Ebook The mont reid surgical handbook (6th edition): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook The mont reid surgical handbook (6th edition): Part 2
Ebook The mont reid surgical handbook (6th edition): Part 2
Benign and Malignant Liver LesionsAndreas Karachristos, MD, PhDThe presence of solid asymptomatic liver lesions is increasingly recognized because of Ebook The mont reid surgical handbook (6th edition): Part 2 the availability of sophisticated imaging. Management depends on knowledge of the pathology, radiologic appearance, and clinical behavior of each lesion. Generally, liver lesions can be morphologically differentiated into solid and cystic. The most common diagnosis of each category is described in Ebook The mont reid surgical handbook (6th edition): Part 2this chapter, and a common clinical problem for each is discussed briefly.48I.SOLID LIVER LESIONSMost importantly, one must differentiate between maliEbook The mont reid surgical handbook (6th edition): Part 2
gnant and benign disease, and if benign (which is far more common), whether the patient needs any further follow-up or treatment.A. BENIGN1. HemangiomBenign and Malignant Liver LesionsAndreas Karachristos, MD, PhDThe presence of solid asymptomatic liver lesions is increasingly recognized because of Ebook The mont reid surgical handbook (6th edition): Part 2on that enlarges by ectasiac.Generally remains stable over time but occasionally may demonstrate growth. Rapid expansion may cause symptoms by stretching of Glisson’s capsule or pressure on neighboring organs.d.In contrast-enhancing computed tomography (CT), during the arterial phase, the tumor appe Ebook The mont reid surgical handbook (6th edition): Part 2ars as a sharply defined mass with sequential globular opacification from “outside in.” In magnetic resonance imaging (MRI), the tumor appears higherEbook The mont reid surgical handbook (6th edition): Part 2
in signal density on T2-weighted images.e.Technetium-99m pertechnate-labeled red blood cell scan can usually provide definitive diagnosis.f.The majoriBenign and Malignant Liver LesionsAndreas Karachristos, MD, PhDThe presence of solid asymptomatic liver lesions is increasingly recognized because of Ebook The mont reid surgical handbook (6th edition): Part 2 Usually hemangiomas smaller than 10 cm do not produce symptoms.h.Kasabach-Merritt syndrome is a rare entity of giant hemangioma associated with diffuse intravascular coagulopathy. Patients need urgent ther-532Hepatobiliary Surgeryb.Developmental vascular malformation that induces a vascular hyperpl Ebook The mont reid surgical handbook (6th edition): Part 2astic process. Unclear relation with oral contraceptives.c.Majority of patients are and remain asymptomatic; however, symptoms occur in up to 10% of pEbook The mont reid surgical handbook (6th edition): Part 2
atients.d.In contrast-enhanced CT, it appears as homogenous hyperattenuating in arterial phase with central scar and radiating bands. In MRI, Tl-weighBenign and Malignant Liver LesionsAndreas Karachristos, MD, PhDThe presence of solid asymptomatic liver lesions is increasingly recognized because of Ebook The mont reid surgical handbook (6th edition): Part 2r colloid scan may be useful in confirming diagnosis.f.The lesion that resembles FNH is fibrolamellar carcinoma.g.The majority of patients can be managed by observation alone. In asymptomatic patients, if definite diagnosis is provided by imaging, no further follow-up is necessary.3. Hepatocellular Ebook The mont reid surgical handbook (6th edition): Part 2adenoma (HA)a.Rare, benign proliferation of hepatocytesb.The annual incidence is approximately 1 in 1,000,000 people in noncontraceptive users, and thEbook The mont reid surgical handbook (6th edition): Part 2
e risk is increased 500-fold in women who are long-term users.c.Female/male ratio is up to 11:1.d.Documented link with long-term oral contraceptive usBenign and Malignant Liver LesionsAndreas Karachristos, MD, PhDThe presence of solid asymptomatic liver lesions is increasingly recognized because of Ebook The mont reid surgical handbook (6th edition): Part 2hough the exact risk is not well defined.g.Usually are solitary but can be multiple in up to 30% of casesh.In contrast-enhanced CT, adenomas often demonstrate moderate enhancement during the arterial phase that tends to be less than that seen in FNH. In MRI, the majority of adenomas are hyperintense Ebook The mont reid surgical handbook (6th edition): Part 2 in Tl-weighted images and isointense or hyperintense on T2-weighted images. There is overlap with FNH, and it sometimes is difficult to differentiateEbook The mont reid surgical handbook (6th edition): Part 2
the tumor.i.Most HAs should be resected. Discontinuation of oral contraceptives should be advised.j.Behavior of HAs during pregnancy is unpredictableBenign and Malignant Liver LesionsAndreas Karachristos, MD, PhDThe presence of solid asymptomatic liver lesions is increasingly recognized because of Ebook The mont reid surgical handbook (6th edition): Part 2abilize the patient.B. MALIGNANTBenign and Malignant Liver LesionsAndreas Karachristos, MD, PhDThe presence of solid asymptomatic liver lesions is increasingly recognized because ofGọi ngay
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