SOL Liver

Common liver lesions

Approach to liver SOL

• History• Clinical examination• Lab – Hemogram, LFT, Albumin,INR• Serology – ALA , Hydatid • Tumor markers – AFP,CEA, CA 19-9

Presentation

• Asymptomatic • Nodule on screening in cirrhotic patients • Presenting with pain and fever • SOL in a known patient of extrahepatic malignancy

Algorithm for Solitary SOL of Liver on USGNagral S , Clinics in GI Surgery

Algorithm for Solid lesions on USG

Nagral S , Clinics in GI Surgery

Algorithm for Multiple Liver SOLs on USG

Nagral S , Clinics in GI Surgery

Beyond USG – CT

• Symptomatic lesions – no response to treatment

• Alterations in LFT

• Underlying liver disease

When MRI ----- HCC vs regenerating nodule vs dysplastic nodule atypical lesions

Role of Biopsy

Usually not required

Diagnostic uncertainty

Screening strategy

BCLC staging

CASE CAPSULE

HISTORY

• 54 yrs gentleman, no comorbidities• Frequency, urgency, in• complete evacuation• No other GI symptoms

• USG abdomen – hypo echoic liver lesions

• Lab - normal

Colonoscopy

• Ulcero proliferative lesion in sigmoid colon• No synchronous lesions/polyps

• Biopsy - adenocarcinoma

What next ?

Chemotherapy

• FOLFOX + bevaxizumab – 7 cycles

• FOLFOX – 5 cycles

PET CT

Surgery

• Sigmoid colectomy + left lateral segmentectomy + metastectomy (seg 4b, seg 5, seg 7)