Liver tumors

Benign tumors is fibromyoma, lipoma, hemangioma and separatornyi cysts.
Fibromyoma, lipoma asymptomatic, are rare. A hemangioma of the liver is divided into old and birth. Senile hemangioma is usually plural, clinically apparent. Congenital hemangioma sometimes reach large sizes. Is experienced as a feeling of heaviness in the epigastric region, sometimes symptoms, caused by compression of adjacent organs. Objectively determine dense tumor that moves when you inhale. On rare occasions, there is a gap hemangioma spontaneous or injury. Surgical treatment. Separatornyi cysts can be single and multiple (polycystic). Polycystic liver combined with cystic degeneration in the kidneys, ovaries, spleen (polycystic disease). The liver is enlarged, firm, painless; sometimes on the surface it can be found elastic tumor. Liver function is not disturbed. Lifetime is rarely diagnosed.
Malignant neoplasms - cancer and sarcoma. Primary liver cancer in most cases develops on the background of existing liver disease (cirrhosis and chronic hepatitis). Clinical symptoms: a rapidly progressive weight loss, gravity in the right hypochondrium, nausea, sometimes vomiting, pain in the liver with irradiation in the back and the right half of the thorax, bloating, diarrhea, and in some cases, persistent low-grade fever. The liver is enlarged, firm, diffuse form its surface is smooth, with a hub bumpy. Diagnosis is confirmed by x-ray, and needle biopsy of the liver or laparoscopy. Treatment - surgery (resection of the liver or part of it). Of drugs used 5-fluorouracil and sarkolizin.
Metastatic liver tumors (secondary liver cancer) are often observed in cancer of the pancreas, gall bladder, stomach, and mammary gland, lungs. The clinical picture is primarily due to the symptoms characteristic for the primary tumor localization. At a palpation of the liver, as well as primary cancer can be defined dense nodes.
Sarcoma of the liver are rare, at a younger age. The clinical picture is similar to primary liver cancer. Treatment is the same as in primary liver cancer.

Benign tumors. Most often observed in the liver vascular tumor - cavernous hemangioma (multiple and single), much less often - lymphangioma. Multiple hemangioma is represented in the form of small tumors the size of a cherry, is located subserous on the surface P. (rare in depth); tumor smooth or slightly rough, painted in dark red, brown or even black, dotted with whitish star-shaped spots. Single hemangioma spherical shape is the size of a fist and more is often on the edge of the left lobe of Peterhof, also subserous, its surface is rough or croproperty, dark red, purple or black.
The tumor lies in the thickness of the Isthmus, on the edge of it, but often it is hanging on the leg. Both views cavernous hemangioma is more common in older women, rarely in men (senile angioma). Cavernous hemangioma, especially the multiple, often asymptomatic. Only if you have large tumors patient feels heavy and dull persistent mild pain in epigastria. Objectively determined rounded possible to reveal certain, moving together with the liver tumor testovaty consistency. In some cases, over the tumor heard vascular noise (noise top). Hemangioma grow very slowly. Only sometimes after the injury occurs a significant growth.
Multiple hemangiomas, if they are asymptomatic, are not subject to any treatment. Angioma, diagnosed before laparotomy or discovered during her, are subject to removal because of the possibility of heavy bleeding. The operation consists in bandages and crossing legs hemangioma, if any; husking tumors in cases where there is the expressed capsule separating the tumor from healthy liver tissue; resection of the share P., which is easier when the location of the tumor in the left lobe. Reported cases of healing by thrombosis with subsequent scarring of the tumor.
Significantly less likely to develop liver adenomas of three types: a) coming from the liver cells - hepatoectomy; b) coming from the epithelium of the biliary tract - cholangiocarcinoma; C) mixed - cholangiocarcinoma. This multi compact little dark-brown color of the tumor, on terms similar to lipoma. X holangiogepatit sometimes reach the size of a fist.
Adenomas are often subkapsuliarna in the right lobe P.; they have their own capsule and easy velosipeda of P. they sometimes Develop after suffering a massive necrosis P. on the background of cirrhosis.
Fibromyoma, fibroids, lipoma is very rare, asymptomatic.
Cysts. There are separatornyi and parasitic cysts. Separatornyi cysts P. divided into true and false. True cysts can be a single, one - and multi-chamber (cystadenoma) and multiple (polycystic liver). In polycystic simultaneously with cystic degeneration P. this same process occurs in the kidneys, less frequently in the pancreas, ovaries, spleen (polycystic disease). Parenchyma P. saved, and therefore its function is not impaired. P. enlarged, firm, painless at a palpation, on the surface it is determined supple smooth different size of the cyst. Often this disease occurs in children. Not manifesting any symptoms, polycystic P. lifetime is usually not diagnosed.
Rare dermoid cysts of the liver and retention solitary cysts are formed due to blockage of one of the intrahepatic bile ducts. The latter usually congenital and develop from aberrant bile ducts. During these cysts slow asymptomatic.
False cyst is formed from hematoma after injuries Pona is devoid of epithelium cavity, filled with muddy liquid. Wall cyst is fibrous capsule former hematoma. The same origin subcapsular lymph cysts, developing after injury of the liver.
False cysts, in most cases are located on the edge of the right lobe and on its bottom surface, very rarely in square proportion, almost no clinically manifest. Only reaching significant proportions, they cause symptoms compression of the adjacent organs (stomach, duodenum and transverse colon), feeling of heaviness and pain in epigastria, and occasionally vomiting, etc. At this time is already visible deformation of the upper section of the abdomen due to protrusion
cysts. Rarely, jaundice appears (in case of compression of the common bile duct), yet at least ascites. When attached suppuration or bleeding in the cyst signs of abscess.
When the cyst rupture (trauma, tension develops a picture of perforation.
Diagnosis very difficult.
Operative treatment-husking or crossing of legs (the latter often have a cyst, outgoing from the edge of P.). Only in cases where husking is technically impossible, resort to marsupialization (see), vshiva Krai revealed shell cysts incision in the abdomen. In the cyst of the left lobe P. reaching considerable size and disrupt the function of neighboring organs, may require cutting off entire lobe of the liver.


