Hepatic Neoplasms: Gupta Flashcards
What are the two benign nodular hyperplasias of the liver? How do you differentiate them?
Focal nodular hyperplasia- well-demarcated, pooly encapsulated. Spontaneous mass lesion in otherwise healthy liver. Mostly found in young->middle aged adults.
Central stellate scar w/ fibrosis radiating to periphery.
Histo: Some bile duct proliferation.
Nodular regenerative hyperplasia- Liver is ENTIRELY transformed into nodules. Grossly, similar to micronodular cirrhosis, but W/O fibrosis. CAN lead to portal HTN. Occurs in assoc. w/ conditions affecting intrahepatic blood flow (transplantations/vasculitis).
Histo: Sinusoidal dilation. No inflammatory infiltrate, no necrosis. Reticulin framework abnormal (too many hepatocytes squeezed into reticulin-bound hepatocyte plate.)
Nutmeg liver = ?
Congestion of blood
What are the most common benign liver tumors?
Describe them histologically.
Gross appearance?
Clinical importance?
Cavernous hemangiomas
Histo: Blood-filled vascular channels surrounded by a dense fibrous stroma.
Grossly: discrete blue-red, soft nodules, usually less than 2cm, generally located just beneath the capsule.
Clinical importance: prone to rupture
Which benign hepatic lesion is associated with both OCPs and anabolic steroid use?
Are they painful?
What is the surgical emergency we are worried about?
What gene(s) are affected?
Histological hallmark?
Hepatocellular adenoma.
Incidental or can be painful.
Rupture is a surgical emergency.
HNF1-alpha is inactivated- assoc. w/ OCP use. No malignancy risk.
B-catenin activation- high risk of malignant transformation!
Inflammatory adenomas- intermediate risk of malignancy. 10% B-catenin activ. Upregulation of CRP and Serum amyloid A.
Histo: NO PORTAL TRACTS IN LESION! but vascular supply present
What is the most common hepatic tumor of early childhood (
Hepatoblastoma. Histo: can be epithelial mixed with mesenchymal elements (osteoid, cartilage). Looks disorganized AF. Freq. activation of WNT. Assoc. w/ APC. Untreated is fatal Tx w/ surgery, chemo (80% 5yr survival)
Hepatocellular carcinoma has a high association with these two viral diseases, as well as:
Do you have to have a cirrhotic liver for HCC?
Also associated w/ these two toxins:
Common early mutational events?
More common in males/females?
Prognosis?
Dx marker?
Assoc. w/ Hep B, C and chronic liver dz.
No cirrhosis necessary.
Also associated w/ Aflatoxin and EtOH.
Activation of B-catenin and inactivation of p53.
Male predilection.
5th most lethal cancer
Incr. AFP in 50%- liver can make AFP
What are the features of the fibrolamellar variant of HCC?
Found in older kids. LOTS OF (FIBRO)SIS separating obviously dysplastic hepatocytes.
Cholangiocarcinoma is associated with: What is its etiology? It is a malignancy of? Risk factors? What are the premalignant lesions for cholangiocarcinoma? What kind of carcinoma is it? Often produce? Invasion of these two structures is common:
Assoc. w/ liver flukes.
2nd most common primary malignancy of liver after HCC.
Cancer arising from intrahepatic/extrahepatic bile ducts.
RFs: chronic inflammation and cholestasis
Premalignant lesion: biliary intraepithelial neoplasms.
They are adenocarcinomas.
Often produce mucus.
Lymphovascular and perineural invasion are both common.
On histo you see a sinusoid packed full of lymphocytes. What are you thinking?
Hepatosplenic delta-gamma T cell lymphoma.
Tell me about hepatic lymphomas.
Associated with Hep B, C, HIV and primary biliary cirrhosis.
Most are diffuse large B-cell lymphomas, followed by MALT lymphomas.
What is more common, primary hepatic cancer or mets?
Most common source for mets?
Mets from colon, breast, lung, pancreas
