Benign liver neoplasms

General Considerations

-Cavernous hemangiomas, focal nodular hyperplasia, hepatic adenomas are the most common benign tumors of the liver.

-Cavernous hemangioma: The most common benign neoplasm of the liver; more than 80% occur in women

-Focal nodular hyperplasia: second most common after cavernous hemangiomas; occurs at all ages

-Hepatocellular adenoma occurs most commonly in women aged 20-40; usually caused by oral contraceptives

Symptoms & Signs

Most benign neoplasms are aymptomatic; Palpable abdominal mass, bleeding, nausea, vomiting, early satiety

Diagnosis

Cavernous hemangioma: Ultrasound, CT, MRI

FNH: lesions are identified by the presence of a central scar; CT, Ultrasound shows

Spoke-wheeling

Hepatic adenoma: Ultrasound show hyperechoic mass; Hepatic angiography is the most valuable diagnostic tool.

Treatment

Cavernous hemangioma: if symptomatic, surgical resection

Focal nodular hyperplasia & OCPs: no need to discontinue OCPs; annual ultrasonography for 2-3 years; if symptomatic, resection

Hepatocellular adenoma: resection, percutaneous radiofrequency ablation

-Resection is advised in all patients in whom the tumor causes symptoms or measures > 5 cm in diameter, even in the absence of symptoms

-Resection is also recommended even for an adenoma measuring < 5 cm in diameter if a beta-catenin gene mutation is present in a biopsy sample

General Considerations

-Hepatic abscesses may be bacterial, parasitic, or fungal in origin.

-the most common identifiable cause of hepatic abscess is acute cholangitis resulting from biliary obstruction due to a stone, stricture or neoplasm

-Pyogenic liver abscesses are the most common liver abscesses seen in the United States.

-Abscesses are most commonly single, but more than one may be present.

-The right lobe is usually involved.

Causes: suppurative process, infection from appendicitis, diverticulitis, bacterial endocarditis, renal infection, lung infection, infected indwelling catheters,

Symptoms & Signs

Fatigue,fever, right upper quadrant pain, chills, jaundice, weight loss, elevated hemidiaphragm

Diagnosis

Labs: Leukocytosis with a left shift, positive blood cultures, elevated AP level  

Imaging: Chest radiographs, Ultrasonography, CT, or MRI of the liver

Hepatic candidiasis: CT liver shows multiple ‘bulls-eyes’

Treatment

Bacterial abscess: Empiric antibiotic therapy should cover gram-negative and anaerobic organisms

Fungal abscess: Amphotericin B, Fluconazole

Amebiasis: Metronidazole or tinidazole

Surgery: percutaneous drainage, open debridement, lobectomy

Prognosis

-With drainage and antibiotics, the cure rate is about 90%.

-The overall mortality rate of 15%

-The mortality rate is about 40% in patients with malignant disease.

Fungal abscesses are associated with mortality rates of up to 50%

1. What is the most common presenting sign of liver abscess? Fever
2. What is the single most reliable laboratory finding in patients with liver abscess? Elevated serum alkaline phosphatase
3. What is the most useful diagnostic aid in evaluating liver abscess? Ultrasound liver