Benign Neoplastic Diseases - Module 2

Tumour/lesion of abnormal cells that proliferate at a high rate

What is a neoplasm

Either

Are neoplasms diffuse or focal

Either (not all neoplasms are cancer)

Are neoplasms benign or malignant

Primary or metastases

What are the the two types of malignancy

Primary

If you see a solitary malignant mass is it most likely primary or a metastases

Metastases

If you see multiple malignant masses are they most likely primary or metastases

Typically asymptomatic, no altered lab test, well defined, encapsulate, slow growing, do not metastasize, hypovascular or avascular

Describe the the typical benign neoplasm

Homogeneous, slightly more echogenic or isoechoic to the kidney, smooth borders, interspersed vessels, diaphragm well seen

Describe the normal sonographic appearance of the liver

Kidney

What should you compare the echogenicity of the liver to

Normal sonographic appearance of liver and kidney

What does this image represent

Hemangioma

What is the most common benign liver tumour

Blood vessel mass

Describe the break down of the word hemangioma

Women (5:1)

Do hemangiomas occur more often in men or women

Capillaries

What are hemangiomas made up of

Asymptomatic

What are the symptoms of a hemangioma

Cavernous hemangioma

What is another term for hemangioma

Typically small (<3cm), well define, homogenous, and hyperechoic

Describe the sonographic appearance of a hemangioma

May include a heterogenous central area with hypoechoic components

Describe a different sonographic appearance that a hemangiomas may show

No

Do hemangiomas demonstrate any colour flow on Doppler

Bc the blood vessels are too small

Explain why hemangiomas don't show up on colour Doppler

Pregnancy or estrogen therapy (HRT)

What may cause a hemangioma to increase in size

No

Do hemangiomas increase in size with birth control use

Thought to be a link between hemangiomas and estrogen but not fully proved

What is the link between hemangiomas and estrogen

6 months to document change

How long after the initial discovery of an hemangioma would the patient need a follow up g

<3cm

What is the typical size of a hemangioma

Hemangioma

What does this image show

Hemangioma (would need follow up bc bigger)

What does this image show

Atypical appearance of hemangioma

What does this image show

Atypical appearance of hemangioma

What does this image show

Focal nodular hyperplasia

What does FNH stand for

Normal liver tissue, but abnormal arrangement (hyperplastic lesions)

What is a FNH made of

Women

Are FNH's more common in women or women

Hormones (estrogen or FSH)

What is FNH possible influenced by

Asymptomatic

What are the symptoms of FNH

Stealth lesion

What is the nickname of FNH

FNH

What does this image show

Subtle, less than 8cm, central area of decreases echogenicity, Doppler flow centrally

Describe the sonographic appearance of FNH

Look for contour abnormalities, displaced vessels in the liver, central scar (decreased echogencity in the center)

What are some tips to help you find a FNH

Hepatic veins main be randomly displaced or take a curve

Explain an example how a FNH may cause a liver vessel to be displaced

Sulphur colloid scan

What extra image modality is needed to diagnose a FNH

Hot/warm

How does a FNH appear on a sulphur colloid scan

FNH

Are hemangiomas or FNH's usually bigger

Bc has some features that are suggestive of malignancy (decreased echogencity centrally, Doppler flow centrally)

Why are FNH's a diagnostic challenge

Use colour map

What is another tip to help see a FNH

FNH

What does this image show

FNH (seen better with colour map)

What does this image show

FNH

What are the arrows pointing to

False, less common

T/F: adenomas are most common than FNH

Oral contraceptives

What has adenomas been proven to be linked to

Type 1 Glycogen Storage disease (GSD)

Disease is GSD

Glycogen storage disease

What does GSD stand for

Von Gierke's disease

What is another term for GSD

inherited disorder caused by deficiencies of specific enzymes in the glycogen metabolism pathway. Leads to excess glycogen in pt's liver and kidneys

Describe what GSD is

Asymptomatic

What is the usual symptoms of adenomas

Can hemorrhage or infraction, which will cause pain (RUQ?)

