Tumor marker in hepatic adenoma?
Important complications in hepatic adenoma?
- Rupture (with potentially life-threatening intraperitoneal hemorrhage)
- Malignant transformationQ.
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
Most common benign tumor of liver?
- Second most common is Focal Nodular Hyperplasia
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)
Treatment of Focal Nodular hyperplasia?
- No treatmentQ in asymptomatic patients with typical radiologic features
- Resection in cases of diagnostic uncertainty, for histologic confirmation
What is Giant hemangioma?
Lesions >5 cm
What is Kasabach-Merritt syndromeQ?
Syndrome of thrombocytopenia and consumptive coagulopathy, in hemangioma
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
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
MC complication of simple hepatic cyst?
MC extra-renal manifestation of ADPKDQ?
Polycystic Liver Disease
Treatment of polycystic liver disease?
- Laparoscopic unroofingQ for small number of large cysts
- Combination of cyst unroofing + liver resectionQ for reducing liver volume
Gross Morphology of HCC?
Hanging, pushing and invasive tumorsQ
MC symptom of HCC?
Abdominal pain >weight lossQ
Paraneoplastic Syndromes in HCC?
Hypercholesterolemia (MC)Q >hypoglycemiaQ, erythrocytosis, hypercalcemia
Serum AFP level in HCC?
Elevated above 20 ng/mL in >70% of patients with HCC.
Tumor Markers in HCC?
- Protein induced by Vitamin K Absence (PIVKA)
- AFP fractionsQ
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.
Okuda Staging System for HCC ?
Bilirubin, Ascitis, Tumor size, Albumin [@ BATA]
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
Clinical Features of HCC?
- Vascular bruit (25%)Q,
- GI bleed (10%),
- Tumor rupture (2-5%)Q,
- Jaundice due to biliary obstruction (10%)
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
HCC derive its blood supply from?
Hepatic arteryQ. - hyperdense on the arterial phase
Therapy for unresectable HCCQ.
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
FHCC doesn’t produce AFPQ • Associated with elevated neurotensinQ and Vitamin B12 binding globulin levelsQ
Imaging finding in fibrolamellar HCC?
- CalcificationQ differentiates FHCC from FNH
- Heterogeneous enhancementQ is also an important imaging finding
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.
Tumor markers in Fibrolamellar HCC?
- • FHCC doesn’t produce AFPQ
- • Associated with elevated neurotensinQ and Vitamin B12 binding globulin levelsQ
MC primary hepatic tumor of childhood?
Hepatoblastoma - more common in malesQ.
Associations with Hepatoblastoma?
- Beckwith-Wiedemann syndrome and FAPQ
- • No evidence of association with chronic viral hepatitisQ
Age of presentation of hepatoblastoma?
Median age of presentation is 18 months, and almost all cases occur before 3 yearsQ.
Marker for therapeutic response in HepatoblastomaQ?
Serum AFP levels
CT scan finding in hepatoblastoma?
Speckled with calcificationQ.
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.
Pathology of Epitheloid Hemangioendothelioma?
- • Factor VIII stainingQ differentiates it from other nonvascular tumors.
- • Liver parenchymal architecture is preservedQ.
Treatment of Epitheloid Hemangioendothelioma?
Total hepatectomy and liver transplantationQ (disease is diffuse and multifocal).