Medical Archive

Cystic liver lesions

Simple cyst

• ??? ??? monitoring?
• Percutaneous aspiration?? ?? ?
• Echinococcal cyst? ???? r/o???

(Biliary) Cystadenoma

• Malig.?? .15%? malig. Change ??.
• Inflow???? ?? ? ?? (Enucleation)

(Biliary) Cystadenocarcinoma

• Enucleation? ?? complete excision ???? (????? ??)

Solid liver lesions

Hemangioma

• m/c. ?? ??? ????!
• Triphasic CT: ??? ?? ??? ???? – centripetal enhancement
• Ultrasound: ???? ??? ?? ???.
• Rupture risk
  • Spontaneous rupture is very rare.
  • Aspiration, needle Bx? ?? ??

Focal nodular hyperplasia, FNH

• Epidemiology and pathophysiology
  • Benign, ?? ??, Conservative
  • Caused by hyperperfusion from anomalous arteries.
  • Complications such as rupture or malignant transformation do not generally occur.
• Imaging
  • Well-circumscribed, solitary, and <5 cm in size
  • Have a central, stellate scar
• Histology
  • Lobulated with a central, gray-white, depressed stellate scar from which fibrous septae radiate to the periphery.

Hepatocellular adenoma, HCA

• Epidemiology
  • Primarily young women on oral contraception
  • 15%? malig.?? ? ?? ??? ????
• Clinical manifestations
  • Often asymptomatic (incidentally found)
  • Episodic RUQ pain (? ? ???)
• Imaging
  • Solitary, solid lesion in right lobe of liver – multiple lesions occasionally occur.
  • CT?? ??? ????, ????? ?????
  • Peripheral enhancement, rapid clearance of contrast, and no central scar
  • ??? ??? hemoperitoneum
• Histology
  • Irregular, tan-colored group of nodules comprised of large plates of adenoma cells with an absence of normal hepatic architecture (no portal structures or bile ducts)
  • ??? blood supply, 1/3?? spontaneous bleeding
• Management
  • Discontinue oral contraceptives
  • Follow-up imaging with CT or MRI at 6- to 12-month intervals for 2 years
  • If the tumor is > 5 cm ? surgical resection due to increased risk of rupture, bleeding, or malignant transformation 
• Complications
  • Malignant transformation (~10%)
  • Rupture & hemorrhagic shock
    • Suspected in the setting of sudden-onset, severe. RUQ pain and signs of hemorrhagic shock.