GIS22 Pathology of liver tumours and gallstones

Question 1

Epidemiology of HCC
1) More common in which regions
2) Higher incidence and mortality rate in which gender

Answer 1

1) >50% incidence in China including HK
2) Male (4 times female)

Question 2

Name the fungus in foodstuffs which produces aflatoxins.

Answer 2

Aspergillus flavus

Question 3

Are aflatoxins a significant contributor to HCC incidence?

Answer 3

Highly carcinogenic: small dose for long period => HCC in animals
But low aflatoxin levels in foodstuffs in HK

Question 4

Name two clinical features of advanced HCC.

Answer 4

Hepatomegaly
RUQ pain

Question 5

What is the prognosis for cirrhosis with HCC?

Answer 5

Poor
Large, fatal tumours with insidious onset
Often not resectable
Once symptomatic / inoperable => median survival counted in weeks

Question 6

Name three types of HCC according to gross appearance.

Answer 6

Massive
Nodular
Diffuse - inoperable

Question 7

Describe the general gross appearance of HCC.

Answer 7

Soft, hemorrhagic with frequent necrosis
Due to high vascularity and minimal supportive stroma
Prone to hemorrhage, rupture and peritoneal bleeding

Question 8

For tumour in other sites (usually bones), name one feature to reveal diagnosis of a metastatic HCC.

Answer 8

Bile production

Question 9

Explain the pathogenetic basis of hypoglycemia (occasional) in HCC.

Answer 9

1. Replacement of liver by tumour => less glycogen storage in the remaining of liver without tumour
2. Clear cell type stores excessive glycogen within the tumour
3. Secretion of insulin-like peptides

Question 10

Name two routes of venous invasion in HCC.

Answer 10

1. Portal vein branches => intrahepatic metastasis
2. Hepatic vein branches => lung metastasis, bone metastasis

Question 11

Compare the incidence of HCC and intrahepatic cholangiocarcinoma (iCC) in HK.

Answer 11

6-7 : 1