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Liver· Chapter 24

Liver Tumors and Transplantation

Benign liver lesions and when biopsy actually changes management, LI-RADS for hepatocellular carcinoma, Milan and the expanded transplant criteria, atezolizumab plus bevacizumab as first-line systemic therapy, cholangiocarcinoma Bismuth-Corlette staging, MELD-Na listing mechanics, and the post-transplant immunosuppression and complication playbook.

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48 MCQs
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    5-option vignettes with full wrong-answer teaching.
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What this chapter covers

  • Section 24.1: Benign liver lesions

    Cavernous hemangioma is the most common benign liver tumor (approximately 7 percent of autopsies, female predominance 1.5 to 5 to 1, multicentric in up to 30 percent).

  • Section 24.2: HCC surveillance and AASLD 2023

    AASLD 2023 recommends HCC surveillance in all patients with Child-Pugh A or B cirrhosis regardless of etiology, including HCV cured by sustained virologic response, and in Child-Pugh C cirrhosis only if the patient is a transplant candidate.

  • Section 24.3: LI-RADS and HCC diagnosis

    LI-RADS stratifies cirrhotic liver lesions on a five-tier scale plus two additional categories.

  • Section 24.4: HCC treatment by BCLC stage

    BCLC 0 (single lesion under 2 cm, Child-Pugh A, ECOG 0) and BCLC A (single lesion or up to 3 lesions each at most 3 cm, Child-Pugh A or B, ECOG 0) are curative-intent stages.

  • Section 24.5: Cholangiocarcinoma

    Cholangiocarcinoma is anatomically classified into three subtypes that drive different management.

  • Section 24.6: Liver transplant evaluation and MELD 3.0

    MELD 3.0 replaced MELD-Na in 2023 for waitlist allocation.

  • Section 24.7: Transplant exception points and donor types

    Standard exception points correct the calculated MELD when it undercounts severity.

  • Section 24.8: Post-transplant complications and rejection

    Immunosuppression follows a trajectory mirroring rejection risk.

  • Section 24.9: Recurrent disease post-transplant

    Recurrent disease patterns vary by underlying etiology, and disease-specific surveillance and treatment adjustments must continue indefinitely after transplant because the metabolic, viral, autoimmune, or biliary substrate that produced the original failure can re-establish itself in the allograft.

Podcast episodes

  1. 01

    Benign Lesions

    This episode covers the benign liver lesions: the benign masses and what their imaging and hormonal context tells you to do. Start with the benign lesions, because the whole section runs on one decision: the imaging appearance plus the hormonal or drug context usually settles the diagnosis, and biopsy enters only when the imaging is atypical or when the...

  2. 02

    HCC

    This episode covers hepatocellular carcinoma, from who gets surveilled through how a surveillance finding becomes a diagnosis and how that diagnosis picks a treatment.

  3. 03

    Cholangiocarcinoma

    This episode covers cholangiocarcinoma, and the whole thing turns on one idea: where the tumor sits along the biliary tree makes it effectively three different diseases, with three different operations and three different transplant pathways, so the first move is to stop treating it as one cancer.

  4. 04

    Liver Transplant

    This episode covers liver transplantation: how patients are scored and listed, the exception points for the diseases the score undervalues, the donor types, the post-transplant complications and rejection, and the recurrent disease patterns that decide long-term survival.