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Primary Liver Tumors
Fibrolamellar hepatocellular carcinoma is typically a disease of younger adults and females. Patients typically have elevated blood neurotensin levels, normal liver function tests, and no cirrhosis. Epithelioid hemangioendothelioma are usually of borderline malignancy and express factor VIII, confirming their endothelial origin. OLTX may produce prolonged survival. Gallbladder cancer has a worse prognosis. Most patients have a history of antecedent gallstones, but very few patients with gallstones develop gallbladder cancer. Clinical presentation is typically that of chronic cholecystitis, chronic right upper quadrant pain, and weight loss.
Cholangiocarcinoma refers to mucin-producing adenocarcinomas that arise from the biliary tract and have features of cholangiocyte differentiation. They arise on the basis of cirrhosis. Nodular tumors arising at the bifurcation of the common bile duct are called klatskin tumors and are often associated with a collapsed gallbladder. A number of predisposing factors have been identified. Most typically presents as painless jaundice, often with pruritus or weight loss. Diagnosis is made by biopsy, or more commonly via endoscopic retrograde cholangiopancreatography. Treatment include photodynamic therapy, radio-sensitizing therapy, hepatic arterial chemotherapy.
Metastatic and Benign Tumors
Carcinoma of the ampulla of Vater is mainly adenocarcinoma. Locoregional lymph nodes are commonly involved. The most common clinical presentation is jaundice. Patients also have pruritus, weight loss, and epigastric pain. Colorectal and breast hepatic metastases were treated with continuous hepatic arterial infusion chemotherapy. More effective systemic drugs for each of these two cancers have reduced the use of hepatic artery infusion therapy. Three common benign tumors are hemangiomas, adenomas, and focal nodular hyperplasia. Treatment for hemangiomas is unnecessary unless their expansion causes symptoms. Adenomas can cause pain and can bleed or rupture, causing acute problems.