Surgical management of liver haemangioma Dr Chris Yau Dept of Surgery PWH.

Slides:

Advertisements

Similar presentations

Hepatic mass Yekaterina Rabkin 7/22/05.

Advertisements

Introducing Liver Surgery to the MID NORTH COAST NSW Dr George Petrou FRACS 69Lake Rd, Port Macquarie NSW Hepatobiliary Surgery,

Hepatic Adenoma – Can we do more? Joint Hospital Grand Round

Adamantinoma Ted Scriven Sept 15 th, Adamantinoma is a malignant bone tumour Definition.

Joint Hospital Surgical Grand Round

Suen PY Department of Surgery PMH 11 February 2012.

Merseyside and Cheshire Cancer Network HEPATO BILIARY MULTIDISCIPLINIARY TEAM MEETING Referral to Specialist HPB (Liver) MDT, University Hospital, Aintree,

SYSTEMIC HEMANGIOMATOSIS WITH ATYPICAL LIVER HEMANGIOMAS AND DIAPHRAGM INVOLVEMENT Serguey A. Khoruzhik, MD Computed Tomography, Grodno Regional Clinical.

COLLOID CYST OF THE THIRD VENTRICLE: REPORT OF TWO CASES

Biliary Cystadenoma and other complicated cystic lesions of the liver: Diagnostic and therapeutic challenges Teoh AYB Division of HBP Surgery Department.

OSLER RENDU WEBER SYNDROME. AIM To diagnose a rare case of OSLER RENDU WEBER SYNDROME Screening methods for first degree relatives of patients for early.

Hepatic Adenoma 2005.Incidence of HCC in adenomas-8 to 14% “The surgeon is tempted to operate. However in most uncomplicated cases of adenoma it.

Incidentolomas - Evaluation and Management of Incidental Liver Lesions

62 years old man Main complaint: Back pain at night but not during the day Loss of appettite Weight loss.

Liver Cancer ACC RNSG Risk factors 4 th most common cancer in the world Most common primary liver cancer is hepatocellular carcinoma Cirrhosis –

Ayman Abdo MD, AmBIM, FRCPC

In the Name of GOD L iver Masses General Overview Behzad Nakhai, M.D.,FICS Fellowship in HepatoBiliary Surgery Asso Professor Iran University of Medical.

Hepatobiliary pathology By Dr/ Dina Metwaly

Colorectal cancer Khayal AlKhayal MD,FRCSC

Liver surgery AnatomyHepatectomy Liver tumors BenignMalignant.

Mr Will Finch MBBS BSc(Hons) MRCS Urology SpR Edith Cavell Hospital.

Consultant Radiologist Prince Sultan Military Medical City

Approach to a thyroid nodule

Cholestatic liver diseases:

HEPATOCELLULAR CARCINOMA Monton. HCC in Thailand Most common cancer in Thai male Incidence 5 x 100,000 / year Male : female = 3-8:1 Age > 40 yr.

Guzman, Alexander Joseph Hipolito, April Lorraine

Case Report Patient PP Submitted by:Matthew Clower, MSIV Faculty:Sandra Oldham, MD Date:29 August 2007 Radiological Category:Principal Modality (1): Principal.

Unit of Gastrenterology Unit of Endocrinology THEAGENIO Hospital, Thessaloniki Metastatic neuroendocrine tumor of the jejunum-ileum.

Aneurysms & Aneurysm Screening

Management of ovarian cysts

Case Report # 1 Submitted by:James Korf, MS4 Faculty reviewer:Sandra Oldham, MD Date accepted:27 August 2014 Radiological Category:Principal Modality (1):

IRIA 67th Annual Conference

Hamid Tavakkoli, MD Associate Prof. of Gastroenterology.

RADIOLOGY OF THE RENAL SYSTEM

Renal Pathology II, Case 2

IMAGING FEATURES OF TUMOR EXOPHTALMOS IN CHILDREN M. LIMEME, H. ZAGHOUANI BEN ALAYA, S. KRIAA, H. AMARA, D. BEKIR, CH. KRAIEM Imaging department, Farhat.

Management of the primary in Stage IV colorectal cancer Erin Kennedy, MD, PhD, FRCSC Colorectal Surgery Mount Sinai Hospital University of Toronto.

Case scenarios- Neck Swelling

Student SYB Chet Cunha MS IV January 22, History 61 y/o M with known HCV x 5 yrs. presenting with vague abdominal discomfort. Outside CT showed.

H. EL MORABIT, N. EL YOUSFI, S. BOUKLATA. Medical emergency imagery IBN SINA Hospital. INTERVENTIONAL : INTV1 INTV1.

The Royal Marsden Solitary fibrous tumours The outcomes of 106 patients illustrating the unpredictable biological behaviour N Alexander, K Thway, JM Thomas,

Clinical History Patient presents with a palpable upper abdominal mass Patient states possible clinical history of abdominal hernia.

Pancreatic Tumors in Children Presented by Damien W. Carter, MD.

SONG QIANG Department of Radiology, Affiliated Hospital of Xuzhou Medical College Urinary tract and male reproductive system.

