Liver Tumors

 

 

  • Classification of liver tumors
  •                  Benign tumors:
  • – Hepatic hemangioma
  • – Hepatic adenoma
  • – Tumor-like nodular hepatic lesions
  •                     • Focal nodular hyperplasia (FNH)
  •                     • Nodular regenerative hyperplasia (NRH)
  •                     • Macroregenerative nodule
  •                     • Inflammatory pseudotumor

 

  •                Hepatic cysts:
  • – Fibrocystic disease of the liver
  • – Cystadenoma
  • – Cystadenocarcinoma
  • – Hydatid cyst
  • – Caroli’s disease
  • – Other hepatic cysts
  •             • Simple cyst
  •             • Polycystic liver disease
  •                            ♦  Autosomal dominant Polycystic liver disease
  •                            ♦ Autosomal recessive  Polycystic liver disease

 

  • FOCAL NODULAR HYPERPLASIA (FNH)
  • – Circumscribed, usually solitary lesion composed of nodules of benign hyperplastic hepatocytes surrounding a central stellate-scar
  • – Commonly associated with hepatic hemangioma (20%)
  • – No role of OCP in its development, but may accentuate the vascular abnormalities in FNH
  • – Usually asymptomatic, but may produce mild pain
  •                     Pathology:
  • – Firm, coarsely nodular mass with dense central stellate scar and radiating fibrous septa that divide the lesion into lobules
  • – The lesion usually occupies a sub-capsular position and may be pedunculated
  • Investigation:
  •        MRI:
  • • Iso-hyperintense lesion
  • • Rarely hypointense
  • USG/CT:
  • •Central scar may be detected

 

 

  •                    Treatment:
    • – If asymptomatic: left alone
    • – If complicated:
    •          • Surgical resection
    •          • RFA
    •          • Discontinue OCP
    • Periodic USG: if diagnosis not confirmed

     

                     NODULAR REGENERATIVE HYPERPLASIA (NRH)

    • – Associated with RA, Felty’s syndrome
    • – Usually diffuse, may be focal
    • – It may resemble cirrhosis grossly
    • – Nodules are less well defined
    • – Parenchyma softer than cirrhosis
    • – Fibrous septa are lacking
    • – Typically present with portal HTN

     

                                         

                                          MACROREGENERATIVE  NODULE

    • – Occurs in advanced cirrhosis, after massive hepatic necrosis
    • – Pre-malignant in presence of cirrhosis
    • – May be mistaken as hepatic tumor during imaging

     

                               INFLAMMATORY PSEUDOTUMOR                  

    • – Due to focal infection
    • – May be mistaken for tumor
    • – Occur particularly in young man

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