Hepatic Neoplasms Flashcards
What is the benign neoplasm in the liver?
Hepatocellular Adenoma
What are the Malignant tumors of the Liver?
• Hepatoblastoma
• Hepatocellular Carcinoma
• Cholangiocarcinoma
• Other
• Metastasis
What are the 2 types of Nodular Hyperplasia that we see in the liver?
- Focal Nodular Hyperplasia
- Nodular Regnerative Hyperplasia
Focal Nodular Hyperplasia
• Who is it typically seen in?
• What is the morphology?
• Etiology?
- 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
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?
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
What factor is common to both Focal Nodular and Nodular Regerative Hyperplasias?
Alteration of Portal Blood Supply
, arising from obliteration of portal vein radicles and compensatory augmentation of arterial blood supply.
What disease is shown here?
• Key features
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
What disease is shown here?
• key features?
Focal Nodular Hyperplasia
• Characterized by abnormal architecture, bile ductular proliferation, and malformed vessels
What type of nodular hyperplasia is likely represented by this gross liver specimen?
• Key features?
Focal Nodular Hyperplasia
Depressed, white scar with septa radiating to the periphery
What Disease is shown here?
• Key features?
Focal Nodular Hyperplasia
• Hepatocyte Regernation and Chronic Inflammation
• Broad Fibrous Scar with Hepatic Arterial and Bile Duct Elements
What are the Key Features in this tissue?
• Disease?
Reticulin Stain shows widened plates of hepatocytes in the abscence of fibrosis, this is indicative of Nodular Regenerative Hyperplasia
What type of hyperplasia is shown in this liver biopsy?
• Key features?
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
What feature of regenerative Nodular Hyperplasia is shown here?
Atrophic Hepatic Cords on the left and Thick plump cords on the right
Disease?
• Characteristics?
What is the THE MOST COMMON BENIGN liver tumor?
• what key feature are you looking for in these?
Cavernous Hemangioma
• key features: Blood Filled Vascular Channels surrounded by a Dense Fibrous Stroma
What is this?
• how do you think it would look grossly?
Cavernous Hemangioma
Red-blue soft subcapsular nodules
Hepatocellular Carcinoma
• Cell of Origin
• Presentation
• Feared Complication
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
What key histologic features would you expect to see in a hepatocellular carcinoma?
Cords or hepatocytes with an arterial vascular supply and NO PORTAL TRACTS
**See Below***
What is the most common liver tumor of early childhood?
Hepatoblastoma
• Typically presents in children under 3
What histological appearance would you expect to see in a Hepatoblastoma?
• Mutation associated with this disease?
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
What tumor of the liver is shown?
• Key features?
• Which Side of the Liver would this most likely show up on?
hepatocytes in trabeculae with Extramedullary Hematopoeisis
• more likely to see Hepatoblastoma on the RIGHT side of the liver
Hepatocellular Carcinoma
• what mutations are most commonly implicated in this tumor?
• what serum markers should you look for?
HCC often has activating mutations of Beta-catenin (inactivation of APC) and inactivating mutations in p53
What is diseases/exposures have high association with Hepatocellular Carcinoma?
- 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**
What is this?
• Key features?
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
A 20 year old male is found to have HCC with no predisposing factors?
• What variant does he likely have?
Fibrolamellar HCC
What key feature of HCC is seen here?
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
What is the 2nd most common primary maligant tumor of the liver behind HCC?
• what tissue does it affect?
Cholangiocarcinoma
• is a malignancy of the biliary tree, arising from bile ducts within and outside of the liver.
What Helminths are associated with Cholangiocarcinoma?
Opisthorchis and Clonorchi
What are the principle risk factors for cholangiocarcinoma?
• what is a cholangiocarinoma called if its located in the perihilar region?
All risk factors for cholangiocarcinomas cause chronic inflammation and cholestasis
perihilar tumors = Klatskin tumors (50%)
T or F: There are pre-malignant lesions that have been identified for cholangiocarcinoma
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).
What are the Key Features of Cholangiocarcinoma?
• what is often produced by these tumors?
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**
What is seen here?
Cholangiocarcinoma
• Other than metastasis, this is really the only gland forming tumor of the liver
How common are metastatic tumors of the liver in comparison with endogenous tumors?
• where do metastatic tumors most often come from?
Mets are WAY more common than primary malignancy, the most common sources come from colon, breast, lung, pancreas
