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Liver Neoplasm

Tumors of the liver include benign tumors such as hepatic adenomas, hemangiomas and focal nodular hyperplasia and malignant neoplasms such as hepatocellular carcinoma, cholangiocarcinoma, hemangioblastoma, angiosarcoma, hemangioendothelioma and mesenchymal tumors.


Presentation

  • HCC presents a variable appearance at CT and MRI.[scielo.br]
  • How do liver abscesses present? Multiple abscesses tend to present more acutely and single ones more indolently. Liver symptoms: Right upper quadrant pain, tenderness, hepatomegaly, possible palpable mass.[brainscape.com]
  • The most common presentation is an asymptomatic mass. Patients may also present with abdominal pain, nausea, vomiting, weight loss, and/or fever.[cancertherapyadvisor.com]
  • Typically presenting with mass effect or incidentally on imaging, MCN-L is considered a premalignant transformation, requiring resection.[academic.oup.com]
  • When results of both studies were normal, hepatic neoplasm was present in 4% (one of 23 patients). The likelihood of hepatic neoplasm in the presence of a positive scan and elevated SAP level was 92% (in 11 of 12).[jamanetwork.com]
Hepatomegaly
  • ALP isoenzyme test (Medical Encyclopedia) Ascites (Medical Encyclopedia) Diet - liver disease (Medical Encyclopedia) Hepatic encephalopathy (Medical Encyclopedia) Hepatomegaly (Medical Encyclopedia) Liver disease (Medical Encyclopedia) Liver scan (Medical[icdlist.com]
  • Most are asymptomatic, but some cause hepatomegaly, right upper quadrant discomfort, or intraperitoneal hemorrhage. Most are detected incidentally on ultrasound or other scans (in Imaging Tests of the Liver and Gallbladder ).[msdmanuals.com]
  • MRI results are inconclusive For confirmed HCC Chest CT – evaluate for extrahepatic metastases Bone scan – when skeletal symptoms present Differential Diagnosis Abdominal pain Acute cholecystitis Acute pancreatitis Infectious diarrhea Parasitic Viral Hepatomegaly[arupconsult.com]
Hepatic Mass
  • Kinnard MF, Alavi A, Rubin RA, Lichtenstein GR: Nuclear imaging of solid hepatic masses . Semin Roentgenol 1995, 30 :375–395. PubMed CrossRef Google Scholar 62. Ault GT, Wren SM, Ralls PW, et al. : Selective management of hepatic adenomas .[link.springer.com]
  • In addition, if there is a need to definitively characterize a hepatic mass, MRI is generally more sensitive and specific, with no associated radiation dose. [5] References [ edit ] Ariff, B; Lloyd, CR; Khan, S; Shariff, M; Thillainayagam, AV; Bansi,[en.wikipedia.org]
  • Preoperative imaging studies are the key to diagnosis in the evaluation of cystic hepatic mass, which differential diagnosis includes simple cysts, echinococcal cysts, liver abscesses, cystic degeneration of a liver neoplasm and liver metastases (5).[scielo.isciii.es]
  • mass CEA, CA 19-9, liver markers (below) Liver tumor markers may be useful in patients with risk factors; however, further studies are needed to confirm role AFP AFP-L3 – more specific than AFP Des-gamma-carboxy-prothrombin (DCP) – more specific than[arupconsult.com]
  • The lack of enhancement is useful in differentiating these postprocedure areas from solid hepatic mass lesions.[pubs.rsna.org]
Hepatic Friction Rub
  • Occasionally, a hepatic friction rub or bruit develops. Occasionally, systemic metabolic complications, including hypoglycemia, erythrocytosis, hypercalcemia, and hyperlipidemia, occur. These complications may manifest clinically.[merckmanuals.com]
Night Sweats
  • Night sweats. Nausea and vomiting. Anorexia and weight loss. How are liver abscesses treated? US/CT guided drainage of the abscess abx. A third generation cephalosporin (ceftriaxone) an anti-amoebic (metronidazole)[brainscape.com]

Workup

  • Workup [ edit ] Upon discovery of a liver tumor, the main issue in the workup is to determine whether the tumor is benign or malignant. Many imaging modalities are used to aid in the diagnosis of malignant liver tumors.[en.wikipedia.org]
  • The combination of Hep Par 1 and MOC-31 will allow for the diagnosis of hepatocellular carcinoma in most cases and will guide the selection of immunohistochemical markers for further workup.[archivesofpathology.org]
Hepatocellular Carcinoma
  • We therefore developed a quantitative immunohistochemical assay and monitored epoxide hydrolase expression in hepatocellular carcinomas (HCC, n 20), cholangio-cellular carcinomas (CCC, n 2) and liver metastases (n 57) of tumours of various origins, and[ncbi.nlm.nih.gov]
  • KEYWORDS: hepatocellular carcinoma, alpha-fetoprotein, diagnosis, hepatitis virus B[ncbi.nlm.nih.gov]
  • Tumors of the liver include benign tumors such as hepatic adenomas, hemangiomas and focal nodular hyperplasia and malignant neoplasms such as hepatocellular carcinoma, cholangiocarcinoma, hemangioblastoma, angiosarcoma, hemangioendothelioma and mesenchymal[symptoma.com]
  • Expert consensus of the Standardized diagnosis and treatment for Hepatocellular carcinoma. J Clin Hepatol. 2009; 12 (5) 13. Zhang X, Zhou L, Chen B, Hu S, Wachtel MS, Frezza EE.[hepatmon.com]
  • Aflatoxin B1 acts synergistically with hepatitis B virus in causing hepatocellular carcinoma.[scienceopen.com]

