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Hcc Flashcards

1
Q

Most frequent amplification hcc

A

1q- 57%
8q 46
6p 22
17q 22

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2
Q

Mc oncogene hcc

A

P53 (tsg)- 18 &35%

& wnt b catenin (pog)- 15.9 %

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3
Q

Ctnnb1 mutation liver

A

Larger in size
Wd
Without inflam features

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4
Q

Tp53 hcc

A

PD
Pleomorphic
Vascular invasion

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5
Q

Schrrhous hcc

A

TSC1/2

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6
Q

Steatotic hcc

A

IL 6/ JAK/stat

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7
Q

Macrotrabecular massive subtype

A

Poor outcome
High AFP
FGF19 amplifications

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8
Q

Molecular hcc subtypes

A

Stromal s1
Stemness angiogenic-s2
Diff ctnnb1
Diff non ctnnb1

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9
Q

Stemness marker

A

EPCAM

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10
Q

Hbv-hcc
Hcv- hcc
Cirrhosis- hcc

A

54%
31%
1-8% yrly

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11
Q

Hereditary conditions causing hcc

A 
High 
Hemochromatosis- 3-4% annual risk, 23 times 
Antitrypsin
Hereditary tyrosinemia
Low- wilson, pbc
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12
Q

Screening- 6 month usg >1 cm

Afp>20 ng

A 
Hep b and c
Alcoholic, nafld nash
Antitrypsin def
Cirrhosis
Pbcholangitis stage 4
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13
Q

LIRADS

A 
1- def benign 0
2- probably 11%
3- intermediate prob of hcc 33
4- high prob hcc not 100% 80 - bx
5- def hcc 96%
5v- venous inv
Lrm- non hcc ca 42% hcc, rest another tr
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14
Q

Components of LIRADS

A
  1. Arterial phase hyperenhancement
  2. Size
  3. Washout and enhancing capsule
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15
Q

Hcc growth pattern most common- nodular expanding pattern

A 
Eggel's classification (1901):
Nodular HCC
Massive HCC
Diffuse HCC
Kaufmann's classification (1958)
Large massive node
HCC in cirrhotic liver
(a) Multiple nodules
(b) Diffuse growth
(c) Combination of nodules and growth
Okuda classification (1984)
Expanding
Spreading
Multifocal
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16
Q

Classf of hcc

A 
Surgical classification:
Invading lesions ("invaders")
Expanding lesions (**pushers")
Pedunculated lesions ("hangers")
Classification of the Liver Cancer Study Group of
Japan (LCSGJ:
Nodular HCC (distinctly nodular type)
Simple nodular (SN) type
Simple nodular type with extranodular growth
(SNEG)
Confluent multinodular type (CMN)
Nodular HCC
Small nodular type with indistinct margins (vaguely
nodular type)
Classification according to size:
Small HCC
Solitary large HCC
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17
Q

Architectural patterns liver

A

Schirrous
Acinar or pseudoglandular
Trabecular

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18
Q

Fibrolamellar hcc

A

0.85% of primary liver cancer
13.4% of all cases in patients younger than 40
• Overexpression of neuroendocrine genes- prohormone convertase 1, neurotensin, delta/notch-like
epidermal growth factor- related receptor, and calcitonin.
histologic features are fibrous
stroma and large eosinophilic tumor cells
More LN inv
Cytokeratin 7 and 19
DNAJB1PRKACA Chimera

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19
Q

Hcc with hypercalcemia

A

Sclerosing variant

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20
Q

Hcc with hypoglycemia and hypercholesterolemia

A

Clear cell variant

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21
Q

Grading of hcc

A

Edmondson and
Steiner system, which subdivides HCC into
four grades, from I to IV

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22
Q

Marker distinguishing benign and malig hep lesions

A

Glypican-3

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23
Q

Hepaticellular differentiation markers

A

HepPar1 and arginase

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24
Q

Criteria for Non Invasive Diagnosis in HCC

A

Lesions > 2 cm
Arterial enhancement and venous washout on 1
imaging modality either on CT/MRI/USG or
angiogram
Only arterial enhancement on 2 contrast studies
Lesions 1 - 2 cm
- Arterial enhancement and venous washout on 2
imaging modalities
Arterial enhancement alone and &FP > 200 ng/ml

