DIAGNOSTIC APPROACH TO HEPATIC NEOPLASMS



Most hepatic neoplasms present with right upper quadrant abdominal pain or an abdominal mass. Hemorrhage, systemic manifestations, and biliary obstruction (from strategically located tu­mors] may also occur. Visualization of discrete focal lesions and histological examination of tis­sue are generally required for diagnosis. Thus evaluation employs one or more imaging procedures followed by percutaneous, laparoscopic, or surgical biopsy of one or more lesions. Radionu­clide scanning is a reasonable first step in the work-up, although imaging by computed tomog­raphy or ultrasound may be more sensitive in de­tecting small lesions and offers the advantage of performing guided percutaneous biopsy or aspi­ration cytology. Localization of lesions is gener­ally followed by biopsy; however, additional fac­tors must be considered. Percutaneous biopsies of vascular lesions such as hemangiomas, angios­arcomas, and perhaps hepatocellular adenomas are potentially dangerous, whereas cells obtained by aspiration cytology frequently fail to differ­entiate hepatocellular adenoma, hepatocellular carcinoma, and normal hepatocytes. Thus, the choice of procedures will depend on the diag­nostic and therapeutic options under considera­tion.





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