Liver Cancer and Lymphomas Overview

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Questions and Answers

What is the most common primary cancer that metastasizes to the liver?

Gastrointestinal cancer (correct)

Breast cancer

Skin cancer

Lung cancer

What is a common characteristic of simple hepatic cysts?

They are often large and multiple.

They have heterogeneous internal echoes.

They are mostly symptomatic.

They typically have thin walls and well-defined borders. (correct)

Which clinical feature is NOT commonly associated with metastatic liver disease?

Nosebleeds (correct)

Ascites

Jaundice

Weight loss

What type of liver transplantation involves excising the recipient's liver and gallbladder?

Orthotopic liver transplant Signup and view all the answers

In which type of liver disease are hepatic cysts most commonly inherited?

Polycystic liver disease Signup and view all the answers

What common complication may arise from simple hepatic cysts?

Calcification Signup and view all the answers

Which of the following is an indication for liver transplantation in adults?

Cirrhosis Signup and view all the answers

What are the three main anastomoses required for an orthotopic liver transplant?

Extrahepatic portal vein, hepatic artery, suprahepatic IVC Signup and view all the answers

What are the sonographic findings associated with polycystic liver disease?

Anechoic with well-defined borders Signup and view all the answers

Which type of lymphoma is characterized by the presence of Reed-Sternberg cells?

Hodgkin’s lymphoma Signup and view all the answers

Which type of liver abscess commonly arises from biliary tract diseases?

Pyogenic abscess Signup and view all the answers

What symptoms are typically associated with a hepatic abscess?

Fever, nausea, vomiting, and RUQ pain Signup and view all the answers

Which sonographic finding is characteristic of lymphomas?

Well-defined small hypoechoic nodules Signup and view all the answers

What is a common complication of liver transplantation?

Hepatomegaly Signup and view all the answers

What is the typical size of cysts in polycystic liver disease?

2 to 3 cm Signup and view all the answers

Which demographic is more likely to develop simple hepatic cysts?

Females of all ages Signup and view all the answers

What is a primary symptom of a hydatid liver cyst?

Low-grade fever and right upper quadrant tenderness Signup and view all the answers

What appearance is associated with hydatid cysts on ultrasound?

Honeycomb appearance Signup and view all the answers

What is the main consequence of schistosomiasis affecting the liver?

Portal hypertension due to intrahepatic portal vein occlusion Signup and view all the answers

Which benign liver tumor is characterized by multiple vascular channels?

Cavernous hemangioma Signup and view all the answers

In which demographic are cavernous hemangiomas more commonly found?

Women Signup and view all the answers

Which ultrasound finding is indicative of periportal fibrosis in schistosomiasis?

Increased echogenicity of the portal vein walls Signup and view all the answers

Which condition can cause calcifications in the liver and spleen?

Granulomas from Histoplasmosis or Tuberculosis Signup and view all the answers

What is the typical management approach for a hydatid liver cyst?

Surgical resection or medical treatment Signup and view all the answers

What is the most common organism associated with pyogenic liver abscesses?

Escherichia coli Signup and view all the answers

Which imaging characteristic is associated with a pyogenic liver abscess when gas is present?

Hyperechoic with dirty shadowing Signup and view all the answers

What symptom is most indicative of an amebic liver abscess?

Right upper quadrant pain Signup and view all the answers

In which patient population is hepatic candidiasis most likely to develop?

Immunocompromised patients Signup and view all the answers

Which of the following best describes the appearance of an amebic liver abscess on sonography?

A complex mass with low-level echoes Signup and view all the answers

Which parasite is responsible for causing echinococcal cysts?

Echinococcus granulosus Signup and view all the answers

Which symptom is NOT typically associated with fungal liver abscesses?

Intense itching Signup and view all the answers

Which of the following diagnostic methods is essential for confirming the diagnosis of a liver abscess?

Needle aspiration Signup and view all the answers

What characteristic is commonly associated with a cavernous hemangioma in a sonographic exam?

Well-defined, homogeneous, hyperechoic mass Signup and view all the answers

Which of the following best describes the typical blood flow pattern of a hemangioma?

Low-velocity blood flow too low to be detected Signup and view all the answers

Which statement is true regarding focal nodular hyperplasia (FNH)?

It is referred to as a 'stealth lesion' due to its slight sonographic disparity. Signup and view all the answers

What is a common sonographic finding in focal nodular hyperplasia?

Multinodular mass that may have a central scar Signup and view all the answers

How does the size of a typical hemangioma compare to that of focal nodular hyperplasia?

