2 39yo woman had RLQ pain in Febraury Long-term use of oral contraceptivesCT 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 lobeLFTs normalAFP=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 largeMetastasis – most common neoplasm in the liver, bad prognosisFocal nodular hyperplasiaMost common benign hepatic tumorUsually asymptomatic, may have pain if hemorrhagesCentral fibrous scar with fibrous septae characteristic
4 Differential diagnosis of a hepatic mass Hepatocellular carcinomaUsually associated with cirrhosisAlpha-fetoprotein is the most common laboratory abnormality, elevated in 70-90%Resection is usual treatment, but prognosis is poorOther malignant lesionsFibrolamellar carcinoma – younger, no cirrhosisHepatoblastoma – infantsAngiosarcoma – industrial exposureCholangiocarcinoma – biliary disease
5 Differential diagnosis of a hepatic mass Hepatocellular adenomaAssociated with oral contraceptivesLFTs usually normalComplications include hemorrhageUsually require resectionOther benign lesionsNodular regenerative hyperplasiaHepatic cystBiliary cystadenoma
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