Benign Liver Lesion surgery department.pptx

Surgery ppt for benign liver lesion like cystic lesion hyperplasia and the likes

1. Surgical Disorder of the Liver Benign liver Lesion Dr. Taha

2. Introduction O ccur in up to 20% of the general population Are much more common than malignant tumors. The most common benign lesions are Cysts , H emangiomas , F ocal nodular hyperplasia (FNH), and H epatocellular adenomas

3. Hepatic cysts Cystic lesions of the liver can arise primarily (congenital) or secondarily from trauma ( seroma or biloma ), infection( pyogenic or parasitic), or neoplastic disease . Congenital cysts are usually simple cysts containing thin serous fluid and occur in 5% to 14% of the population, with higher prevalence in women they have a well-defined thin wall and no solid component and are filled with homogeneous, clear fluid

4. B enign solid liver lesions D ifferential diagnosis includes H emangioma , A denoma , FNH , and B ile duct hamartoma .

5. Hemangioma O ccur in 2% to 20% of the population P redominantly seen in women Most common solid benign liver masses

6. Clinical feature Most hemangiomas are discovered incidentally large lesions - compression of adjacent organs or intermittent thrombosis Spontaneous rupture (bleeding) – rare Kasabach Meritt syndrome . thyrombocytopenia and fibrinopenia Diagnosis Biphasic Abdominal CT Scan closing iris sign / MRI Liver Biopsy rarely- Risk of Bleeding/Caution

7. Treatment Follow up. A Resection can be accomplished by E nucleation or Formal hepatic resection , Embolization :- better for unresectable / large /unfit patient

8. Hepatic adenomas Most commonly seen in premenopausal women older than 30 years of age and A re typically solitary Prior or current use of estrogens (oral contraceptives) is a clear risk factor Lack bile duct glands and Kupffer cells, have no true lobules, and contain hepatocytes that appear congested or vacuolated due to glycogen deposition

9. Clinical Feature R isk of spontaneous rupture with intraperitoneal bleeding (10% to 25% of cases). A bdominal pain, and H ave a risk of malignant transformation 5% to a well-differentiated HCC . Management Surgical Resection recommended that large hepatic adenomas (>4–5 cm) be surgically resected . Oral contraceptive or estrogen use should stop Radiofrequency ablation if multiple

10. Focal Nodular Hyperplasia more common in women of childbearing age biphasic CT scan usually is diagnostic of FNH, on which such lesions appear well circumscribed with a typical central scar FNH lesions usually do not rupture spontaneously and have no significant risk of malignant transformation .

11. Treatment Reassurance and prospective observation irrespective of size. Surgical resection can be recommended, when patients are symptomatic or when Hepatic adenoma or HCC cannot be definitively excluded Oral contraceptive or estrogen use should stop

12. Bile Duct Hamartoma typically small liver lesions, 2 to 4 mm in size, visualized on the surface of the liver at laparotomy. They are firm, smooth, and whitish yellow in appearance. They can be difficult to differentiate from small metastatic lesions, and excisional biopsy often is required to establish the diagnosis.