Hemangioma is usually less than 3 cm. Signup and view all the answers

Which demographic is more likely affected by focal nodular hyperplasia?

Women under 40 years of age Signup and view all the answers

What is the typical echogenicity of a hemangioma on ultrasound?

Homogeneous and hyperechoic Signup and view all the answers

What is a characteristic feature of focal nodular hyperplasia that may not always be visible on imaging?

Central scar Signup and view all the answers

Study Notes

Liver Cancer

Most common primary cancers that metastasize to the liver are from the gastrointestinal tract, breast, or lung.
Clinical features include weight loss, jaundice, right upper quadrant pain, hepatomegaly, and ascites.
Liver function tests will be abnormal.
Sonographic findings of metastatic liver disease are variable, often depending on the location of the primary cancer.
- May be hyperechoic, hypoechoic, Bull's eye or target metastases, calcified metastases, or cystic metastases.
- May appear as one mass, several masses, or diffuse involvement.

Lymphomas

Lymphomas are malignant neoplasms.
The two main types are Hodgkin's lymphoma and non-Hodgkin's lymphoma.
The presence of splenomegaly or retroperitoneal nodes may help confirm the diagnosis of lymphadenopathy.
Sonographic findings include:
- Well-defined small hypoechoic nodules.
- Diffuse infiltrative disease.
- Abdominal lymphadenopathy.

Liver Transplantation

The two main types of liver transplantation are orthotopic and heterotopic.
Orthotopic liver transplant: The recipient liver and gallbladder are excised and the cadaveric liver is transplanted.
Heterotopic liver transplant: The recipient liver remains in place and a portion of donor liver is transplanted.
Orthotopic transplantation is the most common type of liver transplantation.
Liver transplantation is performed to eliminate irreversible liver disease.
Indications for liver transplantation in adults include cirrhosis.
Indications for liver transplantation in children include biliary atresia.
The most common complications of liver transplantation are hepatomegaly and infection.
The arterial and venous anastomosis for orthotopic liver transplant requires at least three anastomosis:
- The extrahepatic portal vein.
- Hepatic artery.
- Suprahepatic IVC.
- Infrahepatic IVC may be necessary.
Sonography is not a valuable tool for confirmation of liver transplant rejection (not sensitive for diagnosis).

Cystic Lesions

Cystic lesions may be congenital or acquired, solitary or multiple.
Differential diagnosis of liver cyst includes:
- Simple cyst.
- Polycystic liver disease.
- Hydatid cyst.
- Cystic tumors.
- Abscess.

Simple Hepatic Cyst

Simple hepatic cyst is usually incidental because most patients are asymptomatic.
As the cyst grows, it may cause pain or a mass effect.
Hepatic cysts occur more often in females than in males.
Sonographic findings of simple (benign) cyst include:
- Thin wall, well-defined borders, and anechoic, with posterior enhancement and edge shadowing.
Complications, such as hemorrhage, may occur and cause pain.
Calcification may be seen within the cyst wall and may cause shadowing.

Polycystic Liver Disease

Polycystic liver disease is inherited in an autosomal dominant pattern.
50% to 74% of patients with polycystic renal disease have hepatic cysts.
The cysts are small, less than 2 to 3 cm, and multiple throughout the hepatic parenchyma.
Liver function tests are usually normal.
Sonographic findings include:
- The cysts generally present as anechoic, well-defined borders with acoustic enhancement.

Infectious Diseases

Hepatic abscesses occur most often as complications of biliary tract disease, surgery, or trauma.
The three basic types of abscess formation are intrahepatic, subhepatic, and subphrenic.

Pyogenic Abscesses

Pyogenic abscess is a pus-forming abscess.
Can result from the spread of infection from inflammatory conditions such as appendicitis and cholecystitis.
Commonly occur in the right lobe of the liver.
Clinically, patients present with fever, nausea, vomiting, right upper quadrant pain, and hepatomegaly.
Elevated liver function tests and leukocytosis are present.
The most frequent organisms are Escherichia coli and anaerobes.
Aspiration is needed to confirm diagnosis.
Sonographic findings include:
- The abscess may be hypoechoic with acoustic enhancement.
- May be complex, with irregular thick walls.
- If gas is present, it can be hyperechoic with dirty shadowing or ring-down artifact.

