benign liver tumors...differential benign • cavernous hemangioma • focal nodular hyperplasia •...
TRANSCRIPT
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: peripheralcentripital – 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 Hemangioma
No Peripheral central, hyperintense on delayed
Nothing If symptoms: enucleation or resection
FNH No rapid enhancement during arterial phase - Hypointense central
scar
- Sulfur Colloid Scan
Nothing If symptoms: resection
HC adenoma
Yes hypervascular lesion arterial phase
Resection
Compare/Contrast Tumors Malignant? CT MRI
T1 T2 Treatment
Cavernous Hemangioma
No Peripheral central, hyperintense on delayed
Nothing If symptoms: enucleation or resection
FNH No rapid enhancement during arterial phase - Hypointense central
scar
- Sulfur Colloid Scan
Nothing If symptoms: resection
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
Cystic Tumors Echinococcal/Hydatid Cysts • Presentation:
• Travel SW US, Scotland, Greece, Europe
• Asymptomatic, +/- fever, abdominal pain
• Pathogenesis • Echinococcus – humans
intermediary hosts • Diagnosis: Imaging • Treatment: Albendezole,
enucleation
Questions?