Hepatic Masses

hemangioma, focal nodular hyperplasia, hepatic adenoma

What are the benign solid liver lesions?

hemangioma

What is the most common benign liver lesion?

asymptomatic, but can present with RUQ or fullness if larger

Symptoms of hemangioma?

severe RUQ pain

What can someone present with if they have a lesion rupture of the hemagioma?

MRI

What imaging is most sensitive to see a hemangioma?

no because they are vascular

Can you biopsy a hemangioma? why?

surveillance imaging

What to do if the hemagioma is <5cm?

contrast-enhanced MRI in 6-12 months

If hemangioma is >5cm what do you do?

repeat contrast-enhanced MRI 6-12 months

If hemangioma is growing at a rate >3mm per year what do you do?

symptoms, size

Decision to resect hemgioma is based on what?

focal nodular hyperplasia

What is the second most benign liver lesion?

focal nodular hyperplasia

this is a focal, nodule of hyperplastic tissue, composed of hyperplastic hepatocytes with normal architecture

normal

How is the hepatic architecture with an FNH present?

aberrant dystrophic artery

portal tract injury resulting in arterial to venous shunts

congenital vascular malformation

FNH is a proliferation of hepatocytes often seen as a reaction to what?

fibrous scar around center of the lesion (central stellate scar)

How can the FNH present on imaging?

no

For FNH is there recommendations to limit OCP or monitor during pregnancy?

hepatocellular adenoma

made from adenoma cells without normal hepatic architecture, this is less common than the other benign, solid liver lesions

women, increased estrogen exposure

Hepatic adenomas are more common in male or female? Why?

estrogen

There is a clear connection b/w hepatic adenomas and what hormone?

incidental imaging findings to acute, life-threatening hemorrhage

What is the range of symptoms for hepatic adenoma

hypotension, peritoneum

With hepatic adenoma there is a sudden, severe pain associated with _______ and this reflects rupture into…

alk phos and GGT, CRP

What abnormal labs are seen with hepatic adenoma?

normal

Will AFP be elevated or low in a hepatic adenoma?

HCC

AFP is increased in what liver problem?

surveillance imaging recommended 6mo after dx

if no growth annual MRI over 2-3 years

How to deal with <5cm hepatic adenomas in women?

surgical resection, or RFA or embolization

How to deal with hepatic adenomas >5cm for women?

estrogen, however not recommended to avoid pregnancy

What should women avoid with a hepatic adenoma?

2nd trimester

If a pregnant woman has a hepatic adenoma >5cm when should a resection occur?

undergo surgery regardless of size of the lesion, increased risk of malignant transformation

How should hepatic adenomas be managed in men? Why?

colorectal cancer

breast

upper GI malignancies

lung

renal

melanoma skin cancer

What are cancers that commonly spread to the liver?

US, CT, MRI

Metastatic disease lesions can be detected by what imaging?

cross sectional imaging

What imaging is better able to characterize metastatic disease?

no

Can US differentiate b/w adenoma and metastatic disease?

chronic liver disease

HCC develops in the setting of what?

imaging and labs every 6 months

HCC surveillance?

RUQ pain, weight loss, anorexia/early satiety

Sx of HCC?

CT and MRI

What imaging modalities are preferred for HCC?

no, increased procedural risk, false negatives, tumor seeding along biopsy tract

Is a tissue sample required to make dx of HCC? Why not?

resection or liver transplant

ablation

embolization

radiation/chemo/immunotherapy

Tx of HCC?

simple hepatic cyst

this is often found incidentally, asymptomatic and generally small in size

has possibility to enlarge and beocme infected or rupture

no

If someone is asymptomatic with a simple hepatic cyst do we need to intervene/follow-up?

mucinous cystic neoplasm (cystadenoma)

This is a rare cystic tumor occurring within liver parenchyma, can be found incidentally or may cause RUQ pain/fullness

biopsy

What is needed for definitive dx of mucinous cystic neoplasm (cystadenoma)?

resection

Preferred tx for noninvasive MCNs is what?

entamoeba histolytica

Amoebiasis is caused by what parasite?

fecal/oral, then spreads to extraintestional sites

How is entamoeba histolytica spread?

amoebic colitis

What is entamoeba histolytica called when it invades bowel mucosa?

abdominal cramping, weight loss, fever, severe watery/bloody diarrhea

heme positive stool

mimic IBD in presentation and endoscopic appearance

entamoeba histolytica symptoms?

RUQ pan, fever, jaundice is rare unless abscess if obstructive

Liver extraintestinal dx presentation?

serologies, stool sample, non-invasive liver imaging

How to dx entamoeba histolytica ?

supportive care with fluid replacement

iodoquinol and metronidazole

Tx of symptomatic entamoeba histolytica ?

within the colon

Where does iodoquinol work?

metronidazole

What is the drug of choice for liver abscess?

iodoquinol or paromomycin

entamoeba histolytica asymptomatic tx?