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Ebook The mont reid surgical handbook (6th edition): Part 2

(BQ) Part 2 book "The mont reid surgical handbook" presents the following contents: Benign and malignant liver lesions, renal transplantation, liver transplantation, pancreas transplantation, malignant skin lesions, diseases of the breast, breast reconstruction, gastric tumors, malignant pancreas disease, colorectal cancer,. and other content. | Benign and Malignant Liver Lesions Andreas Karachristos MD PhD The presence of solid asymptomatic liver lesions is increasingly recognized because of 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 this chapter and a common clinical problem for each is discussed briefly. 48 I. SOLID LIVER LESIONS Most importantly one must differentiate between malignant and benign disease and if benign which is far more common whether the patient needs any further follow-up or treatment. A. BENIGN 1. Hemangioma a. This is the most common benign tumor prevalence rate is 7 to 20 in ultrasound and autopsy series. Female male ratio is 3 1. b. Vascular malformation that enlarges by ectasia c. 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 appears as a sharply defined mass with sequential globular opacification from outside in. In magnetic resonance imaging MRI the tumor appears higher in signal density on T2-weighted images. e. Technetium-99m pertechnate-labeled red blood cell scan can usually provide definitive diagnosis. f The majority of patients can be managed by observation alone. g. Resection or enucleation is indicated in symptomatic patients or inability to exclude malignancy. 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 therapy including embolization or resection with concomitant treatment of coagulopathy. 2. Focal nodular hyperplasia FNH a. FNH is the second most .