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Part IV ♦ Gastrointestinal Disorders

HEPATIC ADENOMA I. Etiology: Usually seen in women on oral contraceptives (OCPs), and both genders with anabolic steroids. II. Clinical presentation: 30% present with spontaneous rupture (mortality with rupture is 9%); otherwise found incidentally. III. Diagnosis: MRI is test of choice. IV. Treatment A. Medical: Stop OCPs, stop anabolic steroids. B. B Surgical: 1. Elective: Resect if greater than 4 cm or in anticipation of pregnancy. 2. Emergent (rupture): Embolization or resection. V. Prognosis. A. Excellent for small lesions. B. Five percent risk of malignant transformation in large adenomas. FOCAL NODULAR HYPERPLASIA I. Etiology: Hyperplastic response to an anomalous artery. II. Clinical presentation: A. Females > males. B. Usually incidentally found. III. Diagnosis A. Based on imaging. B. MRI shows characteristic “central stellate scar”. IV. Treatment: Observation—tumor rarely bleeds and has no malignant potential. V. Prognosis. Excellent. The lesion may regress. Quick Cuts • Hemangiomas show characteristic centripetal enhancement and do not need to be resected unless symptomatic. • Hepatic adenomas can rupture and should be resected if greater than 4 cm or plans for pregnancy. • Focal nodular hyperplasia (FNH) has a central stellate scar on imaging and does not need to be resected unless symptomatic.

CUT TO CASEBOOK See NMS Surgery Casebook , 3rd edition, Case 7.17: Hepatic Mass.

HEPATOCELLULAR CARCINOMA (FIG 10-4) I. Etiology: A. Most common primary malignant liver tumor. B. Associated with chronic hepatitis B/C virus, cirrhosis, hemochromatosis, schistosomiasis, and carcinogens.