Histopathology Liver disease Flashcards
Benign types
Haemangioma
Liver cell adenoma
Blie duct malformations
Focal nodular hyperplasia
Malignant
HCC Cholangiocarcinoma Angioarcoma heptaoblastoma Lymphoma Metastasis
Haemangioma description
Most common benign vascular tumour
Haemangioma detection
Incidental pick up and rarely rupture
Bile duct malformation epi
Common Incidental finding at surgery Often misinterpreted as metastasis Benign Along with bile duct adenoma
Liver cell adenoma more common in
Women
Liver cell adenoma associated with
Contraceptive use (this subtype is the least likely to turn malignant)
FNH Similar features to
Cirrhosis
FNH presentation
Tumour like malformation
Central scar
Can become very large
More common in women
HCC epi
- Most common primary malignant tumour
- More common in men
- 5th most common malignancy in men worldwide
HCC causes
- Cirrhosis
- Hep B/C
- ASH/NASH
- Autoimmune hepatitis, chronic biliary disease
HCC least common causes
- Haemochromatosis
- A1AT-defiency
- Wilson’s disease
Diagnostic test
Alpha-feto protein (large increase) (seen in more than 50% of HCC or testicular)
Fibrolamellar HCC
Occurs in younger people
No background cirrhosis
Better Prognosis
Hepatoblastoma occurs in
Children under 5 years
Hepatoblastoma epi
Most frequent liver tumour in children
Most are male
Hepatoblastoma Diagnosis
AFP often raised
Hepatoblastoma Appearance
Lobulated
Hepatoblastoma Prognosis
Good
Hepatoblastoma Histological
Different histological variants
Angiosarcoma epi
Rare but most common sarcoma of liver
Most common in men
Angiosarcoma causes
Thorotrast
Arsenic
Anabolic steroids
Vinyl chloride
Angiosarcoma prognosis
Poor
Cholangiocarcinoma prognosis
Often aggressive with poor prognosis
Cholangiocarcinoma associated with
Chronic inflammation of bile ducts (PSC, parasites, pyogenic cholangitis)
Metastasis: epi
Most common malignant tumour in the liver
Common primary sites: colon, upper GI,lung, heart
Medical
Types
- Viral hepatitis
- Alcoholic/non-alcoholic fatty liver disease
- Autoimmune hepatitis
- Chronic biliary disease (PSC/PBC)
- Drug induced liver injury
- Inherited disorders (Wilson’s. haemochromatosis, A1At-defiency)
Hep A
- No carrier state
- Faeco-oral transmission
- Course can be mild, cholestatic or lead to liver failure
- Just acute
- Vaccine available
Hep B
- Transmission via bodily fluids
- Acute and chronic disease
- High prevalence worldwide
- Can lead to cirrhosis and HCC
Hep C
- Usually associated with chronic state
- Blood transmission
- Often leads to cirrhosis and can lead to HCC
Delta virues
- Super/co-infection in pre-existing hepatitis B
* Can lead to fulminant hepatitis
Hep E
Hep E
(Non-) alcoholic fatty liver disease → causes
Alcohol excess Obesity Diabetes Drugs Many more
(Non-) alcoholic fatty liver disease → can lead to
Fibrosis/cirrhosis
(Non-) alcoholic fatty liver disease → can lead to epi
Very common in the western world
High burden on health services
Autoimmune hepatitis →blood tests
High ALT
High IgG
ANA +
Autoimmune hepatitis → presentation
Acutely but usually chronic disease
Autoimmune hepatitis → can lead to
Cirrhosis
Autoimmune hepatitis →treated with
Steroids or immunosupression
Primary sclerosing cholangitis
Epi
Often present in young/middle aged males
Primary sclerosing cholangitis
Common in
Patients with UC
Primary sclerosing cholangitis
Appearance
Typical appearance in biliary tree imaging
Primary sclerosing cholangitis
Path
Progressive inflammation and fibrosis of large intra and extra hepatic bile ducts
Primary sclerosing cholangitis
Can lead to and increased risk of
Secondary biliary cirrhosis and increased risk of CC
Primary sclerosing cholangitis
Tests
AMA negative
Well recognised in children
p-ANCA+
Primary biliary cirrhosis:
Epi
Middle aged females
Primary biliary cirrhosis:
Tests
AMA +
IgM+
Alk phos raised
Primary biliary cirrhosis:
Can lead to
Cirrhosis
Drug induced liver injury:
Note
• Any histological picture can b caused by drugs, some are dose dependent some are not.
Hugely variable
Wilson’s disease
Definition
Autosomal recessive mutation on chromosome 13
Abberant storage of copper in many organs including the liver
Wilson’s disease
Leads to
Liver failure amongst other symptoms
Wilson’s disease
Presents in
Often presents in childhood
Haemochromatosis:
Definition
Autosomal recessive mutation of HFE gene on chromosome 6
Haemochromatosis:
Leads to
Increased iron absorption and storage in the liver
Haemochromatosis:
Increased risk of
HCC
Alpha – 1 – antitrypsin defiency: mutation
In the A1AT gene on chromosome 14
Alpha – 1 – antitrypsin defiency:
Path
Abnormal protein leads to accumulation in the liver
Alpha – 1 – antitrypsin defiency:
Increased risk of
HCC
Cirrhosis:
irreversible destruction of the liver architecture associated with fibrosis and nodule formation which may follow necrosis