in this video we'll talk about benign liver tumors this is not really a complex topic there's not a whole lot you need to memorize here but there are a few really high yield buzzwords that I want you to deposit in the back of your mind because when you're taking your exams oftentimes when you see or hear about liver pathology your brain is going to reflex to the really really high yield topics hepatocellular carcinoma cirrhosis all of the microbiology that we associate with different liver pathology but it's really important to know about the benign liver tumors because these have such characteristic associations and buzzwords so in other words it's free points if you take five minutes to learn it and I'm all about giving you the most amount of free points possible so let's Dive Right into this in this video we'll talk about three different benign liver tumors one is hepatic Hemangioma two is hepatocellular adenoma and three is focal nodular hyperplasia let's start with hepatic command geoma so hepatic Hemangioma really not a whole lot to memorize so we're starting off pretty easy this is the most common benign liver tumor and that's important for step two level two and Beyond so kind of a theme Here step two level two and Beyond focuses a lot more on epidemiology so if you have a patient on step two level two or step three level three they describe something they show you some Imaging and you're thinking this is probably some type of liver growth if you think it's benign and you have no other information in the vignette to guide your answer you should probably pick hepatic Hemangioma based simply on the fact that it's the most common benign liver tumor again epidemiology very important to know once you're at that step two level two phase this has a very high female to male ratio it tends to affect middle aged adults roughly between the ages of 30 and 50. this is likely influenced by estrogen levels but that's not important to know again a high yield fact here most common benign liver tumor now anytime we have a tumor in the liver you're going to see some key clinical features right upper quadrant pain early satiety and nausea and vomiting this should make sense right there's a growth in the liver so we have right upper quadrant pain we have sort of a mass effect pushing on the surrounding so you're going to get early satiety and you're going to get nausea and vomiting this is going to be the clinical features of all the benign liver tumors not just specific to hepatic hemangioma here's an image of hepatic Hemangioma really the only thing to pay attention to here is that it's very well demarcated and this can be useful when you're taking exams if you see an image and you see a very well demarcated liver growth then that kind of nudges you in the direction of hepatic Hemangioma but it's uniform and it's homogeneous as far as the histology goes you'll see cavernous vascular spaces lined by flat endothelial cells admittedly this image is not very high yield what I want you to take away from hepatic Hemangioma is that it's the most common benign liver tumor and it's very well demarcated on Imaging that's hepatic hemangioma for hepatocellular adenoma this has the highest female to male ratio of all of the benign liver tumors so it tends to affect women of child bearing age what's incredibly important to memorize here is that hepatocellular adenoma is highly associated with two substances one oral contraceptives and two anabolic steroids so on your exam if you have a patient that's on either one of these things and all of a sudden they have those clinical features suggestive of a possible growth in the liver you need to have that light bulb go off in your head that Associates oral contraceptives and anabolic steroids with hepatocellular adenoma now this has a risk of hemorrhage and rupture during pregnancy and it also has a risk of malignant transformation to hepatocellular carcinoma clinical features are going to be the exact same that we've already talked about so again we have a growth in our liver that's going to hurt so we're going to have right upper quadrant pain we're going to have that growth kind of expanding the surface area in the abdomen so we're going to get full sooner we're also going to feel a little bit of a little bit of nausea and some vomiting now treatment really really important because hepatocellular adenoma is associated with oral contraceptive and anabolic steroid use the best treatment is to Simply discontinue the offending agent so if you're taking oral contraceptives stop using them if you're taking anabolic steroids stop using them now really really handy to Manicure hepatocellular adenoma ha helps me memorize what the association is so for oral contraceptives they h a they help avoid pregnancy anabolic steroids they help add huge gains okay so h a hepatocellular adenoma ha for helping to avoid pregnancy in the case of oral contraceptives and AJ for helping to add gains in the case of anabolic steroids quickly for histology you'll see in large hepatocytes with abnormal lobules but that's hepatocellular adenoma the big takeaway from hepatocellular adenoma is its association with oral contraceptives and anabolic steroids let's conclude by talking about focal nodular hyperplasia so this has a high female to male ratio and it tends to affect females it roughly in the age range of 30 to 40 and if it affects males they tend to be more elderly this is associated with hepata Excuse me hepatic arteriovenous malformation so avms so that's a very very high yield association with focal nodular hyperplasia clinical features exactly the same features that we've already seen again to beat a dead horse here we've got a tumor in the liver that's going to hurt the liver we're going to feel right upper quadrant pain the amount of surface area in our abdomen is going to be expanding so we're not going to be as hungry we're going to get early satiety and also we're going to feel nauseous and we're going to vomit so this should all make perfect sense now focal nodular hyperplasia two two really high yield things to know one is It's associated with avms that we already talked about and the other is what you see on Imaging so here's an image that shows what's known as a central stellite Scar and it kind of looks like a a star-like uh graphic in the middle of the tumor so if you see this this is very very different from the well demarcated homogeneous images that I've shown you thus far so if you're taking your exam and you've got right upper quadrant pain and maybe some vague symptoms otherwise and they show you this image your brain needs to go off firing saying oh that's a central stellate scar it looks like a star if you will in the growth that has to be focal nodular hyperplasia so of all of the benign liver tumors that we've talked about today this is the only one with three where words in the name and because it is focal nodular hyperplasia I always memorize F and H and fnh is associated with the things that have three letters because fnh itself has three letters so fnh is associated with CSS which is Central stellate scar again three letters and avms arteriovenous malformations so all you need to take away literally from focal nodular hyperplasia is fnh equals CSS and AVM if you can memorize that then these are free points for you on your test day