Liver tumors basic(学习资料).ppt

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1、Liver Tumors,Ayman AbdoMD,AmBIM,FRCPC,Objective,Identify the most important features of common benign liver tumorsKnow the risk factors,diagnosis,and management of hepatocellular carcinoma,Classification,HemangiomaFocal nodular hyperplasiaAdenomaLiver cysts,Primary liver cancersHepatocellular carcin

2、omaFibrolamellar carcinomaHepatoblastoma2.Metastases,Benign,Malignant,Benign Liver Lesions,HemangiomaFocal nodular hyperplasiaAdenomaCysts,HemangiomaClinical Features,The commonest liver tumor5%of autopsiesUsually single smallWell demarcated capsuleUsually asymptomatic,HemangiomaDiagnosis and Manage

3、ment,DiagnosisUS:echogenic spot,well demarcatedCT:venous enhancement from periphery to centerMRI:high intensity areaNo need for FNATreatmentNo need for treatment,CT/Hemangioma,Focal Nodular Hyperplasia(FNH)Clinical Features,Benign nodule formation of normal liver tissueCentral stellate scarMore comm

4、on in young and middle age womenNo relation with sex hormonesUsually asymptomaticMay cause minimal pain,Focal Nodular Hyperplasia(FNH)Diagnosis and Management,Diagnosis:US:Nodule with varying echogenicityCT:Hypervascular mass with central scarMRI:iso or hypo intense FNA:Normal hepatocytes and Kupffe

5、r cells with central core.Treatment:No treatment necessaryPregnancy and hormones OK,CT/FNH,Hepatic AdenomaClinical features,Benign neoplasm composed of normal hepatocytes no portal tract,central veins,or bile ductsMore common in womenAssociated with contraceptive hormonesUsually asymptomatic but may

6、 have RUQ painMat presents with rupture,hemorrhage,or malignant transformation(very rare),Hepatic AdenomaDiagnosis and Management,DXUS:filling defectCT:Diffuse arterial enhancementMRI:hypo or hyper intense lesionFNA:may be neededTxStop hormonesObserve every 6m for 2 yIf no regression then surgical e

7、xcision,Adenoma,Liver Cysts,May be single or multipleMay be part of polycystic kidney diseasePatients often asymptomaticNo specific management requiredHydated cyst,Malignant Liver Lesions,Malignant Liver Tumors,Hepatocellular carcinoma(HCC)Fibro-lamellar carcinoma of the liverHepatoblastomaIntrahepa

8、tic cholangiocarcinomaOthers,HCC:Incidence,The most common primary liver cancerThe most common tumor in Saudi menIncreasing in US and all the world,HCC:Risk Factors,The most important risk factor is cirrhosis from any cause:Hepatitis B(integrates in DNA)Hepatitis CAlcoholAflatoxinOther,HCC:Clinical

9、Features,Wt loss and RUQ pain(most common)AsymptomaticWorsening of pre-existing chronic liver disAcute liver failureO/E:Signs of cirrhosisHard enlarged RUQ massLiver bruit(rare),HCC:Metastases,Rest of the liverPortal veinLymph nodesLungBoneBrain,HCC:Systemic Features,HypercalcemiaHypoglycemiaHyperli

10、pidemiaHyperthyroidism,HCC:labs,Labs of liver cirrhosisAFP(Alfa feto protein)Is an HCC tumor markerValues more than 100ng/ml are highly suggestive of HCCElevation seen in more than 70%of pt,HCC:Diagnosis,Clinical presentationElevated AFPUSTriphasic CT scan:very early arterial perfusionMRIBiopsy,US:H

11、CC,CT:Venous Phase,CT:Arterial Phase,HCC:Prognosis,Tumor sizeExtrahepatic spreadUnderlying liver diseasePt performance status,HCC:Liver Transplantation,Best available treatmentRemoves tumor and liverOnly if single tumor less than 5cm or less than 3 tumors less than 3 cm eachRecurrence rate is lowNot

12、 widely available,HCC:Resection,Feasible for small tumors with preserved liver function(no jaundice or portal HTN)Recurrence rate is high,HCC:Local Ablation,For non resectable ptFor pt with advanced liver cirrhosisAlcohol injectionRadiofrequency ablationTemporary measure only,Radio Frequency Ablatio

13、n,Ethanol Injection,HCC:Chemoembolization,Inject chemotherapy selectively in hepatic arteryThen inject an embolic agentOnly in pt with early cirrhosisNo role for systemic chemotherapy,Chemoembolization,Fibro-Lamellar Carcinoma,Presents in young pt(5-35)Not related to cirrhosisAFP is normalCT shows t

14、ypical stellate scar with radial septa showing persistant enhancement,Secondary Liver Metastases,The most common site for blood born metastasesCommon primaries:colon,breast,lung,stomach,pancreases,and melanomaMild cholestatic picture(ALP,LDH)with preserved liver functionDx imaging or FNATreatment depends on the primary cancerIn some cases resection or chemoembolization is possible,Summary,HemangiomaFocal nodular hyperplasiaAdenomaLiver cysts,Primary liver cancersHepatocellular carcinomaFibrolamellar carcinomaHepatoblastoma2.Metastases,Benign,Malignant,