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45 Cards in this Set

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What are the types of liver lesions?
Primary
- 3 Benign
- 2 Malignant

Metastatic (1)

3:2:1
What are the types of Benign Primary liver lesions?
- Hemangioma
- Focal Nodular Hyperplasia (FNH)
- Adenoma
What are the types of Malignant Primary liver lesions?
- Hepatocellular Carcinoma (HCC)
- Cholangiocarcinoma (CCA)
If a patient tells you they are on oral contraceptives, what kind of liver lesion are you worried about?
Hepatic Adenoma
If a patient tells you they have a history of extra-hepatic malignancies, what kind of liver lesion are you worried about?
Metastatic liver lesion
If a patient tells you they have underlying liver disease, what kind of liver lesion are you worried about?
Hepatocellular Carcinoma (HCC)
If a patient tells you they have a history of primary sclerosing cholangitis (PSC), what kind of liver lesion are you worried about?
Cholangiocarcinoma (CCA)
In a non-cirrhotic liver, what are the most common causes of liver lesions?
- 45% metastasize from GI tract
- 24% metastasize from lung
- 8% metastasize from urogenital tract
- 8% metastasize from breast

ONLY 3% originate in liver
- 45% metastasize from GI tract
- 24% metastasize from lung
- 8% metastasize from urogenital tract
- 8% metastasize from breast

ONLY 3% originate in liver
In a cirrhotic liver, what are the most common causes of liver lesions?
77% originate in liver
- 10% metastasize from GI
- 7% metastasize from lung
- 3% metastasize from urogenital tract
77% originate in liver
- 10% metastasize from GI
- 7% metastasize from lung
- 3% metastasize from urogenital tract
How does the presence of cirrhosis in the liver help you predict what type of cancer is in the liver?
- Non-cirrhotic: most likely to be a metastases from elsewhere (only 3% originate in liver)

- Cirrhotic: most likely to be a primary lesion (77% originate in liver)
- Non-cirrhotic: most likely to be a metastases from elsewhere (only 3% originate in liver)

