MCQ Hepatobiliary Liver mass

  1. Tumor marker in hepatic adenoma?
  2. Important complications in hepatic adenoma?
    • Rupture (with potentially life-threatening intraperitoneal hemorrhage)
    • Malignant transformationQ.
  3. CT Findings in Hepatic Adenoma?
    Hypervascular and heterogeneous on the arterial phase and become isodense or hypodense on the portal phase as a result of arteriovenous shunting
  4. Most common benign tumor of liver?
    • Hemangioma
    • Second most common is Focal Nodular Hyperplasia
  5. Radiological finding of Focal Nodular Hyperplasia?
    Central scar contains a large artery that branches out into multiple smaller arteries in a spoke-wheel patternQ (on angiography)
  6. Treatment of Focal Nodular hyperplasia?
    • No treatmentQ in asymptomatic patients with typical radiologic features
    • Resection in cases of diagnostic uncertainty, for histologic confirmation
  7. What is Giant hemangioma?
    Lesions >5 cm
  8. What is Kasabach-Merritt syndromeQ?
    Syndrome of thrombocytopenia and consumptive coagulopathy, in hemangioma
  9. Treatment of liver hemangioma and adenoma?
    • Observation for asymptomatic casesQ, Enucleation with inflow control is TOC for symptomatic casesQ. No malignant potential
    • Adenoma - malignant potential and resection is the treatment of choice
  10. Treatment of simple hepatic cyst?
    • Nonsurgical treatment: Aspiration and injection of a sclerosing agent (most frequently ethanol) Q
    • Surgical therapy: Fenestration or unroofing the extrahepatic portion of cystQ
  11. MC complication of simple hepatic cyst?
    Intracystic bleedingQ.
  12. MC extra-renal manifestation of ADPKDQ?
    Polycystic Liver Disease
  13. Treatment of polycystic liver disease?
    • Laparoscopic unroofingQ for small number of large cysts
    • Combination of cyst unroofing + liver resectionQ for reducing liver volume
  14. Gross Morphology of HCC?
    Hanging, pushing and invasive tumorsQ
  15. MC symptom of HCC?
    Abdominal pain >weight lossQ
  16. Paraneoplastic Syndromes in HCC?
    Hypercholesterolemia (MC)Q >hypoglycemiaQ, erythrocytosis, hypercalcemia
  17. Serum AFP level in HCC?
    Elevated above 20 ng/mL in >70% of patients with HCC.
  18. Tumor Markers in HCC?
    • Protein induced by Vitamin K Absence (PIVKA)
    • Glypican-3;
    • AFP fractionsQ
  19. Non-invasive Diagnostic Criteria for HCC?
    • • Focal lesion 1-2 cm: Two imaging techniques with arterial hypervascularization and venous washoutQ.
    • • Focal lesion >2cm: One imaging technique with arterial hypervascularization and venous washoutQ.
  20. Okuda Staging System for HCC ?
    Bilirubin, Ascitis, Tumor size, Albumin [@ BATA]
  21. Cancer of the Liver Italian Program (CLIP) components?
    • PACT (Portal vein thrombosis, AFP levels, Child-Pugh stage, Tumor extension)Q
    • The CLIP system is applicable to Hepatitis C-related HCC casesQ
  22. Clinical Features of HCC?
    • Vascular bruit (25%)Q,
    • GI bleed (10%),
    • Tumor rupture (2-5%)Q,
    • Jaundice due to biliary obstruction (10%)
  23. Milan criteria (Mazzafero)?
    • A patient is selected for transplantation when he/she has
    • • One nodule <5 cm
    • • Two or three nodules all <3 cm
    • • No gross vascular invasion or extrahepatic spread
  24. HCC derive its blood supply from?
    Hepatic arteryQ. - hyperdense on the arterial phase
  25. Therapy for unresectable HCCQ.
  26. Features of Fibrolamellar HCC?
    • Occurs in young adults without underlying cirrhosisQ
    • Non-encapsulated but well circumscribed, so high resectability rateQ
    • Grows slowly and and has better prognosisQ
  27. FHCC doesn’t produce AFPQ • Associated with elevated neurotensinQ and Vitamin B12 binding globulin levelsQ
  28. Imaging finding in fibrolamellar HCC?
    • CalcificationQ differentiates FHCC from FNH
    • Heterogeneous enhancementQ is also an important imaging finding
  29. Primary based on characteristics of Hepatic Metastases?
    • • From breast cancer - hypoechoic (echopoor)Q on ultrasonography.
    • • From carcinoma colon and RCC - hyperechoic (echogenic)Q.
    • • From mucinous adenocarcinoma of colon are typically calcifiedQ.
  30. Tumor markers in Fibrolamellar HCC?
    • • FHCC doesn’t produce AFPQ
    • • Associated with elevated neurotensinQ and Vitamin B12 binding globulin levelsQ
  31. MC primary hepatic tumor of childhood?
    Hepatoblastoma - more common in malesQ.
  32. Associations with Hepatoblastoma?
    • Beckwith-Wiedemann syndrome and FAPQ
    • • No evidence of association with chronic viral hepatitisQ
  33. Age of presentation of hepatoblastoma?
    Median age of presentation is 18 months, and almost all cases occur before 3 yearsQ.
  34. Marker for therapeutic response in HepatoblastomaQ?
    Serum AFP levels
  35. CT scan finding in hepatoblastoma?
    Speckled with calcificationQ.
  36. Treatment of hepatoblastoma?
    • • For unresectable tumors, the initial surgical procedure should include a diagnostic biopsy and placement of a vascular access device for chemotherapyQ. • A second laparotomy is performed after four cycles of chemotherapy, if imaging studies show a good response, and the tumor appears resectable.
    • • Neoadjuvant chemotherapy (cisplatin, 5-fluorouracil, vincristine) followed by resectionQ
    • • 50% of patients with pulmonary metastases can be cured with resectionQ of the hepatic tumor and chemotherapy or resection of the pulmonary metastasesQ.
  37. Pathology of Epitheloid Hemangioendothelioma?
    • • Factor VIII stainingQ differentiates it from other nonvascular tumors.
    • • Liver parenchymal architecture is preservedQ.
  38. Treatment of Epitheloid Hemangioendothelioma?
    Total hepatectomy and liver transplantationQ (disease is diffuse and multifocal).
Card Set
MCQ Hepatobiliary Liver mass
LIver mass