{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 24, Ep 1 of 4: Benign Liver Lesions by Context","html":"","width":"100%","height":180,"duration":407,"description":"Episode one of the Liver Tumors and Transplant chapter runs the benign masses on a single decision: imaging appearance plus hormonal or drug context usually settles the diagnosis, and biopsy enters only when the imaging is atypical or the lesion has real malignant potential. Peripheral nodular enhancement filling inward is a hemangioma, hepatobiliary-phase retention is focal nodular hyperplasia, and hepatobiliary-phase darkening is an adenoma. From the adenoma you stratify by sex, size, growth, and beta-catenin status, because that subtype is what turns a benign mass into a resection case. The two edge entities, nodular regenerative hyperplasia and peliosis hepatis, round out the pattern-recognition set.\n \nTopics covered\n\nImaging-plus-context decision rule\nCavernous hemangioma and its enhancement pattern\nKasabach-Merritt syndrome\nFocal nodular hyperplasia and the central scar\nHepatic adenoma and oral contraceptives\nAdenoma molecular subtypes and beta-catenin\nAdenoma resection versus surveillance\nNodular regenerative hyperplasia and peliosis hepatis\n \n \nKey decisions\n\nA cavernous hemangioma shows peripheral nodular enhancement in the arterial phase that fills inward over the venous phase, and that classical pattern means no biopsy and no surveillance.\nTreat a hemangioma only when it is giant and symptomatic, causes Kasabach-Merritt syndrome with thrombocytopenia and consumptive coagulopathy, or drives high-output heart failure.\nFocal nodular hyperplasia retains a hepatobiliary contrast agent like gadoxetate because it has functioning hepatocytes and bile ductules, while an adenoma goes dark in that phase, so no needle is needed and the pill is not stopped when imaging is classical.\nResect any hepatic adenoma in a man regardless of size, plus any lesion five centimeters or larger, any growing lesion, any beta-catenin-positive lesion, any that has bled, and resect before a planned pregnancy.\nSmall adenomas in young women on the pill can be watched: stop the pill...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}