Hepatic

Question 1

Risk factors for HCC

Answer 1

Patients at risk for HCC:
Cirrhosis:
- Hepatitis B,c
- Genetic hemochromatosis
- Non alcholic fatty liver disease
- Stage 4 primary billiary cholangitis
- Alpha 1 antitrypsin deficiency
- Other causes of cirrhosis
Without cirrhosis:
- Hepatitis

Question 2

Milan criteria for hcc

Answer 2

The Milan criteria are a set of guidelines used to determine which patients with hepatocellular carcinoma (HCC) are eligible for liver transplantation and have a good clinical outcome. The criteria are as follows 1:
Solitary HCC ≤ 5 cm in size.
≤ 3 HCCs, each ≤ 3 cm in size.
No hepatic vascular invasion by tumor.
No presence of metastatic disease

Question 3

IHC for HCC

Answer 3

CD 34
CK 07
Glypican 03
Hsp 70
Alpha fetoprotein

Markers of primary HCC
1. Herpar -1 (hepatocyte paraffin)
2. AFP
3. CD10
4. P-CEA – polyclonal CEA
5. GPC-3
6. Arginase-1

Question 4

Causes of liver mets

Answer 4

Causes of liver mets :
1. Colorectal ca- 1/5th of CRC present with liver mets at the time of diagnosis.
2. Non-colorectal neuroendocrine-
• Small bowel carcinoid
• Islet cell tumor- gastrinoma, Glucagonoma
• Appendiceal carcinoid and Insulinoma- rare
3. Non-colorectal non-neuroendocrine-
• GIST
• Melanoma
• RCC
• Wilm’s tumor
• Ca breast
• Gynecological malignancy

Question 5

Type of HCC

Answer 5

WHO classification
1. Hepatocellular carcinoma
2. Fibrolamellar Ca
3. Irrhous HCC
4. Sarcomatoid HCC