What is a complication of adenomas what what symptom would this cause

Non specific (usually hyperechoic but variable, solid, solitary, and well encapsulated, Doppler show central area of Doppler

Describe the appearance of an adenoma

FNH

What is the appearance of an adenoma often similar to

Cold

What does an adenoma appear on a sulphur colloid scan

8 to 15cm

What is the typical size of a adenoma when found on ultrasound

Hyperechoic but can have variable echogencity

What is the usually echogencity of a adenoma

Phagocytic cells

What are kupffer cells

Contains kupffer cells which gobble up the sulphur which makes them appear warm on the scan

Explain why a FNH appear warm on a sulphur colloid scan

Do not have kupffer cells so do not phagocytize the sulphur and appear cold

Explain why a adenoma appears cold on a sulphur colloid scan

Adenoma

What does this image show

False, pretty common in other parts of the body but not the liver

T/F: lipomas are one of the most commonly found neoplasms in the liver

Subcutaneous tissue

What type of tissue are lipomas usually found in

Asymptomatic

What are the symptoms of a lipoma in the liver

Hyperechoic, homogenous

Describe the sonographic appearance of a lipoma

Hemangioma

What is the appearance of a lipoma similar to

Contrast enhance CT or MRI, RBC scintigraphy, surfer colloid scans, micro bubble enhanced sonography, biopsy

What are the 5 different tests often used for neoplasms in the liver

Nuclear medicine test

What is a RBC scintigraphy

Inject something that is picked up for a RBC, and would show up in a hemangioma.

Describe the RBC scintigraphy test

Used to prove an atypical hemangioma

What are RBC's used for

Nuclear medicine test, inject sulphur and see if mass absorbs it

What is a surfer colloid scan

FNH vs adenoma

What is a sulfur colloid scan used for

Ultrasound scan with bubbles

What is a micro bubble enhanced sonography

If not getting the answers with the imagining, will do biopsy to make sure

When is a biopsy used

Repeat ultrasound after 3-6 months (make sure not changing then leave it alone)

What is the treatment for a hemangioma

Conservative, depending on size (leave it alone if small, may remove if causing symptoms

What is the treatment for a FNH

Surgery recommend

What is the treatment for an adenomatoid

Bc can get so large and hemorrhage (results in more serious complications)

What is the treatment for an adenomatoid

Conservative (same as hemangioma, if it ain't broke don't fix it)

What is the treatment for a lipoma

Extremely homogenous, more echogenic than the kidney, isoechoic or slightly more echogenic to the liver, hilum disrupted by vessels, inverted comma shape

Describe the normal sonographic appearance of the spleen

Splenomegaly

What is indicated when the spleen starts to loose the normal shape of an inverted comma

Cavernous hemangioma

What is the most common benign neoplasm of the spleen

Liver

Is a hemangioma in the liver or the spleen more common

True

T/F: a cavernous hemangioma in the spleen is congenital

Asymptomatic

What is the symptoms of a hemangioma in the spleen

Hyperechoic to complex with cystic degeneration (more variability in appearance than in liver)

Describe the sonographic of a hemangioma in the spleen

No, further testing is required to differentiate

Are ultrasound findings for a hemangioma in the spleen conclusive

Hemangioma in the spleen

What does this image show

Hemangioma in the spleen

What does this image show

Hemangioma in the spleen (see with contrast study)

What does this image show

Larger and more complex usually than as seen in liver

Compare the sonographic appearance of a hemangioma in the spleen as compared to one in the liver

No

Do hemangiomas in the spleen usually have a lot of colour flow

Rare

Are hamartoma's rare or common

Lymphoid tissue

What tissue is hamartoma's made of

Homogeneous, solid, echogenic, not encapsulated

Describe the sonographic appearance of a Hamartoma

Rare

Are lymphangioma's rare or common

Lymphatic malformation in the spleen

What is a lymphangioma