18-8: Nodules and Tumors Flashcards
what are the benign hepatic masses?
nodular hyperplasias
hemangiomas
adenomas
what are the malignant hepatic masses?
hepatoblastoma
hepatocellular carcinoma
cholangiocarcinoma
angiosarcoma
lymphoma
metastatic
what is focal nodular hyperplasia?
a single well-demarcated lesion with central scar
incidental finding in otherwise normal liver
map-like pattern of strong cytoplasmic GS staining
what conditions are associated with FNH?
hepatic or extra-hepatic hemangioma
vascular malformations
some brain tumors
what is nodular regenerative hyperplasia?
multiple nodules that resemble cirrhosis however there is no fibrous septa
risk of portal hypertension
what conditions are associated with NRH?
HIV
rheumatologic disease
what is the most common benign neoplasm of the liver?
cavernous hemangioma
what is the presentation of cavernous hemangioma?
F > M
usually asymptomatic and incidental discovery
risk of hemorrhage due to subcapsular location
what is the presentation of hepatocellular adenoma?
F > M
associated with oral contraceptives and anabolic steroids
increased incidence with obesity and metabolic syndrome
usually an incidental finding on imaging but may be found due to rapid growth or hemorrhage
what are the adenoma subtypes?
HNF1-a inactivated adenoma
Inflammatory adenoma
B-Catenin activated adenoma
HNF1-a inactivated adenoma
strong female predilection
fatty tumor without atypia
minimal risk of malignant transformation
Inflammatory adenoma
strongly associated with females and obesity/metabolic syndrome
overexpress CRP and amyloid A
risk for malignant transformation
B-Catenin activated adenoma
40% occur in men
associated with oral contraceptives and anabolic steroids
high risk for malignant transformation
what is the clinical presentation of hepatoblastoma?
< 3 years old
asymptomatic abdominal swelling
occasionally presents with jaundice and pruritis
what are the histological features of the epithelial type hepatoblastoma?
small polygonal fetal cells or smaller embryonal cells forming acini, tubules or papillary structures
what are the histological features of the mixed type hepatoblastoma?
contains primitive mesenchyme of osteoid, cartilage or striated muscle along with epithelial tissue
where is a hepatoblastoma likely to metastasize?
the lungs
what conditions are associated with hepatoblastoma?
FAP
Beckwith-Wiedemann Syndrome
what is the most common primary malignancy of hepatocytes?
hepatocellular carcinoma
where is HCC most common?
in Asia and sub-Saharan Africa where chronic HBV infection is common
what factors are most important in the formation of HCC?
viral infections (HBV and HCV)
toxic injuries (aflatoxins and alcohol)
what typically precedes HCC?
chronic liver disease with cirrhosis
*15-20% arise in noncirrhotic livers
what are the macroscopic and microscopic features of HCC?
macro: single, large, hard, scirrhous tumor with fibrous bands
micro: large polygonal cells with granular cytoplasm, vesicular nuclei with a prominent nucleolus and parallel lamellae of dense collagen bundles
what is the treatment for HCC?
Surgical resection for noncirrhotic livers or cirrhotic livers with adequate function
Transplant for advanced cirrhotic livers
Tumor ablation for unresectable tumors or those that cannot receive a transplant
what is the origin of intrahepatic cholangiocarcinoma?
arising from the intrahepatic biliary tree
what is the origin of biliary adenocarcinoma?
arising from extrahepatic bile ducts
where is intrahepatic cholangiocarcinoma most common?
Southeast Asian countries where liver fluke infestations are endemic
what are some risk factors associated with intrahepatic cholangiocarcinoma?
fibropolycystic liver disease
primary sclerosing cholangitis
liver fluke infestation
hepatolithiasis
Hep B and C
Nonalcoholic fatty liver disease
where are the majority of intrahepatic cholangiocarcinoma located within the biliary tree?
at the bifurcation of the biliary system (Klatskin tumors)
What features are similar between intrahepatic and extrahepatic tumors?
clearly defined glandular/tubular structures lined by malignant epithelial cells embedded in an abundant fibrous stroma
lymphovascular and perineural invasion are common
how do the presentations of intrahepatic and extrahepatic tumors differ?
intrahepatic may be asymptomatic or present as a liver mass
extrahepatic present with symptoms related to biliary obstruction
angiosarcoma is caused by exposure to which substances?
vinyl chloride
arsenic
Thorotrast
what diseases are associated with hepatic lymphoma?
Hep B and C
HIV
Primary biliary cholangitis
which is more common, primary liver cancer or metastatic malignancy?
metastatic malignancy from another primary source
ex: colon, breast, lung and pancreas
what symptoms are universal to all hepatic malignancies?
anorexia
fevers
jaundice
nausea
RUQ pain
sweats
weight loss
