1. SOL Liver

2. Common liver lesions

3. Approach to liver SOL
• History
• Clinical examination
• Lab – Hemogram, LFT, Albumin,INR
• Serology – ALA , Hydatid
• Tumor markers – AFP,CEA, CA 19-9

4. Presentation
• Asymptomatic
• Nodule on screening in cirrhotic patients
• Presenting with pain and fever
• SOL in a known patient of extrahepatic malignancy

5. Algorithm for Solitary SOL of Liver on USG
Nagral S , Clinics in GI Surgery

6. Algorithm for Solid lesions on USG
Nagral S , Clinics in GI Surgery

7. Algorithm for Multiple Liver SOLs on USG
Nagral S , Clinics in GI Surgery

8. Beyond USG – CT
• Symptomatic lesions – no response to treatment
• Alterations in LFT
• Underlying liver disease

9. When MRI -----
HCC vs regenerating nodule vs dysplastic nodule
atypical lesions

10. Role of Biopsy
Usually not required
Diagnostic uncertainty

11. Screening strategy

12. BCLC staging

16. CASE CAPSULE

17. HISTORY
• 54 yrs gentleman, no comorbidities
• Frequency, urgency, in
• complete evacuation
• No other GI symptoms
• USG abdomen – hypo echoic liver lesions
• Lab - normal

20. Colonoscopy
• Ulcero proliferative lesion in sigmoid colon
• No synchronous lesions/polyps
• Biopsy - adenocarcinoma

21. What next ?

22. Chemotherapy
• FOLFOX + bevaxizumab – 7 cycles
• FOLFOX – 5 cycles

24. PET CT

25. Surgery
• Sigmoid colectomy + left lateral segmentectomy
+ metastectomy (seg 4b, seg 5, seg 7)