Amebic Abscess

Amebic abscess occurs when a parasite (Entamoeba histolytica) from the intestines reaches the liver via the portal vein.
Difficult to differentiate from a pyogenic abscess.
Amebic abscess may be the correct diagnosis if the patient has traveled outside of the United States.
Aspiration may be required for diagnosis.
Symptoms and findings include:
- Right upper quadrant pain, fever, and bloody diarrhea.
- Leukocytosis and elevated liver function tests.
Sonographic features include:
- The abscess is hypoechoic with low-level echoes (complex mass), may be round or oval and lack defined wall echoes, and have some acoustic enhancement.
- Typically occurs in the right lobe (dome), contiguous with the liver capsule.

Fungal Abscess (Candidiasis)

Hepatic candidiasis is caused by a species of Candida.
Usually occurs in immunocompromised hosts such as patients undergoing chemotherapy, organ transplant recipients, or individuals with human immunodeficiency virus (HIV) infection.
Clinically: right upper quadrant pain, fever, and hepatomegaly.
Specific diagnosis can only be made with needle aspiration.
Sonographic findings:
- Bull’s-eye (target) lesions - shows diffuse, homogeneous, hypoechoic foci.
- The appearance of these lesions can change over the course of the disease process.

Echinococcal Cyst (Hydatid Cyst)

Develops from a parasite known as Echinococcus granulosus.
This parasite lives in dog feces.
Food contaminated (with eggs) by infected feces consumed indirectly by sheep, cattle, goat, and possibly humans.
Seldom encountered within the United States.
It has the highest incidence in countries in which sheep herding is common.
The parasite moves from the bowel through the portal vein to enter the liver (the most common site for growth).
Clinically, low-grade fever and right upper quadrant tenderness.
Surgical resection or medical treatment may be used to manage a hydatid liver cyst.
Sonographic appearance can be variable.
- Simple cyst can contain some debris.
- Honeycomb appearance.
- Floating membranes can be seen within the cyst (water lily sign).
- Hydatid cysts may also appear as cysts within a cyst.
- The mass may also contain some elements of dense calcification.

Schistosomiasis

Schistosomiasis is a parasitic infection in humans.
Endemic in tropical zones around the world.
Eggs reach the liver through the portal vein resulting in periportal fibrosis.
The intrahepatic portal veins occlude resulting in portal hypertension.
Sonographic findings include:
- Occluded intrahepatic portal veins.
- Thickening and increased echogenicity of the portal vein walls.
- Secondary signs of portal hypertension.

Granulomas

Present as small calcifications in the liver and spleen.
Caused by Histoplasmosis or Tuberculosis infection.

Benign Hepatic Tumors

Cavernous hemangioma.
Focal nodular hyperplasia (FNH).
Hepatic Lipoma.
Hepatic adenoma.
Hepatic Hematoma.

Cavernous Hemangioma

Cavernous hemangioma is the most common benign neoplasm of the liver.
More common in women.
Patients are usually asymptomatic (incidentally detected).
Hemangiomas consist of multiple vascular channels (blood-filled spaces) that create multiple sonographic interfaces which give this mass its characteristic hyperechoic appearance.
May enlarge as a result of estrogen stimulation during pregnancy.
Sonographic findings include:
- They are found in the subcapsular hepatic parenchyma or in the posterior right lobe.
- The lesion has well-defined borders, is round or oval, homogeneous, hyperechoic mass that is usually less than 3 cm in size with acoustic enhancement.
- There is low-velocity blood flow that is too low to be detected by color Doppler. This diminished blood flow pattern may help to distinguish the hemangioma from a malignant mass.
- Cavernous hemangioma. The appearance is typically a homogeneous, hyperechoic mass that is usually less than 3 cm in size.

Focal Nodular Hyperplasia (FNH)

The second most common benign liver mass after hemangioma.
Typically contains a central scar that is not always detected with sonography.
Patients who have FNH are most often asymptomatic.
Hormonal influence may be present as FNH is found more commonly in women under 40 than in men.
FNH generally demonstrate a solitary, well-circumscribed (isoechoic, hyperechoic, or hypoechoic), a non-encapsulated multinodular mass, and many have a central scar.
The size of the mass is usually less than 5 cm.
FNH has been referred to as a “stealth lesion” because it may be difficult to identify secondary to its slight sonographic disparity from normal liver parenchyma.
Sonographic finding includes:
- FNH may be difficult to identify secondary to its slight sonographic disparity from normal liver parenchyma.

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Description

This quiz covers essential information about liver cancer and lymphomas, including clinical features, diagnostic findings, and the importance of sonography. It discusses metastasis to the liver from various primary cancers and identifies key aspects of lymphoma diagnosis. Enhance your understanding of these crucial medical topics.