Hepatic Neoplasms Flashcards

1
Q

What is the benign neoplasm in the liver?

A

Hepatocellular Adenoma

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2
Q

What are the Malignant tumors of the Liver?

A

• Hepatoblastoma
• Hepatocellular Carcinoma
• Cholangiocarcinoma
• Other
​• Metastasis

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3
Q

What are the 2 types of Nodular Hyperplasia that we see in the liver?

A
  • Focal Nodular Hyperplasia
  • Nodular Regnerative Hyperplasia
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4
Q

Focal Nodular Hyperplasia
• Who is it typically seen in?
• What is the morphology?
• Etiology?

A
  • Tyically young or middle aged
  • Spontaneous mass lesion in an otherwise nl liver that is well demarcated but not well encapsulated and can be pretty large
  • Often associated with Oral Contraceptive Use
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5
Q

Nodular Regenerative Hyperplasia
• What does this appear similarly to grossly?
• How does it differ from focal Nodular Hyperplasia?
• What condition can it cause?
• Associations to make with this appearance?

A

Appears similar to Cirrhosis but does NOT have fibrosis on microscopy. Similar to cirrhosis it can cause portal Hypertension.

• Usually this is an incidental finding and occurs in association with conditions affecting intrahepatic blood flow, including solid-organ (particularly renal) transplantation, hematopoetic stem cell transplantation, and vasculitis​

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6
Q

What factor is common to both Focal Nodular and Nodular Regerative Hyperplasias?

A

Alteration of Portal Blood Supply
, arising from obliteration of portal vein radicles and compensatory augmentation of arterial blood supply.

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7
Q

What disease is shown here?
• Key features

A

Nodular Regenerative Hyperplasia
• Grossly liver becomes nodular and resembles fibrosis but when cut there is no fibrosis and therefore a lack of fibrous septa giving it a more “nice roast-like” appearance

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8
Q

What disease is shown here?
• key features?

A

Focal Nodular Hyperplasia
• Characterized by abnormal architecture, bile ductular proliferation, and malformed vessels

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9
Q

What type of nodular hyperplasia is likely represented by this gross liver specimen?
• Key features?

A

Focal Nodular Hyperplasia
Depressed, white scar with septa radiating to the periphery

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10
Q

What Disease is shown here?
• Key features?

A

Focal Nodular Hyperplasia
Hepatocyte Regernation and Chronic Inflammation
Broad Fibrous Scar with Hepatic Arterial and Bile Duct Elements

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11
Q

What are the Key Features in this tissue?
• Disease?

A

Reticulin Stain shows widened plates of hepatocytes in the abscence of fibrosis, this is indicative of Nodular Regenerative Hyperplasia

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12
Q

What type of hyperplasia is shown in this liver biopsy?
• Key features?

A

Sinusoids are dilated in the absence of inflammatory infiltrates or necrosis, this is indicative of **Nodular Regenerative Hyperplasia

****
Remember this disease is associated with association with conditions affecting intrahepatic blood flow, including solid-organ (particularly renal) transplantation, hematopoetic stem cell transplantation, and vasculitis

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13
Q

What feature of regenerative Nodular Hyperplasia is shown here?

A

Atrophic Hepatic Cords on the left and Thick plump cords on the right

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14
Q

Disease?
• Characteristics?

A
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15
Q

What is the THE MOST COMMON BENIGN liver tumor?
• what key feature are you looking for in these?

A

Cavernous Hemangioma
• key features: Blood Filled Vascular Channels surrounded by a Dense Fibrous Stroma

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16
Q

What is this?
• how do you think it would look grossly?

A

Cavernous Hemangioma

Red-blue soft subcapsular nodules

17
Q

Hepatocellular Carcinoma
• Cell of Origin
• Presentation
• Feared Complication

A

Hepatocellular Carcinomas are derived from Hepatocytes and are often associated with PAIN due to rapid growth. RUPTURE is a feared complication

They may present as a male on steroids or a female on OCPs that has sudden onset up pain with shocky symptoms

18
Q

What key histologic features would you expect to see in a hepatocellular carcinoma?

