Student SYB

1
Student SYB

• Chet Cunha MS IV
• January 22, 2009

2
History

• 61 y/o M with known HCV x 5 yrs. presenting with
  vague abdominal discomfort.
• Outside CT showed single suspicious lesion in
  liver.
• US guided bx shows mild chronic hepatitis with no
  evidence of malignancy or cirrhosis.
• PE and ROS unremarkable.

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DDxHepatic mass lesions

• Malignancy - HCC, lymphoma, hemangiosarcoma,
  intrahepatic cholangiocarcinoma, mets (GI, GU,
  ovarian, pancreatic)
• Benign tumors - hemangioma, adenoma
• Cysts - hepatic cysts, hydatid cysts, polycystic
  liver disease
• Abscesses - pyogenic, amebic, fungal
• Focal fatty infiltration
• Carolis disease

4
Labs

• CBC/BMP unremarkable.
• No LFT abnormalities.
• Elevated Alpha-fetoprotein.
• HAV/HBV serologies negative.

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W/U of hepatic lesion

• CT with contrast
• MRI
• US
• Tc-99m
• Lipiodol Angiography with CT f/u
• US, CT guided, or open bx for definitive dx

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Imaging - Lipiodol Angiogram
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Imaging - Lipiodol Angiogram
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Imaging - Triphasic CT 2 weeks after Angiography
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Imaging - Triphasic CT 2 weeks after Angiography
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Imaging - Triphasic CT 2 weeks after Angiography
Periportal lymphadenopathy
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Imaging - Triphasic CT 2 weeks after Angiography
Smaller middle lobe but no frank evidence of
cirrhosis
12
HCC

• Most often seen in presence of cirrhosis (EtOH,
  HBV, HCV, hemochromatosis, aflatoxin, alpha 1
  antitrypsin)
• AFP often, but not always elevated
• 3 growth patterns
• Solitary mass (often large)
• Multifocal/nodular
• Diffuse

13
HCC Radiographically

• US appearance variable
• MR - hypo in T1, hyper in T2
• Unenhanced CT - hypoattenuated lesions
• CT with contrast - hyper in arterial phase
• Often invades portal vasculature

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HCC - Treatment Options

• Surgical resection
• Chemoembolization
• Radiofrequency ablation
• Chemotherapy
• Liver transplantation (If pt has 1 lesion lt5cm or
  3 lesions lt3cm)

N.B. these measurements can be reevaluated
following neoadjuvant therapy
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Further Reading

• Gourtsoyiannis, N.C., Ros, P.R.
  Radiologic-Pathologic Correlations from Head to
  Toe. Springer Publishing, Berlin 2005.
• Grossman, Z.D., Katz, D. S., et al.
  Cost-Effective Diagnostic Imaging. Mosby
  Elsevier, Philadelphia, 2006.
• Weinstein, W.M., Hawkey, C.J., Bosch, J. Clinical
  Gastroenterology and Hepatology. Mosby Elsevier,
  Philadelphia, 2005.