Benign Liver Tumors. Cameron Schlegel PGY-1 3/6/2013

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(1)

Benign Liver Tumors

Cameron Schlegel

PGY-1

(2)

Outline

Benign Liver Tumors are, in general….

Asymptomatic

Diagnosed: imaging

Treatment: Do no harm

Unless…

Malignant potential

Causing symptoms

(3)

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

(4)

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

(5)

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;

(6)

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

(7)

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

(8)

Imaging Characteristics of Benign Liver

Tumors

(9)

Imaging Characteristics of Benign Liver

Tumors

(10)

Imaging Characteristics of Benign Liver

Tumors

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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

- Sulfur Colloid Scan

Nothing

If symptoms: resection

HC

(12)

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

- Sulfur Colloid Scan

Nothing

If symptoms: resection

HC

(13)

Cystic Tumors

Simple

Multiple

Cystadenomas

Echinoccocal

(14)

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

(15)

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

(16)

Cystic Tumors

Cystadenomas

Presentation:

Benign w malignant

potential

Slow growing,

Pathogenesis

Multilocular, single layer

cuboidal/columnar

epithelium

Dx: Imaging

(17)

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

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Figure

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References

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