hepatobiliary and pancreatic neoplasms Flashcards
benign epithelium neoplasm
adenoma
papilloma
malignant epithelium neoplasm
adenocarcinoma
papillary carcinoma
benign mesenchyme carcinoma
fibroma
lipoma
osteoma
leiomyoma
malignant mesenchyme neoplasm
fibrosarcoma
liposarcoma
osteosarcoma
leiomyosarcoma
benign melanocytes neoplasm
naevus
malignant melanocyte neoplasm
melanoma
malignant blood cells neoplasm
lymphoma/leukaemia
benign primary liver tumours
haemangioma - most common
hepatocellular adenoma
bile duct adenoma
malignant metastatic liver tumours
metastatic tumours (homing from elsewhere) most common, especially from GI tract
primary tumours
- heptocellular carcinoma
- cholangiocarcinoma
- hepatoblastoma - most common liver tumour in the young
liver cell adenoma
common in young women, esp on oral contraceptives
complications
- rupture - sub capsular
- rare progression to hepatocellular carcinoma
morphology of liver cell adenoma
pale, yellow/tan bile stained well demarcated usually sheets of hepatocytes = normal but - portal tracts - prominent arterial vessels and draining veins
hepato cellular carcinoma
highest incidence is in Asia
less in North America, Western Europe
high incidence in countries with high HBV and HCV infection +/- cirrhosis
- process takes 20-40 years
in the west - most have cirrhosis, rarely before 60 years
aetiology of HCC
- HBV, HCV
- chronic alcoholism
- food contamination by aflatoxins
- haemachromatosis
morphology of HCC
liver enlarged
single, multiple or diffusely infiltrative
usually paler than the surrounding liver
strong predilection to invasion of vascular channels - intra-hepaticc metastases - satellite nodules
malignant hepatocytes
- large nuclei, nucleoli, mitoses, thick liver cell plates
- well differentiated - acinar, pseudo glandular formations, solid
cholangiocarcinoma
malignancy of the biliary epithelium - intrahepatic, extra hepatic
associated with PSC, congenital disease eg. carolis disease, exposure to thorotrast
SE asia - chronic infection of the biliary tree by liver flukes
cholangiocarcinoma may produce
- mass or thickening and narrowing of bile ducts
- may track along the portal tracts if in the liver
- adenocarcinoma with a markedly desmoplastic (fibrotic) stroma
- haematogenous - lungs, bone, brain
- mixed - cholangio-hepatocellular carcinomas
metastatic liver tumours
most common hepatic malignancy
- tends to be multiple foci
- usually from the GIT
- can also be from great or lung
exocrine pancreas
- acini
benign tumours
- serous cyst adenoma
- cystic neoplasms
- mutinous cystic neoplasm
malignant tumours
- pancreatic adenocarcinoma
- acing cell carcinoma
endocrine pancreas
- pancreatic neuroendocrine neoplasms
- solid pseudo papillary neoplasm
pancreatic cancer
4th leading cause of cancer deaths
usually present with advances unresectable lesions
poor prognosis
pancreatic duct carcinoma
more common >65 smokers 2-3 times ore likely to develop pancreatic cancer new onset diabetes precursor lesions family history chronic pancreatitis
variants of PDAC
colloid carcinoma - adenocarcinoma with abundant extracellular mucin production
direct infiltration
t stage
pancreatic cancers spread along
perineurial spaces
early lymph node involvement
n stage
prognosis pancreatic cancer
poor
molecular carcinogenesis
- K-ras, G-nas
- P53
- SMAD
- HER2
precursor lesions
- pancreatic intraepithelial neoplasia
dysplasia of pancreatic ducts
cystic neoplasms
- mutinous cystic neoplasm
- intraductal papillary mucous neoplasms
precursor lesions - benign but can progress to a cancer
MCN/IPMN prognosis
gastropancreato-duodenectomy
or distal pancreatectomy
- with no invasion - excellent prognosis
- with invasion - better than de novo PDAC
pancreatic nueroendocrine tumours
- islets of langerhans scattered throughout the pancreas
- most in the tail
- all are malignant
- most are low grade and can be removed for cure
pre-operative diagnosis
endoscopic ultrasound guided (EUS)
team od radiologists, endoscopists cytologists
rapid on site evaluation
cytological assessment
