Ultrasound Imaging of Liver Tumors – Current Clinical Applications
Syspath 10 Lecture4 Liver Tumors
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Transcript of Syspath 10 Lecture4 Liver Tumors
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57 y.o former IVDU with known chronic hepatitis C cirrhosis 57 y.o former IVDU with known chronic hepatitis C cirrhosis found to have a mass in the liverfound to have a mass in the liver
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Etiology of HCCEtiology of HCC• Common causes: Common causes: HBVHBV
HCVHCV Aflatoxin BAflatoxin B AlcoholAlcohol
• Rare causes: Rare causes: Contraceptive & Anabolic SteroidsContraceptive & Anabolic Steroids
Metabolic diseasesMetabolic diseases Storage diseasesStorage diseases Vinyl ChlorideVinyl Chloride Older ageOlder age
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Some Facts about HCCSome Facts about HCC
• One of the most common cancers in the worldOne of the most common cancers in the world• Represents 80% of primary malignant liver Represents 80% of primary malignant liver
tumorstumors• 80% associated with HBV and / or HCV80% associated with HBV and / or HCV• Relative risk in HBsAg + about 200Relative risk in HBsAg + about 200• Cirrhosis present in 90%Cirrhosis present in 90%• Male predominance (4 to 8:1)Male predominance (4 to 8:1)• Incidence increase with ageIncidence increase with age
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Rising Incidence of HCCA Byproduct of the Hepatitis C Epidemic
• Incidence of HCC- 1976-1980: 1.4/100,000
- 1991-1995: 2.4/100,000
• Mortality: 41%• Significant shift to younger (40-60) age group
• Approx. 3.9 million in U.S. infected with Hepatitis C- Infected in 1960’s and 1970’s
- After 20 yr, HCC will develop in 1.9-6.7%
El-Serag, NEJM 1999
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Hepatocellular CarcinomaHepatocellular Carcinoma
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Non-cirrhotic liver with HCC
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Intrahepatic cholangiocarcinomaIntrahepatic cholangiocarcinoma
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Intrahepatic Bile Duct CarcinomaIntrahepatic Bile Duct Carcinoma
• Resembles carcinoma of extrahepatic biliary tree
• Less frequent than HCC
• F:M ratio 1:1 (F more ?)
• No relation to cirrhosis
• Rarely invades portal vein
• Hypovascular
• Associated conditions:
primary sclerosing cholangitis, liver flukes, hepatolithiasis, fibrocystic liver disease, chronic hepatitis C, Thorotrast.
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HCC vs CholangiocarcinomaHCC vs Cholangiocarcinoma
Cirrhosis Yes No
Underlyingdisease
Cirrhosis,HBV,HCV, ALD,others
PSC, C. sinensis,cystic disease,hepatolithiasis,Thorotrast
Increasedserum level
AFP CEA, CA19.9
Histology Trabecular Glandular
Immunostain Heppar 1, AFP,poly CEA
CK7 +, CK20 -
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Angiosarcoma
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Benign Neoplasms
• Cavernous hemangiomas – most common
• Hepatic Adenomas
• Focal Nodular Hyperplasia
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Metastatic Colon Ca
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Focal Nodular Hyperplasia