Hepatobilliary Neoplasia

Question 1

The most common neoplasms of the liver are:

Answer 1

Metastatic tumors

Question 2

The most common tumor sites that metastasize to the liver are?

Answer 2

Colon, Stomach, Pancrea, Breast, Lung

Cancer sometimes penetrates benign liver

Question 3

Hepatocellular carcinoma prognosis?

Answer 3

Its bad, less than 5%

Question 4

Hepatocellular carcinoma is what>

Answer 4

Malignant epithelial neoplasm of the liver composed of cells resembling hepatocytes to a greater or lesser degree

Question 5

Epidemiology of hepatocellular carcinoma?

Answer 5

3x more common in males, 3x more common in asian americans

Question 6

Hepatocellular carcinoma is most common in pts with what?

Answer 6

Viral hepatitis

Question 7

Pts with hepatocellular carcinoma present with what?

Answer 7

Jaundice, encephalopathy, ascites, bleeding, mild-moderate abdominal pain, wt. loss, diarrhea, bone pain

Question 8

What are the useful predictors of prognosis for hepatocellular carcinoma?

Answer 8

Size
Differentiation
Invasion and Metastasis
Presence or Absence of Cirrhosis

Question 9

Why is biopsy a risky procedure in HCC?

Answer 9

Because many Hepatocellular carcinomas are highly vascularized. You can get a massive hemorrhage if you’re not careful

Question 10

Most common HCC histologic patterns?

Answer 10

Microtrabecular and macrotrabecular

Question 11

Major serum protein marker for hepatocellular carcinoma

Answer 11

alpha-fetoprotein

Question 12

Whats the problem with alpha fetoprotein being the major marker?

Answer 12

It is also elevated in acute or chronic liver injury, gonadal tumors, pregnancy, and some gastric cancers

Over 20 the specificity is 91%
Over 200 the specificity is 99%

Question 13

What is the mainstay treatment for liver cancer?

Answer 13

Surgical resection

Question 14

Surgical resection is problematic however because most pts are not eligible due to tumor extent or underlying liver dysfunction

Answer 14

ok

Question 15

What are some other treatments for liver cancer?

Answer 15

Inject ethanol into the tumor…pretty awesome

Question 16

Hepatic adenomas are most common in what kinds of pts

Answer 16

Those who have taken or are taking anabolic steroids, androgenic steroids, or estrogenic steroids

BIRTH CONTROL

Question 17

Are hepatic adenomas malignant?

Answer 17

nope…they go away when you stop taking the drug

Question 18

Note that hepatic adenomas may expand during pregnancy because of the increase in estrogen levels…tehy are estrogen sensitive. This increases the possibility of rupture and intraperitoneal hemorrhage.

Answer 18

The tumors will regress as soon as the pregnancy is over though

Question 19

Most common benign tumor in the liver

Answer 19

Hemangioma

Question 20

Hemangioma histo>

Answer 20

blood filled vascular space

Question 21

Hepatoblastoma

Answer 21

Rare malignant epithelial neoplasm in children

Question 22

Cholangiocarcinoma

Answer 22

Malignant epithelial neoplasm with Biliary differentiation

Question 23

Cholangiocarcinoma epidemiology

Answer 23

more common in males

Ages 50-70

Question 24

Cholangiocarcinoma strongly associated with what other condition

Answer 24

Primary sclerosing cholangitis

Question 25

Extrahepatic cholangiocarcinoma at the bifurcation of the hepatic bile duct is called?

Answer 25

Klatskin tumor

Question 26

KRAS mutation in what percent of intrahepatic tumors? | Extrahepatic

Answer 26

50% 15% extrahepatic

Question 27

appearance of cholangiocarcinoma?

Answer 27

tan-white (no bile made)

Question 28

cholangiocarcinoma spreads mostly via what route?

Answer 28

Lymph

Question 29

Cholangiocarcinoma histo

Answer 29

abnormal tubular structures embedded in a dense fibrous matrix

Question 30

Extrahepatic cholangiocarcinoma symptoms

Answer 30

Pruritis, RUQ pain, wt loss, Jaundice, clay colored stool and dark urine, Lab: high bilirubin highalk phos

Question 31

Entrahepatic cholangiocarcinoma symptoms

Answer 31

dull RUQ pain and wt loss Lab: bilirubin may be normal or a little high alk phos will be high

Question 32

Cholangiocarcinoma prognosis

Answer 32

Bad

Question 33

Gall Bladder carcinoma more common in who

Answer 33

Its really rare overall but most common in females, hispanics, native americans

Question 34

Risk factors of gall bladder cancer?

Answer 34

gall stones

Question 35

Liver mets have what appearance

Answer 35

multiple, rounded, potentially hemorrhagic or necrotic

Question 36

Liver mets often allow surprisingly normal function of the liver due to regeneration capacity

Answer 36

ok