Benign Liver Tumors Cameron Schlegel PGY-1 3/6/2013
Outline Benign Liver Tumors are, in general. Asymptomatic Diagnosed: imaging Treatment: Do no harm Unless Malignant potential Causing symptoms
Differential Benign Cavernous Hemangioma Focal Nodular Hyperplasia Hepatocellular Adenoma Cystic Tumors Paraganglioma Inflammatory Pseudotumor Peliosis Hepatis Angiomyolipoma/Lipoma Biliary Papillomatosis Caroli Disease Peribiliary Cysts Von Meyenburg Complexes Biliary cystadenomas Malignant Hepatocellular Carcinoma Intrahepatic Cholangiocarcinoma Metastases
Differential Benign Cavernous Hemangioma Focal Nodular Hyperplasia Hepatocellular Adenoma Cystic Tumors Paraganglioma Inflammatory Pseudotumor Peliosis Hepatis Angiomyolipoma/Lipoma Biliary Papillomatosis Caroli Disease Peribiliary Cysts Von Meyenburg Complexes Biliary cystadenomas Malignant Hepatocellular Carcinoma Intrahepatic Cholangiocarcinoma Metastases
Cavernous Hemangioma Presentation: Most common benign liver tumor Female, 40, usually <5cm and solitary Asymptomatic Syndromes: Kasabach-Merritt, Osler-Rendu-Weber, VHL Symptomatic in children, 70% mortality Pathogenesis: Endothelial lining of blood vessels Diagnosis: Imaging CT: peripheral centripital MRI: T1 hypointensity; T2hyperintensity
Focal Nodular Hyperplasia Presentation Second most common benign liver tumor Females, 40s, solitary lesions Not stimulated by hormones Asymptomatic Pathogenesis: Hepatocellular hyperplasia 2/2 vascular malformation High concentration Kupffer cells Well circumscribed, unencapsulated, central fibrous scar Benign hepatocytes in nodules, separated by fibrous septa that originate from central scar Diagnosis: Imaging CT: hypoattenuating on early phase images MRI: arterial enhancement
Hepatocellular Adenoma Presentation Females (90%), 20-40s, solitary (80%) OCP/Androgen use Iron overload B-thalassemia, type 1 or 3 glycogen storage, diabetes mellitus Asymptomatic Intraperitoneal hemorrhage (30-50%) Malignant transformation 10% Pathogenesis Well differentiated hepatocytes lacking bile ducts/portal triads Diagnosis: Imaging CT: hypo- to isoattenuating MR: T1 hyper-isointense; T2 hyper
Imaging Characteristics of Benign Liver Tumors Kane et al. Benign Hepatic Tumors and Iatrogenic Pseudotumors. Radiographics. 2009
Imaging Characteristics of Benign Liver Tumors
Imaging Characteristics of Benign Liver Tumors
Compare/Contrast Tumors Malignant? CT MRI T1 T2 Treatment Cavernous Hemangio ma No Peripheral central, hyperintense on delayed Nothing If symptoms: enucleation or resection FNH No rapid enhancement during arterial phase - Hypointense central scar Nothing If symptoms: resection - Sulfur Colloid Scan HC adenoma Yes hypervascular lesion arterial phase Resection
Compare/Contrast Tumors Malignant? CT MRI T1 T2 Treatment Cavernous Hemangio ma No Peripheral central, hyperintense on delayed Nothing If symptoms: enucleation or resection FNH No rapid enhancement during arterial phase - Hypointense central scar Nothing If symptoms: resection - Sulfur Colloid Scan HC adenoma Yes hypervascular lesion arterial phase Resection
Cystic Tumors Simple Multiple Cystadenomas Echinoccocal
Cystic Tumors Simple cysts: Asymptomatic Pathogenesis: Embryonal development of intrahepatic biliary duct Single layer columnar/cuboidal epitheliuam, straw-colored serous fluid Diagnosis: imaging Treatment: Injection or enucleation if symptomatic
Cystic Tumors Multiple Cysts: Asymptomatic Polycystic liver disease autosomal dominant Hepatic parenchyma and function preserved Pathogenesis: histo same as simple cysts Diagnosis: Imaging Treatment: resection or transplant if symptomatic
Cystic Tumors Cystadenomas Presentation: Benign w malignant potential Slow growing, Pathogenesis Multilocular, single layer cuboidal/columnar epithelium Dx: Imaging Treatment: Resection
Echinococcal/Hydatid Cysts Presentation: Travel SW US, Scotland, Greece, Europe Asymptomatic, +/- fever, abdominal pain Pathogenesis Echinococcus humans intermediary hosts Diagnosis: Imaging Treatment: Albendezole, enucleation Cystic Tumors
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