Digestive system Diagnostic imaging department of xuzhou medical college of xuzhou medical college.

 Macroscopic anatomy › External view › The quadrate lobe belongs anatomically to the right lobe and functionally to the left

Hamid Tavakkoli, MD Associate Prof. of Gastroenterology.

Imaging of Focal Nodular Hyperplasia: A Review

Foot pain Dr Shrenik Shah Shrey hospital. Clinical details M/23 year -CA student Pain over instep– mild since 2 years but increased since 5 months No.

Spontaneous rupture of HCC Ruptured HCC following TACE

Liver mass Mazen Hassanain. Radiology Arterial enhancement: adenoma, FNH, hemangioma, HCC, NET mets Portal enhancement: CRC liver mets.

Differential Diagnosis

Liver mesenchymal tumor mimicking Klatskin tumor

Brain imaging prior to lung cancer resection

Rapid on-site evaluation may optimize patient selection for radio-frequency-ablation therapy Dr Wolfgang Pokieser Pathologisch-bakteriologisches Institut.

Radiologic Findings CT US MR

Faculty Case Presentation

Two lesions are seen within the lateral segment of the left lobe of the liver (yellow arrows). They appear mildly hyperintense on T2 images and mildly.

Chapter 14 Hepatic Tumors, Malignant 1

Liver Masses: A Clinical, Radiologic, and Pathologic Perspective

Early presentation of de novo high grade glioma with epileptic seizures: electroclinical and neuroimaging findings Rosario Rossi, Andrea Figus, Simona.

An Unusual Cause of Abdominal Pain in Sickle Cell Disease

Early presentation of de novo high grade glioma with epileptic seizures: electroclinical and neuroimaging findings Rosario Rossi, Andrea Figus, Simona.

Volume 68, Issue 4, Pages (April 2018)

Case of the Month: November 2018

Volume 65, Issue 2, Pages (August 2016)

Cystic Neoplasm of the Pancreas Clinical Review of 60 Cases and Treatment Strategy D.K.Kim, S.I.Noh, J.S.Heo, J.H.Noh, T.S.Sohn, S.J.Kim, S.H.Choi, J.W.Joh,

Multiple liver pseudotumors due to hepatic steatosis and fatty sparing: A non-invasive imaging approach Andrea Delli pizzi, Domenico Mastrodicasa, Barbara.

CT-SCAN & MRI LIRADS 2018 Dr. NGUYỄN HỒ TRÚC LINH - MRI.

Presentation transcript:

Surgical management of liver haemangioma Dr Chris Yau Dept of Surgery PWH

Clinical scenario --- pitfall 68 F USG: 3cm hyperechoic lesion right lobe Typical haemangioma Hepatitis marker –ve, AFP CEA normal FU CT scan: 7cm after 3 yr Trisegmentectomy: cholangiocarcinoma 67 F USG: 4cm lesion left lobe Typical haemangioma Hepatitis marker, AFP CEA normal FU USG 1 yr 8cm mass left lobe, multiple satellite lesions right lobe Palliative care

Content Pathology Prevalence / Etiology Clinical presentation Diagnostic tools Surveillance Surgical management Take home message

Liver Haemangioma --Pathology First prescribed by Amboise Pare 1570 (Paris) Benign tumour Size up to 30cm Giant Haemangioma if size > 10cm

Liver Haemangioma --Pathology Macroscopically: red wine colored mass with lobulated appearance Microscpically: large endothelium lined vascular channels packed with red blood cell

Prevelance / Etiology 0.7% to 7.3 % in autopsy finding * Female predominance 1.5 – 6 : 1 ** Present most often between 3rd and 4th decade Positive correlation with female sex hormone * Belghiti, Management of haemangioma, Stuttgart: 1993: ** Yan et al, US guided percutanceous RFA for hepatic haemangioma. World J Gastroenterol, 2003 Sept

Clinical Presentation Asymptomatic Epigastric pain Spontaneous hemorrhage Traumatic hemorrhage Cardiac failure

Dignostic tools USG: Homogenous hyperechoic CT scan: Pre-contrast: Relative hypodense Early phase : Perilesional increase in contrast Delayed: isodense / hyperdense

Diagnostic tools MRI scan: T1 : hypointense T2 : heavily hyperintense Arteriography: Golden standard Cotton Wool appearance

Surveillance NANil Complications 1Nil Malignancy NANil1Change of lesion 12 yrs months12-60 monthsFollow up period 170NilNADrop out No of pt Leifer (US)Nippon (Japan)Gandolfi (Italy)

Surgical Treatment Treatment method: Laparoscopic Vs Open Resection Vs Enucleation RFA Indications of Surgery Uncertain diagnosis Symptomatic Lesion with documented increase in size +/- Giant haemangioma

Surgery result 2.4% 12% Ozden et NA00Mortality NA13%25%Morbidity 000Malignancy Conservative tx 81552Surgery No of pt Farges et alMoreno et alYoon et al

Take home message Majority haemangioma can be treated conservatively Existence of mimicker Repeat scan / FNAC / Surgery if uncertain diagnosis