Dr. Ziegler

Question 1

Angiosarcoma

Answer 1

• neoplasm of endothelial cells
• spindle shaped cells
• CD31 marker
• exposure to vinyl chloride, arsenic, thorium dioxide (thorotrast)
• cause hemoperitoneum from spontaneous rupture

Question 2

Cavernous Hemangioma

Answer 2

• cavernous vascular spaces filled with blood
• single layer of flat endothelium
• DO NOT BIOPSY
• with contrast -> nodular filling from the outside in

Question 3

Hepatic Adenoma

Answer 3

• estrogen, anabolic androgens, glycogen storage disease 1 and 2
• NO capsule
• sheets of hepatocytes w/o bile ducts or portal triads
• glycogen and lipid deposits in cytoplasm
• malignant transformation rare
• adenoma grows during PREGNANCY -> higher risk of rupture

Question 4

Metastases

Answer 4

• most common liver tumor

- MULTIPLE lesions

Question 5

Focal Nodular Hyperplasia

Answer 5

central stellate scar with large artery and multiple radiating branches
-women higher risk

Tx: nothing; leave it alone

Question 6

Hepatocellular Carcinoma

Answer 6

• spread hematogenously
• due to cirrhosis (from HBV, HCV, hereditary hemochromatosis)
• aflatoxin from aspergillus -> G:C to A:T transversion in codon 249 of the p53 tumor suppressor gene
• AFP+

Question 7

paraneoplastic syndromes with hepatocellular carcinoma

Answer 7

• hypoglycemia
• erythrocytosis (produce EPO)
• hypercalcemia (produce PTH)
• derm: dermatomyositis or léser trelat sign
• Budd chiari syndrome