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Chapter 10 ♦ Liver, Gallbladder, and Biliary Tree Disorders

Figure 10-4: CT scan demonstrating hepatocellular carcinoma ( arrow ). (From Erkonen WE, Smith WL. Radiology 101 , 3th ed. Baltimore: Lippincott Williams & Wilkins; 2009.)

II. Clinical presentation: A. Males < females.

B. Usually asymptomatic if small. C. Can present with malaise, fever, jaundice, weight loss, hepatomegaly, abdominal mass. III. Diagnosis: A. Alpha - fetoprotein level (AFP) B. CT or MRI : See classic pattern of enhancement with early arterial enhancement and washout. IV. Treatment: A. Depending on size and location, resect or consider liver transplant. B. If resection is not possible, do chemoembolization or ablation. V. Prognosis: A. 5-year survival is ~40% with resection and ~70% with transplant. B. Vascular invasion is the most important prognostic factor.

CHOLANGIOCARCINOMA I. Etiology:

A. Arises from bile duct epithelium. B. Five percent to 30% of primary hepatic malignancies.

C. Associated with parasitic infections (e.g., Clonorchis sinensis), primary sclerosing cholangitis (PSC), chronic inflammation, gallstones, thorotrast exposure. II. Classification A. Intrahepatic : Within the liver. B. Extrahepatic 1. Hepatic or common bile duct. 2. Klatskin tumor : When located at the confluence of the hepatic ducts.