Malignant neoplasms. Primary liver cancer occurs not as rare as it was assumed until recently. It usually develops on the ground preceded cirrhosis, chronic hepatitis, jelchnokamennaya disease, complicated by cholangitis, opisthorchiasis, and other Tumor comes from liver cells (hepatoma) or from the epithelium of intrahepatic bile ducts (cholangiomas).
Hepatoma (see) are much more common, predominantly in men.
Clinically already in the initial period of development of tumors appear rapidly progressive loss of weight, loss of appetite, weakness, gravity in the right hypochondrium, flatulence, diarrhea, weakness, increased leukocytosis, accelerated ROHE. In the late stage in all cases, there is a large cartilaginous density liver thickened with a rounded edge, painless, with rough surface and large dense nodes. Celebrated brown, dirty-grey colour of the face, crimson colour of the palms. Early slight jaundice, which in the later period is never pronounced. Region P. pushed forward and to the right, sharply reduced its mobility during breathing. Sooner pain in the zone of P. radiating to the back and right halves of the chest, later they become unbearable, often develop ascites, edema of the legs, occasionally splenomegaly, cachexia. In 50% of cases there early and persistent increase the evening the temperature to 38 degrees.
To differentiate cancer P. falls from hypertrophic cirrhosis of Gano, alveolar Echinococcus, vaginal cancer right kidney, congestive liver, etc. Diagnosis is facilitated percutaneous biopsy ("tiny biopsy" by E. C. Zakrzewska).


Fig. 33. Liver resection for cancer.

Treatment is possible only online (resection share P. or part of it) and only when there is a single node on the periphery P. Operation resection of the liver (Fig. 33) encouraging results.
Secondary cancer P. unlike primary malignant tumors, cancer metastases, primary localized in organs of the abdominal cavity, pelvis, breast, lung, found in P. often. Metastases are growing rapidly, outpacing the primary tumor. Thus the liver increases in volume, it becomes thick, rough, slightly painful. The characteristic multiplicity of metastases, but there are single nodes. Diagnosis is relatively simple, it is often more difficult to identify the primary tumor site. The prognosis is poor.
Sarcoma P. are extremely rare, affecting younger people (often children). In the clinic of them there is nothing typical.
Occasionally there are metastases of melanoma. Usually it is a single large site or multiple small sites characteristic slate-gray or black color, which is located on the surface or in the thickness of the liver. In the early stages of melanoma growth urine patient becomes black. The prognosis is poor - the tumor is rapidly increasing in volume, developing early cachexia.
Should rarely in developing P. metastasis vaginal cancer, the lifetime is not diagnosed.