Hepatic mass Yekaterina Rabkin 7/22/05

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)

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

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

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

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

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