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25
Q

Child pugh

A

Class A = 5 to 6 points (least severe liver disease)
Class B = 7 to 9 points (moderately severe liver disease)
Class C = 10 to 15 points (most severe liver disease)

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26
Q

Okuda

A 
Bb -3
Alb-3
Tumr size >50%
Ascites+/-
Stages 1-3
27
Q

CLIP

A

Child
Lab-AFP
Image- tumour morph
PVthrombosis

28
Q

Tnm hcc

A

T1a Solitary tumor <2cm
T1b Solitary tumor >2 cm without vascular invasion
T2
Solitary tumor >2 cm with vascular invasion, or multiple
tumors, none >5 cm
T3
Multiple tumors, at least one of which is >5 cm
T4
Single tumor or multiple tumors of any size involving a major
branch of the portal vein or hepatic vein, or tumor(s) with
direct invasion of adjacent organs other than the gallbladder
or with perforation of visceral peritoneum
N0,N1

29
Q

Node postivity becomes stage 4 in

A
  1. Hcc
  2. Sarcoma
  3. Ubladder
30
Q

Regional nodes for liver tumor

A

Hepatoduodenal
Hilar
Inferior phrenic
Caval

31
Q

Ishak scoring system for

A

Fibrosis score 0-4- F0- none to mod fibrosis
5-6- F1- sev fibrosis or cirrhosis
METAVIR system- f0- f4

32
Q

Markers of hcc

A 
Afp
Des gamma carboxy prothrombin
Pivka 2
Ferritin
Alpha 1 Fucosidase
33
Q

Hjortsjos crook

A

The right posterior sectional duct normally
hooks over the origin of the right anterior
sectional portal vein (“‘Hjortsio’s crook’),6
where it is in danger of being injured if the
right anterior sectional pedicle is clamped too
close to its origin

34
Q

Mc benign tr of liver

A

Hemangioma -70% f>m
Mean age-45
Multiplicity percentage- 10
Estrogen receptor

35
Q

Kasabach merrit syndrome

A

Consumption coagulopathy

36
Q

Ct diag of hemangioma

A 
1.
Low attenuation on noncontrast CT.
2. Peripheral and globular enhancement of the
lesion followed by a central enhancement on
contrast CT
3.
Contrast enhancement of the lesion on
delayed phases
BLOOD POOL SIGN
MRI- LIGHT BULB PATTERN
37
Q

Focal nodular hyperplasia

A 
F>m
30-50 yrs
Second m/c
20%multiple
CENTRAL FIBROUS SCAR
38
Q

Hepatocellular adenoma

A 
F>m
Bleed and malig change
Ocp dose dependent
Multiplicity-12-30%
Sonic hedghog-5% assoc with obesity and adenoma
39
Q

Hep cellular adenoma genetic syndrome

A

GSD- 1a
Mccune albright
Mody-3
Fap?

40
Q

Subtypes of hca

A
  1. HNF1Q-mutated HAS (HNF1A);
  2. Inflammatory (also known as telangiectatic)
    HAS (IHCA)- obesity
  3. ß-catenin- mutated HAs (b-HCA); increased malig risk
  4. Unclassified subtypes
41
Q

Risk factor for bleed in hca

A

• 25% of patients.
Risk factors for hemorrhage
1.Large tumors (>5 cm, especially in the IHCA
subtype)
2.Visualization of arteries within the lesion
•3.Location of the tumor in the left lateral liver
4.Exophytic growth

42
Q

Hca malig transformation

A 
Risk - 5%
to 6%.
•
Lower risk in women.
Risk factors for malignant transformation:
•1.Sex (with a 6- to 10-fold higher risk of
malignant transformation in men)
2.Androgen use
•3.B-HCA subtype
• 4.Tumor diameter of greater than 5
cm
(independent of the subtype).
5.IHCAs containing B-catenin mutations
43
Q

Hca indication for LT

A

a. Multiple unresectable lesions in men
b. Large HCA associated with intrahepatic venous shunt
c. Patients with glycogen storage disorders unresponsive to medical treatment.

