Unit 6- Malignant Hepatic Masses ~ Elie

Primary malignant liver tumors are:

Rare

What is the most common malignant hepatic neoplasm?

HCC or Hepatoma

What are the clinical signs of liver cancer?

• Nausea & vomiting

• Fatigue

• Weight loss

• Hepatomegaly

• Portal HTN & Splenomegaly are common

What is HCC?

Hepatocellular Carcinoma

In HCC, what precedes 80% percent of cases?

Cirrhosis

In HCC, what precedes 20% of cases?

Hepatitis, Parasites, and carcinogenic exposure

What are the sonographic signs of HCC?

• Focal

• Hypoechoic, hyperechoic or isoechoic with thin hypoechoic halo

• Multi-nodular or diffuse

• Hepatomegaly

• Biliary obstruction

• Portal hypertension

• Ascites

• Budd-Chiari syndrome

• Disturbed flow patterns

What is the treatment for a Hepatoma?

• Resected if one lobe

• Chemotherapy

• Prognosis is poor

What is the most common malignant tumor of the liver?

Metastatic Disease

Where does metastatic disease spread from?

• GI tract (Colon)

• Breast

• Lung

• Pancreas

Metastatic disease spreads via:

• Blood

• Lymph

What are the sonographic features of Metastatic Disease?

-Hepatomegaly

-Solitary or Multiple masses

-Hyperechoic (Colon)

-Hypoechoic

-Isoechoic

-Diffuse

-Ascites

-Adenopathy

What are the types of masses associated with metastatic disease?

• Cystic

• Target

• Bull’s Eye

In metastatic disease there is:

No invasion of portal or hepatic vessels

The majority of lesions with “halo” are either:

HCC or metastases

To determine what type of mass is being identified it requires:

Further investigation to determine the status

What are the 4 types of Lymphoma’s

• Hodgkin’s

• Non-Hodgkin’s

• Burkitt’s

• Leukemia

What is the echogenicity of a lymphoma?

Hypoechoic

What are the most common malignancies in pediatric patients?

• Neuroblastomas

• Wilm’s Tumor

• Leukemia

An Angiosarcoma is also known as?

Kupffer Cell Sarcoma

What is an angiosarcoma?

• Rare

• Dilated sinusoids with necrotic hepatocytes leave vascular channels lined with malignant cells

• Toxin exposure link with inhalation

What does an angiosarcoma look like on ultrasound?

• Hyper and hypoechoic areas

• Hepatosplenomegaly

• Ascites

What are the Malignant Hepatic Masses?

• Hepatocellular Carcinoma

• Hepatoma

• Metastatic Disease

• Hepatic Adenoma with Halo

• Lymphoma

• Angiosarcoma