A

Cords or hepatocytes with an arterial vascular supply and NO PORTAL TRACTS
**See Below***

19
Q

What is the most common liver tumor of early childhood?

A

Hepatoblastoma
• Typically presents in children under 3

20
Q

What histological appearance would you expect to see in a Hepatoblastoma?
• Mutation associated with this disease?

A

Fetal Liver appearance (Hepatocytes arranged in trabeculae with possible extramedullary hematopoeisis) with potential for mesenchymal components like osteoid or cartilagenous components;

• Mutation associated with this disease is APC (WNT/Beta Catenin) pathways

21
Q

What tumor of the liver is shown?
• Key features?
• Which Side of the Liver would this most likely show up on?

A

hepatocytes in trabeculae with Extramedullary Hematopoeisis
• more likely to see Hepatoblastoma on the RIGHT side of the liver

22
Q

Hepatocellular Carcinoma
• what mutations are most commonly implicated in this tumor?
• what serum markers should you look for?

A

HCC often has activating mutations of Beta-catenin (inactivation of APC) and inactivating mutations in p53

23
Q

What is diseases/exposures have high association with Hepatocellular Carcinoma?

A
  • Hepatitis B and C - do not have to be assd with cirrhosis to cause HCC
  • Chronic Liver Disease
  • **Aflaotoxins
  • EtOH

***Note that EtOH has a synergistic effect with Aflaotoxins**

24
Q

What is this?
• Key features?

A

Hepatocellular Carcinoma
• Cells look a little crazy with balloon degeneration of hepatocytes, and possible Mallory bodies
• you probably are going to need to see a mass + AFP to make this diagnossis

25
Q

A 20 year old male is found to have HCC with no predisposing factors?
• What variant does he likely have?

A

Fibrolamellar HCC

26
Q

What key feature of HCC is seen here?

A

When in association with Cirrhosis you may see a Nodule-in-nodule appearance that suggests an evolving cancer

***Note: below is a Moderately to well differentiated HCC (top to bottom)
***Reticulin Stain would show more than 2 or 3 hepatocytes per plate

27
Q

What is the 2nd most common primary maligant tumor of the liver behind HCC?
• what tissue does it affect?

A

Cholangiocarcinoma
• is a malignancy of the biliary tree, arising from bile ducts within and outside of the liver.​

28
Q

What Helminths are associated with Cholangiocarcinoma?

A

Opisthorchis and Clonorchi​

29
Q

What are the principle risk factors for cholangiocarcinoma?
• what is a cholangiocarinoma called if its located in the perihilar region?

A

All risk factors for cholangiocarcinomas cause chronic inflammation and cholestasis​

perihilar tumors = Klatskin tumors (50%)

30
Q

T or F: There are pre-malignant lesions that have been identified for cholangiocarcinoma

A

True, Premalignant lesions for cholangiocarcinoma are also known, the most important of which are biliary intraepithelial neoplasias (low to high grade, BilIN-1, -2, or -3).​

31
Q

What are the Key Features of Cholangiocarcinoma?
• what is often produced by these tumors?

A

They often produce mucin.

Most are well- to moderately differentiated with clearly defined glandular/tubular structures lined by malignant epithelial cells ​

They typically incite marked desmoplasia. Lymphovascular invasion and perineural invasion are both common

**Note: the middle picture is showing desmoplastic response - light pink = desmoplasia**

32
Q

What is seen here?

A

Cholangiocarcinoma
• Other than metastasis, this is really the only gland forming tumor of the liver

33
Q
A
34
Q

How common are metastatic tumors of the liver in comparison with endogenous tumors?
• where do metastatic tumors most often come from?

A

Mets are WAY more common than primary malignancy, the most common sources come from colon, breast, lung, pancreas