For unfathomable reasons, most hepatic lesions have striking gender bias.
Amoebic liver abscess is 9 times more common in men, and almost always present in the right lobe of the liver. It is almost always single. Coexistent amoebic colitis is rare and occurs in only 10% of cases. Serology is an excellent test.
Pyogenic abscesses are usually multiple. No gender bias.
Hepatocellular carcinoma occurs in a shrunken, cirrhotic liver, usually in the right lobe. It is 3 times more common in men, occurs in older subjects (usually >60) and is associated with a rise in serum alpha-fetoprotein in 70% cases.
Metastatic liver cancers are 30-times more common than primary hepatocellular cancer.
Fibrolamellar hepatocellular carcinoma occurs in much younger subjects- mean age 25. It accounts for 10% of primary liver cancers, and is not associated with a rise in alpha-fetoprotein. Distribution is equal between men and women, and between right and left lobes of liver. Prognosis is good, and if resected before metastasising , this cancer is associated with more than 60% 5-year survival. It occurs in a normal appearing liver (not cirrhotic) and has a central scar. Lesions are usually >10 cm, and can present with subcostal pain, intermittent pyrexia and weight loss over years.
Also with a central scar is focal nodular hyperplasia. It is usually solitary, discovered incidentally, is <5 cm in size, much more common in females and occurs in 3rd to 5th decades of life. Hepatic adenomas are almost exclusively seen in young women on oral contraceptives. When they occur in men, a history of anabolic steroid abuse must be sought. Cholangiocarcinomas are only slightly more common in men, but much more so when associated with sclerosing cholangitis, which is 9-times more common in men. Cholangiocarcinomas are often associated with a rise in serum Ca-19-9. However, this antigen is only present in subjects who have the Duffy blood group antigen. Gallbladder cancer is 2-6 times more common in women. Choledochal cysts are 3-4 times more common in women.
Amoebic liver abscess is 9 times more common in men, and almost always present in the right lobe of the liver. It is almost always single. Coexistent amoebic colitis is rare and occurs in only 10% of cases. Serology is an excellent test.
Pyogenic abscesses are usually multiple. No gender bias.
Hepatocellular carcinoma occurs in a shrunken, cirrhotic liver, usually in the right lobe. It is 3 times more common in men, occurs in older subjects (usually >60) and is associated with a rise in serum alpha-fetoprotein in 70% cases.
Metastatic liver cancers are 30-times more common than primary hepatocellular cancer.
Fibrolamellar hepatocellular carcinoma occurs in much younger subjects- mean age 25. It accounts for 10% of primary liver cancers, and is not associated with a rise in alpha-fetoprotein. Distribution is equal between men and women, and between right and left lobes of liver. Prognosis is good, and if resected before metastasising , this cancer is associated with more than 60% 5-year survival. It occurs in a normal appearing liver (not cirrhotic) and has a central scar. Lesions are usually >10 cm, and can present with subcostal pain, intermittent pyrexia and weight loss over years.
Also with a central scar is focal nodular hyperplasia. It is usually solitary, discovered incidentally, is <5 cm in size, much more common in females and occurs in 3rd to 5th decades of life. Hepatic adenomas are almost exclusively seen in young women on oral contraceptives. When they occur in men, a history of anabolic steroid abuse must be sought. Cholangiocarcinomas are only slightly more common in men, but much more so when associated with sclerosing cholangitis, which is 9-times more common in men. Cholangiocarcinomas are often associated with a rise in serum Ca-19-9. However, this antigen is only present in subjects who have the Duffy blood group antigen. Gallbladder cancer is 2-6 times more common in women. Choledochal cysts are 3-4 times more common in women.
