hepatobiliary and pancreatic neoplasms

Question 1

benign epithelium neoplasm

Answer 1

adenoma

papilloma

Question 2

malignant epithelium neoplasm

Answer 2

adenocarcinoma

papillary carcinoma

Question 3

benign mesenchyme carcinoma

Answer 3

fibroma
lipoma
osteoma
leiomyoma

Question 4

malignant mesenchyme neoplasm

Answer 4

fibrosarcoma
liposarcoma
osteosarcoma
leiomyosarcoma

Question 5

benign melanocytes neoplasm

Answer 5

naevus

Question 6

malignant melanocyte neoplasm

Answer 6

melanoma

Question 7

malignant blood cells neoplasm

Answer 7

lymphoma/leukaemia

Question 8

benign primary liver tumours

Answer 8

haemangioma - most common
hepatocellular adenoma
bile duct adenoma

Question 9

malignant metastatic liver tumours

Answer 9

metastatic tumours (homing from elsewhere) most common, especially from GI tract
primary tumours
- heptocellular carcinoma
- cholangiocarcinoma
- hepatoblastoma - most common liver tumour in the young

Question 10

liver cell adenoma

Answer 10

common in young women, esp on oral contraceptives
complications
- rupture - sub capsular
- rare progression to hepatocellular carcinoma

Question 11

morphology of liver cell adenoma

Answer 11

pale, yellow/tan 
bile stained 
well demarcated usually 
sheets of hepatocytes = normal 
but 
- portal tracts 
- prominent arterial vessels and draining veins

Question 12

hepato cellular carcinoma

Answer 12

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

Question 13

aetiology of HCC

Answer 13

• HBV, HCV
• chronic alcoholism
• food contamination by aflatoxins
• haemachromatosis

Question 14

morphology of HCC

Answer 14

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

Question 15

malignant hepatocytes

Answer 15

• large nuclei, nucleoli, mitoses, thick liver cell plates

- well differentiated - acinar, pseudo glandular formations, solid

Question 16

cholangiocarcinoma

Answer 16

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

Question 17

cholangiocarcinoma may produce

Answer 17

• 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

Question 18

metastatic liver tumours

Answer 18

most common hepatic malignancy

• tends to be multiple foci
• usually from the GIT
• can also be from great or lung

Question 19

exocrine pancreas

Answer 19

• acini

benign tumours

• serous cyst adenoma
• cystic neoplasms
• mutinous cystic neoplasm

malignant tumours

• pancreatic adenocarcinoma
• acing cell carcinoma

Question 20

endocrine pancreas

Answer 20

• pancreatic neuroendocrine neoplasms

- solid pseudo papillary neoplasm

Question 21

pancreatic cancer

Answer 21

4th leading cause of cancer deaths
usually present with advances unresectable lesions
poor prognosis

Question 22

pancreatic duct carcinoma

Answer 22

more common >65 
smokers 2-3 times ore likely to develop pancreatic cancer 
new onset diabetes 
precursor lesions 
family history 
chronic pancreatitis

Question 23

variants of PDAC

Answer 23

colloid carcinoma - adenocarcinoma with abundant extracellular mucin production

Question 24

direct infiltration

Answer 24

t stage

Question 25

pancreatic cancers spread along

Answer 25

perineurial spaces

Question 26

early lymph node involvement

Answer 26

n stage

Question 27

prognosis pancreatic cancer

Answer 27

poor

Question 28

molecular carcinogenesis

Answer 28

• K-ras, G-nas
• P53
• SMAD
• HER2

Question 29

precursor lesions

Answer 29

• pancreatic intraepithelial neoplasia

dysplasia of pancreatic ducts

Question 30

cystic neoplasms

Answer 30

• mutinous cystic neoplasm
• intraductal papillary mucous neoplasms

precursor lesions - benign but can progress to a cancer

Question 31

MCN/IPMN prognosis

Answer 31

gastropancreato-duodenectomy
or distal pancreatectomy

• with no invasion - excellent prognosis
• with invasion - better than de novo PDAC

Question 32

pancreatic nueroendocrine tumours

Answer 32

• islets of langerhans scattered throughout the pancreas
• most in the tail
• all are malignant
• most are low grade and can be removed for cure

Question 33

pre-operative diagnosis

Answer 33

endoscopic ultrasound guided (EUS)
team od radiologists, endoscopists cytologists
rapid on site evaluation
cytological assessment