1. Hepatic mass
Yekaterina Rabkin
7/22/05

2. 39yo woman had RLQ pain in Febraury
Long-term use of oral contraceptives
CT showed 4.7 x 6.9 x 7cm enhancing lesion in the right lower lobe of the liver, also a 15 x11 mm lesion in the left lobe
LFTs normal
AFP=2.7 (0-9.0), CEA=0.8 (<5.0)

3. Differential diagnosis of a hepatic mass
Hemangioma – most frequently identified hepatic mass, may need resection if large
Metastasis – most common neoplasm in the liver, bad prognosis
Focal nodular hyperplasia
Most common benign hepatic tumor
Usually asymptomatic, may have pain if hemorrhages
Central fibrous scar with fibrous septae characteristic

4. Differential diagnosis of a hepatic mass
Hepatocellular carcinoma
Usually associated with cirrhosis
Alpha-fetoprotein is the most common laboratory abnormality, elevated in 70-90%
Resection is usual treatment, but prognosis is poor
Other malignant lesions
Fibrolamellar carcinoma – younger, no cirrhosis
Hepatoblastoma – infants
Angiosarcoma – industrial exposure
Cholangiocarcinoma – biliary disease

5. Differential diagnosis of a hepatic mass
Hepatocellular adenoma
Associated with oral contraceptives
LFTs usually normal
Complications include hemorrhage
Usually require resection
Other benign lesions
Nodular regenerative hyperplasia
Hepatic cyst
Biliary cystadenoma

8. Pt stopped oral contraceptives and came in for a repeat CT June 27
The masses are minimally decreased in size
Patient is going to follow up with surgery for resection and biopsy of the mass

9. Source Douglas R. LaBrecque, MD
Mass Lesions & Neoplasia of the Liver - CURRENT DIAGNOSIS & TREATMENT IN GASTROENTEROLOGY - 2nd Ed. (2003)
» Section VI. Diseases of the Liver & Biliary System