Flashcards in Liver - focal liver lesions Deck (61)
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)
What is the most common solid liver tumour in non cirrhotic patients?
What are the causes of a benign focal liver lesions? (4)
Focal nodular hyperplasia
What are the 2 causes of malignant focal lesions of the liver?
Primary liver cancers
What are the types of primary liver cancers? (6)
Clinical features of haemangioma:
-more common in M or F?
- blood supply?
- size/ number of them?
Usually single and small
Well demarcated capsule
Diagnosis of haemangioma?
US: echogenic spot, well demarcated
CT: venous enhancement from periphery centre
MRI: high intensity area
No need for FNA
Treatment for haemangioma?
No need for treatment
What is a focal nodular hyperplasia?
Benign nodule formation of normal liver tissue (hyper plastic growth of normal hepatocytes)
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
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
What 3 things are present on histology focal nodular hyperplasia?
What age groups and gender are focal nodular hyperplasia more common in?
Young and middle age women (no relation with sex hormones)
Symptoms of focal nodular hyperplasia?
Usually asymptomatic, amy cause minimal pain
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
Treatment of focal nodular hyperplasia?
No treatment necessary
(no change required regarding pregnancy and hormones - some older texts give mixed message)
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
Clinical features of hepatic adenoma:
Which sex is it more common in?
What is it commonly associated with?
What can it rarely present with?
Usually asymptomatic but may have RUQ pain - symptoms are size related
May present with rupture, haemorrhage or malignant transformation (very rare)
What lobe of the liver are hepatic adenomas commonly found in?
The right lobe
What is multiple adenomas called?
What is this associated with?
Glycogen storage diseases
What has been identified within adenomas that confer malignant risk?
Identifiable oncogene mutations
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
What can happen do hepatic adenomas after discontinuation of Oral contraceptives?
Diagnosis of hepatic adenoma?
US: filling defect
CT: diffuse arterial enhancement
MRI: hypo or hyper intense lesion
FNA: may be needed
Treatment for a hepatic adenoma?
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
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
Malignant risk with adenoma and focal nodular hyperplasia?
Adenoma = malignant degeneration
Focal nodular hyperplasia = no malignant risk
Type of cystic lesions of the liver? (5)
Pyogenic or amoebic abcess
Clinical features of a simple cyst:
-Biliary tree communication?
-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: