Chapter 14: Liver tumors Flashcards
A liver mass is incidentally seen on imaging in a middle-aged woman with a history of contraceptive use.
The mass is tan and lobulated beneath the liver capsule - this one has ruptured, hemorrhage. Can cause intraperitoneal bleeding.
Microscopically, hepatocytes appear benign but are not arranged in lobular architecture.
Hepatic adenoma.
A liver mass is removed and examined histologically. It has multiple fibrous septa and regenerative nodules.
Focal nodular hyperplasia - nodular lesion that resembles cirrhosis. Not neoplastic, not associated with contraceptives.
A patient presents with portal hypertension and a liver mass. Small hyperplastic nodules are found without fibrosis in an otherwisenormal liver.
Nodular Regenerative Hyperplasia
A cause of portal hypertension. Oral contraceptives? Anabolic steroids? Extrahepatic infections?
Not pre-neoplastic.
A patient at autopsy is found to have a small liver mass unrelated to the cause of death. Biopsy is shown below.
Cavernous hemangioma.
Most common tumor of the liver.
A patient presents with small cystic bild ducts embedded ina fibrous stroma.
Bile duct microhamartomas (Von Meyenburg Complexes).
What are the most common causes of hepatocellular carcinoma?
Hepatitis B virus: Integration, not necessarily cirrhosis.
Hepatitis C virus: Interaction HCV with core protein?
Alcoholic cirrhosis
Hemochromatosis and alpha1-antitrypsin deficiency.
Aflatoxin B1.
A middle-aged male with a history of chronic hepatitis C presents with a painful and enlarging mass in the RUQ. Biopsy is taken.
Hepatocellular Cracinoma:
Poorly circumscribed, nodular area of yellow partially hemorrhagic hepatocellular carcinoma.
B. Acinar pattern, surround concretions of inspissated bile.
Paraneoplastic manifedstations: Polycythemia, hypoglycemia, hypercalcemia. AFP levels elevated.
An adolescent patient presents with an enlarging, painful RUQ mass. A biopsy is taken.
Fibrolamellar hepatocellular carcinoma: Uncommon. Adolescents and young adults. Eosinophilic, neoplastic hepatocytes arranged in clusters and surrounded by delicate collagen fibers.
A patient with a past medical history of primary sclerosing cholangitis and infection with liver fluke (C. sinensis) presents with an enlarging RUQ mass. A biopsy is taken and shows well-differentiated neoplastic glands in a dense fibrous stroma.
Cholangiocarcinoma (bile duct carcinoma). Arises from biliary epithelium at any part of the biliary tree.
Metastasize throughout the body. Liver transplant rarely successful.
A neonate presents with abdominal enlargement, vomiting, and failure to thrive. Serum AFP is elevated.
A liver mass is found that is circumscribed and partially necrotic and hemorrhagic, with epithelial and mesenchymal cells. The cells are small and fusiform and are arranged in ribbons or rosettes.
Hepatoblastoma.
Other associations: Cardiac and renal malformations, hemihypetrtrophy, macroglossia.
A patient with known exposure to thorium dioxide presents with a liver mass. A biopsy is taken and shows multicentric tumor with multiple hemorrhagic nodules. Spindle-shaped neoplastic endothelial cells line sinusoids and compress liver cell plates.
Presents with hepatomegaly, jaundice, and ascites. Pancytopenia, hemolytic anemia.
Hemangiosarcoma
Thorium dioxide, vinyl chloride, or inorganic arsenic.
A patient presents with massive hepatomegaly. The liver is imaged and contains many nodules. It is removed.
Metastatic carcinoma in the liver.
This one is metastatic colon cancer. GI, breast, and lung common.
Pancreatic, melanoma, and hematologic malignancies often involve the liver.
A patient presents soon after a liver transplant with jaundice. A biopsy is taken.
Acute rejection of a liver transplant.
Portal triad expanded by polymorphous inflammatory infiltrate - small and large lymphocytes, plasma cells, macrophages, neutrophils. Bile ducts damaged.
A patient presents after 2 months of allograft rejection. Biopsy shows damaged interlobular bile ducts, leading to persistent cholestasis.
Chronic ductopenic rejection or Vanishing bile duct syndrome.
