MCQ Hepatobiliary Liver mass

Normal

• Rupture (with potentially life-threatening intraperitoneal hemorrhage)
• Malignant transformationQ.

Hypervascular and heterogeneous on the arterial phase and become isodense or hypodense on the portal phase as a result of arteriovenous shunting

• Hemangioma
• Second most common is Focal Nodular Hyperplasia

Central scar contains a large artery that branches out into multiple smaller arteries in a spoke-wheel patternQ (on angiography)

• No treatmentQ in asymptomatic patients with typical radiologic features
• Resection in cases of diagnostic uncertainty, for histologic confirmation

Lesions >5 cm

Syndrome of thrombocytopenia and consumptive coagulopathy, in hemangioma

• 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

• Nonsurgical treatment: Aspiration and injection of a sclerosing agent (most frequently ethanol) Q
• Surgical therapy: Fenestration or unroofing the extrahepatic portion of cystQ

Intracystic bleedingQ.

Polycystic Liver Disease

• Laparoscopic unroofingQ for small number of large cysts
• Combination of cyst unroofing + liver resectionQ for reducing liver volume

Hanging, pushing and invasive tumorsQ

Abdominal pain >weight lossQ

Hypercholesterolemia (MC)Q >hypoglycemiaQ, erythrocytosis, hypercalcemia

Elevated above 20 ng/mL in >70% of patients with HCC.

• Protein induced by Vitamin K Absence (PIVKA)
• Glypican-3;
• AFP fractionsQ

• • 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.

Bilirubin, Ascitis, Tumor size, Albumin [@ BATA]

• PACT (Portal vein thrombosis, AFP levels, Child-Pugh stage, Tumor extension)Q
• The CLIP system is applicable to Hepatitis C-related HCC casesQ

• Vascular bruit (25%)Q,
• GI bleed (10%),
• Tumor rupture (2-5%)Q,
• Jaundice due to biliary obstruction (10%)

• 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

Hepatic arteryQ. - hyperdense on the arterial phase

Sorafenib

• Occurs in young adults without underlying cirrhosisQ
• Non-encapsulated but well circumscribed, so high resectability rateQ
• Grows slowly and and has better prognosisQ

• CalcificationQ differentiates FHCC from FNH
• Heterogeneous enhancementQ is also an important imaging finding

• • From breast cancer - hypoechoic (echopoor)Q on ultrasonography.
• • From carcinoma colon and RCC - hyperechoic (echogenic)Q.
• • From mucinous adenocarcinoma of colon are typically calcifiedQ.

• • FHCC doesn’t produce AFPQ
• • Associated with elevated neurotensinQ and Vitamin B12 binding globulin levelsQ

Hepatoblastoma - more common in malesQ.

• Beckwith-Wiedemann syndrome and FAPQ
• • No evidence of association with chronic viral hepatitisQ

Median age of presentation is 18 months, and almost all cases occur before 3 yearsQ.

Serum AFP levels

Speckled with calcificationQ.

• • 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.

• • Factor VIII stainingQ differentiates it from other nonvascular tumors.
• • Liver parenchymal architecture is preservedQ.

Total hepatectomy and liver transplantationQ (disease is diffuse and multifocal).