- Cirrhotic: most likely to be a primary lesion (77% originate in liver)
What is the most common benign liver lesion?
Hemangioma (found in 1% of all autopsies)
Will you find cirrhosis with Hemangiomas?
No - they are primarily found in non-cirrhotic livers
What are Hemangiomas? Size?
- Congenital vascular malformations (blood-filled cavities lined by endothelium)
- Range from 1-20 cm (>10 cm called a "giant hemangioma")
When are most Hemangiomas diagnosed?
- Majority during 3rd-5th decade
Are Hemangiomas unitary lesions or do they present with multiple lesions?
- Unitary in 70% of cases
- Multiple in 30% of cases
What is the risk for malignancy with a Hemangioma?
NO malignant potential!
What symptoms are caused by Hemangiomas?
Mostly asymptomatic unless they are at the surface of the liver and stretch the capsule
What kind of liver lesion is this?
What kind of liver lesion is this?
Focal Nodular Hyperplasia (FNH) - benign
Focal Nodular Hyperplasia (FNH) - benign
What is the second most common benign liver lesion?
Focal Nodular Hyperplasia (FNH)
Focal Nodular Hyperplasia (FNH)
Will you find cirrhosis in patients with Focal Nodular Hyperplasia (FNH)?
No - FNH is found in non-cirrhotic livers
No - FNH is found in non-cirrhotic livers
What causes Focal Nodular Hyperplasia (FNH)?
- Reaction to intra-hepatic anomolous artery leading to hyper-perfusion
- Hyper-perfused area enlarges until it outgrows it's blood supply
- Reaction to intra-hepatic anomolous artery leading to hyper-perfusion
- Hyper-perfused area enlarges until it outgrows it's blood supply
Who is most commonly affected by Focal Nodular Hyperplasia (FNH)?
- Women
- Ages 20-50
- Women
- Ages 20-50
What is the size of Focal Nodular Hyperplasia (FNH)?
Majority < 5 cm (rarely exceeds 10 cm)
Majority < 5 cm (rarely exceeds 10 cm)
Does Focal Nodular Hyperplasia (FNH) present as a unitary lesion or does it present with multiple lesions?
- Unitary in 80-90% of cases
- Multiple in 10-20%
- Unitary in 80-90% of cases
- Multiple in 10-20%
What risk for malignancy is there with Focal Nodular Hyperplasia (FNH)?
NO malignant potential
NO malignant potential
What is the third most common benign liver lesion?
Hepatic Adenoma
Is there cirrhosis in livers with Hepatic Adenoma?
No - found in non-cirrhotic livers
What is a Hepatic Adenoma?
Benign proliferation of hepatocytes
Who is primarily affected by Hepatic Adenoma?
- Majority in women of child-bearing age
- Associated with contraceptive use
- Glycogen storage disease
- Diabetes Mellitus
What is there a risk for in Hepatic Adenoma, unlike in Hemangiomas and Focal Nodular Hyperplasia (FNH)?
- Hemorrhage
- Malignant transformation
What type of liver lesion is associated with pregnancy? What can happen?
Hepatic Adenoma - growth and rupture can occur during pregnancy
How do you treat Hepatic Adenoma?
- Contraceptives should be discontinued (associated w/ contraceptive use)
- Avoid pregnancy (this could lead to growth and rupture of adenoma)
- Surgical resection to avoid risk of cancer and tumor rupture
Where is there higher incidence of Hepatocellular Carcinoma?
- China
- Parts of Africa
- SE Asia
How has the incidence and 5-year survival of Hepatocellular Carcinoma changed in the last 40 years?
- Cases of HCC is increasing
- 5-year survival is increasing
- Cases of HCC is increasing
- 5-year survival is increasing
What ethnicity is HBV most frequent in? HCV?
- HBV most frequent in Asians
- HCV most frequent in Non-Asians
What are the most common viral causes of Hepatocellular Carcinoma?
- HCV - 47% of cases
- HBV - 15% of cases
What happens to the blood flow in Hepatocellular Carcinoma?
- Normal: blood flow is 70% from portal vein and 30% hepatic artery blood flow

- HCC: switches so that 95% of blood flow supplied by arterial blood and only 5% from portal vein
- Normal: blood flow is 70% from portal vein and 30% hepatic artery blood flow

- HCC: switches so that 95% of blood flow supplied by arterial blood and only 5% from portal vein
What happens in Hepatocellular Carcinoma when a radiologist infuses IV contract?
- First 60 seconds is the arterial phase (where contrast goes first) - lights up the cancer
- Arterial blood flow disappears and venous blood flow goes away and now it is hard to see the lesion
Which protein is elevated in 60-70% of patients with Hepatocellular Carcinoma? How much?
Alpha Fetoprotein (AFP) - > 200 ng/mL
Where is Alpha Fetoprotein (AFP) produced? When is it elevated?
- Produced by fetal liver and placenta
- Elevated in 60-70% of patients w/ HCC

- Can be elevated w/ hepatic inflammation or cirrhosis in the absence of HCC
What diagnostic features are consistent with a diagnosis of Hepatocellular Carcinoma?
- Alpha Fetoprotein (AFP) > 200 ng/mL
- Liver lesion on imaging

Don't need to biopsy!!
How do you prevent Hepatocellular Carcinoma?
- HBV vaccination
- Treatment of viral hepatitis
- Coffee?
What are the most common primary sites that metastasize to the liver?
- GI: colon, pancreas, esophageal, gastric
- Lung
- Urogenital
- Breast
- Melanoma
- GI: colon, pancreas, esophageal, gastric
- Lung
- Urogenital
- Breast
- Melanoma
Why are pseudocysts not true cysts?
- Lack of epithelial lining (fibrous and granulation tissue)
- No malignant potential
How do you classify pancreatic cysts?
Non-neoplastic, benign:
- True cysts
- Retention cysts
- Mucinous, non-neoplastic cysts
- Lymphoepithelial cysts