44
Q

Inflammatory pseudotumor of liver

A

Inflam myofibroblastic tumors
80% symptomatic
Benign
T/t - surveillance steroid and antibiotics

45
Q

Cystic neoplasm of hepatobiliary

A 
Biliary cystadenoma -mucon, ovarian stroma,females m/c seg 4
Biliry IPMN
biliary cystadenoca
Cystic intrahep changioca
NET..
46
Q 
30. What is the future liver remnant aimed at
before planning for liver resection in non
cirrhotic patients
a. 25%
b. 15%
C.
40%
d. 50%
A

Volumetric analysis:
25% of liver remaining without underlying
parenchymal disease
40% with underlying liver disease.

47
Q

31.
What is true about Indocyanine green
clearance test?
a. Should be administered within 1 hour after
food intake
b. > 20 % retention rate - hepatectomy should
be performed.
C. <14% - hepatectomy is contraindicated.
d. None of the above.

A 
•
Should
be administered
after
over
night
fasting.
Retention rate
<14
%
Good functional
volume.
>20% - Contraindication to the surgery.
48
Q

Assessment preop liver

A 
Assessment
I Clearance/retention tests
A
Indocyanine green (ICG)
B
Lidocaine/Cyp1a2-monoethylglycinexylidide(MEGX)
C99tc mebrofenin radioisotope
Galactose elimination capacity
D
Aminopyrine breath test 13C
E
Hippurate ratio
F
Trimethadione/dimethadione(TMO/DMO)
G
Amino acid
H
Caffeine
T
Antipyrine
I Redox chemistry
A
Arterial ketone body ratio (AKBR)
B
Redox tolerance index (RTI)
III Volumetry
A
B
Computed tomography (CT)
Magnetic resonance imaging (MRI)
IV Scintigraphy
A
99m technetium galactosyl human serum
albumin (99m Te-GSA)
49
Q

Brisbane classification -2000

A

Liver resection

50
Q

Gd EOB-DTPA liver tumors

A

Useful in small tumors
Low specificity and high sensitivity
Malig cells dont show takeup

51
Q

Local ablation therapies

-<3cm

A

1.Chemical- 95%etoh 5%acetic acid
Coag necrosis dehydration vasc thrombosis
In <2cm
2.thermal -D+2, circumferentialy 1 cm
a)Cold- cryo iceball creation less than -40degreeC
b)Heat- 60degree
rfa and microwave- radiant cooling effect allows near vasc structure
3. Irreversible electropolation
Non thermal, pulsed DC, transmembrane potential , no heat sink , leads to cell memb perforation

52
Q

Criteria for liver transplant

A

Milan and UCSF

53
Q

MILAN

A

Single tr = 5 cm
Upto 3 trs all les than 3 cm
Absence of macrovascular invasion and extrahepatic spread

54
Q

UCSF

A

Single tr less than 6.5 cm
Multiple less than 3 nodules all less than 4.5 cm
Total les than 8 cm

55
Q

MELD

56
Q

Transarterial treatment hcc chemo

A 
90-100% HA SUPPLY
Pv gives 75 % to liver though
Agents- Doxorubicin
Cisplatin
Epirubicin
Mitoxanteone
Mitomycin C
57
Q

Embolic materials liver

A 
Agents:
Gelatin sponge particles
Polyvinyl alcohol (PVA) particles,
Calibrated microspheres,
• Absolute ethanol,
Starch microspheres
• Cyanoacrylate
58
Q

Taradioembolisarion in hcc

A

Yt 90- beta rays

Microspheres therasphere or resin -Sirte x

59
Q

Indications for tace

A 
Unresectable child a
Child b
Bclc a
Bridge to transplant - new
Na therapy
60
Q

Adjuvant in Hcc trial name?

A

STORM - no role FOR ACT OR NACT

61
Q

Systemic treatment for hcc

A

Tkinhib- SORAFENIB

ALSO VEGF PDGRF BLOCK

62
Q

Role of sorafenib

400 mg bd dose according to bb and alb

A

Sharp trial role in advanced
Asia pacific- hep b hcc
In child A pt
If bb more than 3 times uln - dont give

63
Q

S/e of sorafenib

Crash (20 decks)

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