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A. Hemangiomasnavigator

  1. Usually leave alone (rarely rupture)
  2. Symptomatic - surgical resection
  3. Diagnosis made with computerized tomographic (CT) scan and/or angiogram
  4. May be accompanied by hypothyroidism [3]
    1. Mainly with very large hemangiomas
    2. Due to excess of Type 3 iodothyronine deiodinase
    3. This enzyme breaks down L-thyroxine
    4. Very high doses of L-thyroxine replacement may be required

B. Focal Nodular Hyperplasianavigator

  1. Hamartoma without Kupffer cells
  2. No association with malignancy
  3. Typically <5cm in diameter
  4. Unencapsulated and well circumscribed
  5. Homogeneous appearance on CT scan
  6. Diagnosis with liver / spleen scan

C. Hepatic Adenomanavigator

  1. Usually occurs in young women
  2. Disease Associations
    1. Most commonly associated with long term oral contraceptive pill use
    2. Complication of anabolic steroids
    3. Also occurs in tyrosinemia and type I or IV glycogen storage disease
    4. Familial diabetes mellitus also a risk factor
  3. Easily rupture usually causes acute pain
  4. Always resect

D. Liver Abscess navigator

  1. Bacterial (usually mixed infection) - primary or secondary
  2. Amoebic Abscess - Entamoeba histolytica [5]
  3. Echinococcal cyst - rarely causes fever and abdominal pain
  4. Fungal or mycobacterial abscesses are occassionally found

E. Metastatic Tumorsnavigator

  1. About 30 times more common than primary liver cancer
  2. Colon cancer is most common cause
  3. Gastric and pancreatic adenocarcinomas also lead to liver masses
  4. Hodgkin's Disease may involve the liver, but is usually not nodular

F. Hepatocellular Carcinoma [4] navigator

  1. Usually associated with cirrhosis
  2. Underlying viral hepatitis and/or alcoholism
  3. Most commonly hepatitis C virus (HCV) in developed world
  4. Rarer fibrolamellar variant, usually solitary nodule [2]

G. Diagnosisnavigator

  1. In general, liver biopsy (usually percutaneous) is required for clear diagnosis
  2. This is typically preceeded by a diagnostic imaging test
    1. Ultrasound is usually initial diagnostic modality
    2. Except for gallstones, rarely gives certain diagnosis
    3. Conventional or helical (spiral) CT Scan if often used and is preferred modality
  3. MRI Scanning is now used initially or when CT scan is inconclusive

References navigator

  1. Saini S. 1997. NEJM. 336(26):1889 abstract
  2. Reinus JF and Yantiss RK. 2000. NEJM. 343(21):1553 (Case Record)
  3. Huang SA, Tu HM, Harney JW, et al. 2000. NEJM. 343(3):185 abstract
  4. Mor E, Kaspa RT, Sheiner P, Schwartz M. 1998. Ann Intern Med. 129(8):643 abstract
  5. Haque R, Huston CD, Hughes M, et al. 2003. NEJM. 348(16):1565 abstract