3. Benign liver tumors (General Surgery)=.pptx

Hydatid disease, also known as cystic echinococcosis, is a parasitic infection caused by a tapeworm. It can lead to the formation of fluid-filled cysts in various organs, including the liver, lungs, heart, brain, and bones123. The cysts may grow slowly and can remain alive for many years. The disease is rare in North America.

1. BENIGN LIVER TUMORS

2. Cavernous Hemangioma Most Common liver tumor (20%). All ages. F:M of 5:1 In adults: mean age of 50 y Most often in right lobe ≥ 10 ( 5 ) cm are called Giant hemangiomata .

3. Cavernous Hemangioma Cause: unknow Congenital Clusters of blood-filled cavities, lined by endothelial cells , fed by the hepatic artery

4. Clinical Presentation Asymptomatic: Most hemangiomata < 5cm, found incidentally during US or CT scan for unrelated reason. Large hemangioma can manifest as abdominal mass or pain .

5. Complications: 1- Alteration of internal structure, such as inflammation (low grade fever, wt loss, abdominal pain). 2- Alteration in coagulation , which could lead to systemic disorders ( Kasabach-Meritt syndrome: intravascular coagulation, clotting and fibrinolysis within the hemangioma) 3- Hemorrhage , which can cause hemoperitoneum . 4- Compression of adjacent structures: jaundice

6. Diagnosis: On Ultrasongraphy : Classic appearance of hemangioma is that of an echogenic mass of uniform density (homogenous) , less than 3cm in diameter, with acoustic enhancement and sharp margins.

7. On Triphasic CT scan : Criteria for diagnosis are 1- Low attenuation on non-contrast CT. 2- Peripheral enhancement of the lesion followed by central enhancement on contrast CT. ( Progressive Centripetal Filling ) 3- Contrast enhancement of the lesion on delayed scans.

8. Fig. 70.4. Multiphasic helical CT of a typical hemangioma . A, On precontrast CT, the lesion is hypodense . After contrast medium injection, the lesion enhances with peripheral puddling (B) and becomes homogeneously hyperdense on delayed phase imaging (C) .

9. Management: Whatever the size, NO TREATMENT FOR ASYMPTOMATIC HEMANGIOMA. Assurance. Indications for Surgery : 1- Severe symptoms. 2- Complications. 3- Exclude Malignancy .

10. Lines of treatment: Angiographic non-selective (Hepatic artery) or selective embolization. Radiotherapy: liver irradiation Surgical resection ( enucleation , hepatic resection, laparoscopic technique depending on the size and anatomic location). Liver transplantation for symptomatic patients with technically unresectable complicated giant hemangiomata .

11. Focal Nodular Hyperplasia Second most common. Women 30-50 years. Hyperplastic reaction resulting from arterial malformation ( increased arterial flow hyperperfuses the local liver parenchyma leading to secondary hepatocellular hyperplasia).

12. Clinical and Biologic data: Asymptomatic. Large FNH: Abdominal pain (discomfort). Pressure manifestation. Severe pain (torsion of pedunculate lesions) No risk of malignancy Complications: Rupture and bleeding (rare).

13. Diagnosis: Ultrasound: Hypo or isoechoic. The central scar is slightly hyperechoic Color doppler show the a central feeding artery with a stellate or spoke-wheel pattern corresponding to the artery running from the central scar to fibrous septa.

14. CT SCAN : hypo or isodense mass. Central scar in 30% only. FNH enhances at arterial phase but the central scar is hypodense. The lesion return to isodense in portal phase.

15. Fig. 70.10.  CT and MRI of a typical FNH. A, On contrast-enhanced CT, the lesion enhances homogeneously at the arterial phase. B and C, Pre- and postcontrast gadolinium T1-weighted MRI sequences. MRI shows a homogeneous lesion that enhances strongly after contrast administration. Note that the central scar does not enhance at the arterial phase (C) . D, T2-weighted MRI sequence. The lesion is isointense and contains a hyperintense scar (see corresponding pathologic view in Fig. 70.6).

16. Management: Whatever the size and number of lesions, there is no treatment for asyptomatic FNH when the diagnosis is firmly established. Assurance. Surgical resection is indicated in doubtful cases or in symptomatic patients.

17. Hepatocellular Adenoma Rare benign liver tumor . Usually in females, menstrual age Strongly associated with OCPs . Usually solitary , sometimes multiple.

18. Clinical Presentation Small adenomas are asymptomatic. Large adenoma: Abd pain or mass. Complications : 1- Spontaneous bleeding (20-40% more in women, during pregnancy, >5cm)). 2- Malignant transformation (10%, more in men with large adenoma)

19. Diagnosis: Ultrasonography : well delineated heterogenous hepatic mass, the hyperechogenicity is due to the presence of fat and glycogen. CT : hypervascular and heterogenous on arterial phase and presence of hemorrhage and necrosis MRI Biopsy

20. Fig. 70.15.  Hemorrhagic hepatocellular adenoma. A and B, The lesion is heterogeneous on ultrasound (A) and precontrast CT (B) . C, Arterial phase CT shows lack of lesion hypervascularity , which is related to the hemmorhage . The hyperdensity on precontrast CT reflects the hemorrhage.

21. Adenoma with hemorrhage

22. Management: Small lesions (<3 cm): low risk of complications can be observed after cessation of OCPs and avoidance of pregnancy (may regress). Indications of Surgical resection : Adenomas > 3 ( 4 ) cm Large symptomatic Suspicion malignancy Complications