GI - Pathology (Liver Part II: Cancer & other conditions)

Question 1

What is the most common primary malignant tumor of the liver in adults? What is another name for it?

Answer 1

Hepatocellular carcinoma/hepatoma

Question 2

What are 6 conditions/factors associated with hepatocellular carcinoma/hepatoma?

Answer 2

Associated with (1) hepatitis B and C, (2) Wilson disease, (3) hemochromatosis, (4) alpha1-antitrypsin deficiency, (5) alcoholic cirrhosis, and (6) carcinogens (e.g., aflatoxin from Aspergillus)

Question 3

To what complication may hepatocellular carcinoma/hematoma lead?

Answer 3

May lead to Budd-Chiari syndrome

Question 4

What are 4 historical/physical exam findings associated with hepatocellular carcinoma/hepatoma?

Answer 4

Findings: (1) jaundice (2) tender hepatomegaly (3) ascites (4) anorexia

Question 5

How does hepatocellular carcinoma/hepatoma spread?

Answer 5

Spreads hematogenously

Question 6

How is hepatocellular carcinoma/hepatoma diagnosed?

Answer 6

Diagnosis: High alpha-fetoprotein; ultrasound or contrast CT

Question 7

Besides hepatocellular carcinoma, what are 3 other liver tumors?

Answer 7

(1) Cavernous hemangioma (2) Hepatic adenoma (3) Angiosarcoma

Question 8

Is cavernous hemangioma of the liver common or rare? Is it benign or malignant? Also, at what patient age range does it typically occur?

Answer 8

Common, benign liver tumor; typically occurs at age 30-50 years

Question 9

What is important to note about diagnostic methods in cavernous hemangioma, and why?

Answer 9

Biopsy contraindicated because of risk of hemorrhage

Question 10

Is hepatic adenoma common or rare? Is it benign or malignant? To what factor/condition(s) is it often related?

Answer 10

Rare, benign liver tumor, often related to oral contraceptive or anabolic steroid use

Question 11

What are 2 possible outcomes of hepatic adenoma?

Answer 11

May regress spontaneously or rupture (abdominal pain and shock)

Question 12

Is angiosarcoma of the liver benign or malignant? What is its origin?

Answer 12

Malignant tumor of endothelial origin

Question 13

With what 2 exposures is angiosarcoma of the liver associated?

Answer 13

Associated with exposure to arsenic, vinyl chloride

Question 14

In general, what causes nutmeg liver? Give 2 clinical contexts in which this may occur?

Answer 14

Due to back up of blood into liver. Commonly caused by right-sided heart failure and Budd-Chiari syndrome.

Question 15

Briefly describe the appearance of nutmeg liver.

Answer 15

The liver appears mottled like a nutmeg

Question 16

What complication can result from persistence of nutmeg liver, and how does it occur?

Answer 16

If the condition persists, centrilobular congestion and necrosis can result in cardiac cirrhosis

Question 17

What defines Budd-Chiari syndrome? In what condition does it result, and what are 4 symptoms of that condition?

Answer 17

Occlusion of IV or hepatic veins with centrilobular congestion and necrosis, leading to congestive liver disease (hepatomegaly, ascites, abdominal pain, and eventual liver failure).

Question 18

What visible physical findings (positive or negative) may patients with Budd-Chiari develop?

Answer 18

May develop varices and have visible abdominal and back veins. Absence of JVD.

Question 19

What are 4 conditions with which budd-chiari syndrome is associated?

Answer 19

Associated with (1) hypercoagulable states, (2) polycythemia vera, (3) pregnancy, and (4) HCC

Question 20

What is the pathophysiology of alpha1-antitrypsin deficiency in the liver? What classing clinical finding does this cause?

Answer 20

Misfolded gene product protein aggregates in hepatocellular ER => cirrhosis with PAS (+) globules in liver

Question 21

What is the mode of inheritance of alpha1-antitrypsin deficiency?

Answer 21

Codominant trait

Question 22

What effects does alpha1-antitrypsin deficiency have in the lungs?

Answer 22

In lungs, decreased alpha1-antitrypsin => uninhibited elastase in alveoli => decreased elastic tissue => panacinar emphysema