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home - Liver - Liver Masses - Simple liver cysts Written by Dr Sebastian Zeki

Knows the epidemiology pathology clinical presentation and natural
history of benign tumours of the liver

Can define a programme of investigation and characterisation of
benign liver lesions including haemangioma focal modular
hyperplasia and adenoma

Demonstrates ability to make an appropriate differential diagnosis
Formulates appropriate plan of management
Recognises importance of the role of multidisciplinary team in
diagnosis and management



Understands the epidemiology risk factors pathology prevalence
and range of presentations of HCC

Knows the appropriate investigation and staging of the disease
Aware of treatment options including trans-arterial
chemoembolisation (TACE) radiofrequency ablation (RFA) local
ethanol injection

Appreciates the indications and contraindications of each and how
the most appropriate is selected Aware of surgical treatment options

Aware of role of surveillance and referral for specialist multidisciplinary management including liaison with oncology

Appreciates the indications and contraindications of each modality of
treatment and how the most appropriate is selected

Understands the process of selection of patients for liver resection or

Appreciates Involvement of multi-disciplinary team in management
decisions close liaison with surgical radiology oncology and
pathology colleagues

Simple liver cysts

Treatment Cysts should be monitored(>4 cm in diameter) at 3, 6 and 12 months.Increasing size may mean its a cystadenoma so may require surgical intervention. EpidemiologyIt is present in 1 % of the population.It is more common in the right lobe.M:F 1.5:1 among those with asymptomatic simple cysts while it is 9:1 in those with symp-tomatic or complicated simple cysts.Huge cysts are found almost exclusively in women over 50. The larger, the more symptomaticLarge cysts can produce atrophy of the adjacent hepatic tissue Huge cysts can cause complete atrophy of an hepatic lobe with compensatory hypertrophy of the other lobe.Complications: Spontaneous hemorrhage, bacterial infection, torsion of pedunculated cyst, or biliary obstruction Diagnosis USS shows anechoic unilocular fluid filled space with imperceptible walls, and with posterior acoustic enhancement.CT shows a well-demarcated water attenuation lesion that does not enhance following the administration of intravenous contrast.Uncomplicated simple cysts are virtually never septated.Haemorrhage into a simple cyst can lead to confusion in the sonographic differentiation from a cysta-enoma or cystadenocarcinoma.MRI shows a well-defined water-attenuation lesion that does not enhance following the administration of intravenous Gadolinium.On MRI-T1-weighted images the cyst shows a low signal, whereas a very high intensity signal is shown on T2-weighted images. Simple cysts Pathological Features:An outer layer of a thin dense fibrous tissue.An inner epithelial lining consisting of a single layer of cuboidal or columnar epithelium; this layer is found in most but not in all simple cysts.A lack of mesenchymal stroma or cellular atypia. Simple Hepatic Cysts Aspiration is usually not required for diagnosing cysts that have a typical sonographic appearance.When it is performed, the aspirated fluid is always sterile and cytologically negative.It may vary from clear straw color to brown Symptomatic, large simple cysts:1. Needle aspiration with or without injection of sclerosing solution (high failure rate and rapid recurrence)2. Internal drainage with cystojejunostomy3. Wide unroofing ( low recurrence rate)- done laporoscopically is safe as long as accessible4. Cyst resection. Written by Dr Sebastian Zeki

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