Abstract
CLINICOPATHOLOGICAL STUDY AND MANAGEMENT OF PRIMARY HEPATIC SPACE OCCUPYING LESIONS

Dr. Niranjan Jadhav, *Dr. Harshal Ramteke and Dr. Dhirendra Wagh

ABSTRACT

The liver is the largest organ in the abdomen, weighing about 1800 g in men and slightly less in women. A space occupying lesion by definition is a discrete abnormality arising within the liver. Space occupying lesions of the liver can be classified into developmental, neoplastic, inflammatory and miscellaneous. Although in some cases, it is difficult to distinguish these entities with imaging criteria alone, certain focal liver lesions have classic ultrasonic, computed tomographic (CT) and magnetic resonance (MR) imaging feature. The majority of these lesions are detected incidentally in asymptomatic patients.[2] [3] An accurate history and physical examination are essential for the diagnosis and treatment of solid liver masses. For example, the use of oral contraceptives or anabolic steroids might be related to hepatic adenoma (HA), alcohol use and occupational exposure are associated with angiosarcoma and primary sclerosing cholangitis, liver fluke, Caroli’s disease, and choledochal cysts are associat ed with cholangiocarcinoma.[4] Physical examination should look for liver tenderness, stigmata of chronic liver disease, or general deterioration signs (fever, we ight loss). High alkaline phosphatase, high lactate dehydrogenase (LDH), low albumin, high prothrombin time, and iron overload are non-specific but might suggest an underlying chronic hepatitis, cirrhosis or an infiltrative process.[4] Hence, this study mainly intends to know the incidence, various modes of presentation, different modalities of diagnosis, treatment and prognosis in a rural setup, studied to identify factors which can help in better management of these cases thus helping to improve the prognosis and management care in primary hepatic space occupying lesions. Aim: To do the clinicopathological study and management of primary hepatic space occupying lesions. Conclusion: This study was carried out at Jawaharlal Nehru Medical College and Acharya Vinoba Bhave Rural Hospital, Sawangi(M), Wardha, Maharashtra, between July 2015 TO October 2017.  Out of 45 primary hepatic space occupying lesions in this study, most common lesion were liver abscess and hydatid cyst of liver and the most common neoplastic lesion was hepatocelullar carcinoma.  USG was the imaging modality of choice and was highly effective in diagnosis with 100% sensitivity and specificity, although this is operator dependant.  Percutaenous drainage proved to be the best treatment modality in case of liver abscess with supportive therapy and was associated with less complications, which is suggestive that minimal invasive treatment is the need of the hour.  Partial cystectomy with ometoplasty was the treatment of choice in case of hydatid cyst of liver with better outcome.  Management in case of malignant lesions such as hepatocellular carcinoma and intrahepatic cholangiocarcinoma who presented in advanced stages was done by palliation and chemotherapy.  Cholangitis is the most common complication in our study, which is associated to the direct consequence of the disease or due to the iatrogenic causes such as instrumention during surgery or any image guided procedure.

Keywords: Liver, primary hepatic space occupying lesions, hydatid cyst, cholangiocarcinoma, liver abscess.


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