Treatment

  • Using CADLN, a radiologist will be able to compare computer generated volumetric data in serial imaging of the patients over time, that eventually will enable assessing progression or regression of neoplasm growth and help in treatment planning.[ncbi.nlm.nih.gov]
  • In a non cirrhotic liver tumour resection is the treatment of choice, producing similar survival rates to transplantation. Image-guided tumour ablation is now a standard treatment option for patients with early-stage HCC.[brainscape.com]
  • Radiation therapy does not have an established role in the primary treatment of hepatoblastoma or hepatocellular carcinoma but is sometimes used in palliative situations.[cancertherapyadvisor.com]
  • Optimal treatment of hepatic abscess. Am Surg. 2008; 74 (2): 178-82[ PubMed ] 28. de Baere T, Risse O, Kuoch V, Dromain C, Sengel C, Smayra T, et al. Adverse events during radiofrequency treatment of 582 hepatic tumors.[hepatmon.com]
  • Principe A, Lugaresi ML, Lords RC, et al. : Bile duct hamartomas: diagnostic problems and treatment . Hepato-Gastroenterology 1997, 44 :994–997. PubMed Google Scholar 33.[link.springer.com]

Prognosis

  • Therefore, complete excision is recommended, and extensive pathological sampling of these lesions is critical in the determination of prognosis.[journals.lww.com]
  • Diabetes mellitus and pyogenic liver abscess: risk and prognosis. Clin Infect Dis. 2007; 45 (6): 801[ DOI ][ PubMed ] 35. Azab M, Zaki S, El-Shetey AG, Abdel-Moty MF, Alnoomani NM, Gomaa AA, et al.[hepatmon.com]
  • Prognosis is usually poor. Other primary liver cancers are uncommon or rare. Diagnosis usually requires biopsy. Prognosis is typically poor. Some cancers, if localized, can be resected. Resection or liver transplantation may prolong survival.[merckmanuals.com]
  • Prognosis The prognosis depends on success rates of resection in resectable tumors. 5-year survival rates are moderate in low stage tumors but these rates drop below 20-30% in advanced disease.[orpha.net]

Etiology

  • It is associated with inflammatory disorders and malformations of the ducts, but most cases are of unknown etiology.[ncbi.nlm.nih.gov]
  • Hepatitis B and hepatitis C are the most common etiologic agents worldwide in endemic areas but are observed much less often in the United States.[cancertherapyadvisor.com]
  • Further research should be done to clarify the etiologic relationship between androgenic-anabolic steroids and hepatocellular tumors and tumorlike lesions.[ncbi.nlm.nih.gov]
  • Etiology Liver cirrhosis (80% of cases) Risk factors independent of cirrhosis Chronic hepatitis B or C virus infection Nonalcoholic steatohepatitis ( NASH ) Hemochromatosis Wilson's disease Alpha-1 antitrypsin deficiency Schistosomiasis Glycogen storage[amboss.com]

Epidemiology

  • Epidemiology Fifth most common malignancy worldwide Highest incidence in Southeast Asia and Africa Peak incidence in the US: 70–75 years Peak incidence in Africa and Asia: 30–40 years References: [1] Epidemiological data refers to the US, unless otherwise[amboss.com]
  • The management of the network includes a Scientific Committee, an Executive Board and an Epidemiology and Management Coordinating Centre.[icgc.org]
  • Summary Epidemiology Primary liver malignancies are rare in children and adolescents (HCC constitutes less than 25% of them). Annual incidence has been reported to be about 1 in 2 million.[orpha.net]
  • . : Epidemiology of hepatocellular adenoma: the role of oral contraceptive use . JAMA 1979, 242 :644–648. PubMed CrossRef Google Scholar 14.[link.springer.com]
Sex distribution
Age distribution

Pathophysiology

  • Simple cyst: pathophysiologically they are thought to be congenital. They are of no clinical significance and are often found incidentally. Polycystic liver disease: genetic disease usually associated with mutations of polycystic kidney disease.[brainscape.com]
  • Etiology The pathophysiology of hepatocellular carcinoma is not well understood. Underlying liver dysfunction is the main predisposing condition (HBV, HCV).[orpha.net]
  • Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 96. National Cancer Institute website.[medlineplus.gov]
  • […] cutanea tarda Glycogen storage diseases Toxins Aflatoxin B1 – consumption of grains and nuts contaminated with Aspergillus spp (China and Africa) Long-term androgenic steroid therapy Vinyl chloride (occupational exposure) Tobacco use Family history of HCC Pathophysiology[arupconsult.com]
  • Thorotrast exposure (historical), androgenic steroids, tyrosinemia Higher rates in blacks vs. whites (4:1); 70% male Most patients are age 60 years with cirrhosis or ages 20 - 40 years without cirrhosis, occasionally are second tumors in Wilm tumor patients Pathophysiology[pathologyoutlines.com]

Prevention

  • Related information Information for Health Professionals –Recommendations on Prevention and Screening for Liver Cancer Cancer Prevention Series (7) - Liver Cancer Prevention and Screening The Viral Hepatitis Preventive Service provides detailed information[chp.gov.hk]
  • […] and early detection of cervical cancer: American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer.[nccn.org]
  • […] toxicology conference in MENA region March 21, 2018 News Emory University School of Medicine seniors participate in Match Day 2018 March 16, 2018 News Emory Genetics Metabolic Nutrition Program launches new website for Medical Nutrition Therapy for Prevention[emoryhealthcare.org]
  • Behind this clinical enthusiasm, however, lies the research to develop the "true technology," in Thomas' words, that will prevent such clinical catastrophies as hepatic metastases.[books.google.ro]
  • Moreover, Djouder and his team blocked IL-17A using various methods -antibodies and digoxin among others- and prevented the development of NASH and HCC.[sciencedaily.com]

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Last updated: 2019-06-28 12:29