducts

18

Clinical features of hepatic adenoma:
Which sex is it more common in?
What is it commonly associated with?
Symptoms?
What can it rarely present with?

Females
Contraceptive hormones
Usually asymptomatic but may have RUQ pain - symptoms are size related
May present with rupture, haemorrhage or malignant transformation (very rare)

19

What lobe of the liver are hepatic adenomas commonly found in?

The right lobe

20

What is multiple adenomas called?
What is this associated with?

Adenomatosis
Glycogen storage diseases

21

What has been identified within adenomas that confer malignant risk?

Identifiable oncogene mutations

22

How are hepatic adenomas related to Oral Contraceptive?

Related to duration of OC use (>2 years) and oestrogen component, but adenomas have been described with even 6 months of OS use

23

What can happen do hepatic adenomas after discontinuation of Oral contraceptives?

Regression

24

Diagnosis of hepatic adenoma?

US: filling defect
CT: diffuse arterial enhancement
MRI: hypo or hyper intense lesion
FNA: may be needed

25

Treatment for a hepatic adenoma?

Stop hormones
Observe every 6m for 2y
if no regression then surgical excision
New guidelines suggest that male patients should have them removed straight away as they are more prone to developing a malignant transformation

26

Difference between an adenoma and focal nodular hyperplasia appearance?

Adenoma = purely a hepatocyte tumour which is cold on nuclear sulfur colloid scan
Focal nodular hyperplasia = contains all the liver ultrastructure including ES and bile ductules (isointense on sulfur colloid scan) - central scar

27

Malignant risk with adenoma and focal nodular hyperplasia?

Adenoma = malignant degeneration
Focal nodular hyperplasia = no malignant risk

28

Type of cystic lesions of the liver? (5)

Simple
Hydatid
Atypical
Polycystic lesion
Pyogenic or amoebic abcess

29

Clinical features of a simple cyst:
-Appearance
-Biliary tree communication?
-Symptoms?

-liquid collection lined by an epithelium - solitary and uniloculated
- no biliary tree communication
Most of the time asymptomatic but symptoms can be experienced in relation to:
-intracsytic haemorrhage
-infection
-rupture (rare)
-compression

30

Management of a simple cyst?

No follow up necessary
if in doubt, image in 3-6 months
If symptomatic or uncertain of diagnosis (complex cystic lesion), then consider surigcal intervention