MASS LESION

MASS LIVER
NON-NEOPLASTIC NEOPLASTIC

BENIGN

MALIGNANT

NON-NEOPLASTIC LESIONS
CYSTS - POLYCYSTIC DISEASE. - CAROLIS DISEASE. FOCAL NODULAR HYPERPLASIA. NODULAR REGENERATIVE HYPERPLASIA. BILIARY HAMARTOMA. PELIOSIS HEPATIS. HYDATID CYST. AMEOBIC ABSCESS . TUBERCULOMA.

BENIGN TUMORS
EPITHELIAL . 1) HEPATIC ADENOMA. 2) BILE DUCT ADENOMA. NON-EPITHELIAL. 1) HEMANGIOMA. 2) LYMPHANGIOMA.

MALIGNANT TUMORS
EPITHELIAL. NON-EPITHELIAL. 1)HEPATOCELLULAR 1)ANGIOSARCOMA. CARCINOMA. 2)RHABDOMYOSAR 2)HEPATOBLASTOMA. COMA. 3)BILE DUCT CA. 3)LYMPHOMA. 4)HILAR ADENOCA. (KLATSKIN TUMOR) METASTATIC.

POLYCYSTIC LIVER

CAROLIS DISEASE

CAROLIS DISEASE

FOCAL NODULAR HYPERPLASIA

SPONTANEOUS. YOUNG FEMALES. NO TREATMENT .

FOCAL NODULAR HYPERPLASIA

NODULAR REGENERATIVE HYPERPLASIA

MULTIPLE NODULES IN ENTIRE LIVER IN THE ABSENCE OF FIBROSIS. ASSOSIATED WITH AUTOIMMUNE DISORDERS.

NODULAR REGENERATIVE HYPERPLASIA

HYDATID CYST

HYDATID CYST

HYDATID CYST

AMOEBIC ABSCESS

PELIOSIS HEPATIS

HEPATIC ADENOMA

ADENOMA
ORAL CONTRACEPTIVES. MIMIC CARCINOMA. PERITONEAL RUPTURE. HCC ARISE RARELY.

ADENOMA

ADENOMA - MICRO
SHEETS & CORDS OF HEPATOCYTES 2 3 CELLS THICK SEPARATED BY SINUSOIDS. PORTAL TRACTS ABSENT.

CAVERNOUS HEMANGIOMA

HEPATOCELLULAR CARCINOMA

HEPATOCELLULAR CA

HEPATOCELLULAR CA
M : F 3 : 1. 7TH COMMON IN MALE. 9TH COMMON IN FEMALE. OLDER AGE > 60 IN CIRRHOTIC LIVER. 20 40 YRS IN HEPATITIS PATIENTS.

ETIOPATHOLOGY
GENETIC - NO CONVINCING EVIDENCE. - ASSOSIATED WITH FAMILIAL POLYPOSIS COLI, ATAXIA TELANGIECTASIA.

AGE
OLDER AGE YOUNG AGE - ALCOHOLIC. - HEPATITIS.

SEX

MALE

> FEMALE.

METABOLIC
TYROSINEMIA. ALPHA I ANTITRYPSIN DEFICIENCY. PRIMARY IDIOPATHIC HEMOCHROMATOSIS. WILSONS DISEASE . GLYCOGEN STORAGE DISORDERS.

ALPHA 1 ANTITRYPSIN DEFICIENCY

HEMOCHROMATOSIS

NUTRITION

OVERNUTRITION.

CARCINOGEN
AFLATOXIN. NITROSAMINE. TANNIC ACID. CYCASIN.

CHEMICALS & DRUGS

SOLVENTS. ORGANOCHLORIDE PESTICIDES. THOROTRAST. METHOTREXATE. ORAL HYPOGLYCEMIC AGENTS. DIETHYL STILBESTROL. TAMOXIFEN.

ALCOHOL & SMOKING

CIRRHOSIS - 10 15 % RISK.

VIRAL HEPATITIS
HEPATITIS- B . HEPATITIS- C.

CIRRHOSIS

HBV , HCV

ALCOHOL HEMOCHROMATOSIS

OTHERS

HIGH RISK

INTERMEDIATE RISK

LOW RISK

HYPERPLASIA , DYSPLASIA

CARCINOMA

CLINICAL FEATURES
UPPER ABDOMINAL MASS / PAIN. MALAISE , FATIGUE, WT LOSS. JAUNDICE , FEVER, ASCITES, ENCEPHALOPATHY. ESOPHAGEAL VARICEAL BLEED. BUDD CHIARI SYNDROME. METASTASIS.

INVESTIGATIONS
SERUM ALPHA FETO PROTEIN. - 100 200 ng /ml HEPATITIS. - > 500 ng / ml HEPATOMA. SERUM CEA. USG. ANGIOGRAPHY. CT / MRI. BIOPSY.

PARANEOPLASTIC SYNDROME
HYPOGLYCEMIA. ERYTHROCYTOSIS. HYPERCALCEMIA. HYPERCHOLESTEROLEMIA.

FINAL OUTCOME
HEPATIC FAILURE. GI BLEED. RUPTURE IN TO PERITONEUM. CACHEXIA.

MORPHOLOGY
GROSS. EGGEL CLASSIFICATION. 1) UNIFOCAL. 2) MULTIFOCAL. 3) DIFFUSE.

MICROSCOPIC
WELL DIFFERENTIATED. - TRABECULAR. - ACINAR. - SOLID. ANAPLASTIC.

FIBROLAMELLAR CARCINOMA
YOUNG AGE 20 40 YRS. F > M. BETTER PROGNOSIS. NO ASSOCIATION WITH HBV OR CIRRHOSIS.

TREATMENT
SURGICAL RESECTION. INJECTION OF ALCOHOL. CHEMOEMBOLISM. RADIATION. TRANSPLANTATION.

HEPATOBLASTOMA

HEPATOBLASTOMA
0.2 5 % OF CHILDHOOD TUMORS. 25 45 % OF PRIMARY HEPATIC TUMORS. 83 92 % OCCURS IN < 5 YRS OF AGE. 66 % IN < 2 YRS . M > F.

ASSOCIATIONS
HEMIHYPERTROPHY. DOWN SYNDROME. NEPHROBLASTOMA. FAP SYNDROME.

CLINICAL FEATURES
FAILURE TO THRIVE. LOSS OF WT. ABDOMINAL MASS. JAUNDICE. ELEVATED HCG. ELEVATED AFP.

MICROSCOPY
EPITHELIAL. MESENCHYMAL. MIXED.

INTRAHEPATIC BILE DUCT CA

CHOLANGIOCARCINOMA
OLDER AGE. CLONORCHIS SINENSIS. NITROSAMINES. HEPATOLITHIASIS. CAROLIS DISEASE. CHOLEDOCHAL CYST.

ANGIOSARCOMA
VINYL CHLORIDE, ARSENIC, THOROTHRAST.

METASTASIS

SUMMARY

DONT SEE A PERSON AS WHAT HE IS NOW,

BUT SEE HIM AS WHAT HE COULD BE IN FUTURE.