157. Pathology Liver Tumors

Question 1

HCC

• epidemiology
• RF
• Gross
• Dx
• Histo
• prognosis/mets risk

Answer 1

Epi: most common primary malignancy of adults! high incidence in China, SE Asia, SS Africa (low in US, N EU, S America, Australia)
RF: M > F, HBV (BIGGEST RF WORLDWIDE), HCV, Aflatoxin (aspergillus fungi - China, SSA), Cirrhosis (AFLD, NAFLD - metabolic disease)
gross: solitary mass on background of cirrhosis, arterial enhancing
Dx: high AFP (not needed for dx), radiology is diagnostic
Histo: no portal tract, hepatic plate expansion (Reticulin stain shows plates 4-5 cells thick instead of 1), hepatocytes grow in haphazard/non-linear pattern

Prognosis: poor survival (30% 5 year survival if localized; 3% 5 year survival if distant)
Mets risk to lungs

Question 2

Hepatocellular Adenoma

• Histo
• prognosis/mets risk
• tx
• gross
• RF

Answer 2

Histo: no normal portal tract visible, hepatocytes grow in relatively normal manner
Prognosis: no metastatic potential, but can risk growing, bleeding, and becoming malignant
tx: Surgical resection

Gross: well-circumscribed mass on non-cirrhotic background

RF: elevated hormone levels (OCPs, steroids/hormones for body builders)

Question 3

Cholangiocarcinoma

• histo
• gross
• location
• RF
• prognosis
• labs

Answer 3

Histo: loss of normal hepatocytes and bile duct, background of fibrotic stroma with malignant appearing ducts (angulated/proliferative)
Gross: mass assoc with bile duct; white, firm, poorly circumscribed with upstream bile duct proliferation
Location: bile ducts anywhere w/in biliary tree (intra and extra hepatic)
RF: diseases causing chronic inflammation of biliary tree: parasites, PSC, IBD (usually UC)
Prognosis: poor survival
Labs: high Alk-P, high GGT (normal AST/ALT)

Question 4

Hemangioma

• epidemiology
• what is it
• dx
• histo

Answer 4

epi: most common BENIGN liver neoplasm (20% population), F>M
Proliferation of vascular spaces
Dx: IMAGING (no biopsy due to high risk of bleeding)
CT: hypodense lesion with peripheral arterial enhancement and gradual centripetal venous enhancement!
Histo: vascular spaces filled with blood

Question 5

Hepatoblastoma

• epidemiology
• cause
• assoc
• tx
• histo

Answer 5

Epi: most common liver tumor of EARLY childhood (rare after 3yo)
Cause: freq activation of WNT signalling pathway (mutation in APC gene)
common in pts with FAP (familial adenomatous polyposis)
Tx: resection and chemotherapy
histo: collection of immature hepatocytes - darker, less cytoplasm

Question 6

Metastatic Colon Cancer

• histo
• tx
• features of metastatic disease: common tumors that metastasize, how they spread, gross

Answer 6

Histo: angulated gland forming neoplasm with dirty necrosis in center of glandular space, often multiple tumors
tx: resection, chemotherapy, embolization, radiation

Metastatic Disease
MOST COMMON NEOPLASM (secondary) IN LIVER
90% show more than one nodule
common spread from colon, lung, breast
spread through blood vessels
gross: multiple masses with no cirrhosis