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DERS (GIT) > L14- GIT Pathology VII (liver cancer) > Flashcards

L14- GIT Pathology VII (liver cancer) Flashcards

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1
Q

(1) is the most common benign liver tumor. They are more common in (males/females). They present as (solitary/multiple) mass(es) and are usually discovered via (4) and can be mistaken for (5). (6) may be the only presenting symptom / abnormality.

A

1- Hemangioma (benign non-epithelial neoplasm)
2- females (5:1)
3- solitary mass (usually)
4- incidentally on CT, laparoscopy, laparotomy
5- metastatic tumor
6- abdominal pain

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2
Q

describe liver hemangioma appearance (histology)

A

blood-filled vascular channels separated via dense fibrous stroma

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3
Q

Hepatic Adenomas (benign epithelial neoplasm):

  • (1) and (2) use are the main associations
  • (3) and (4) are the main risks / complications
  • (5) must considered in pregnancy
A

1- oral contraceptives
2- anabolic steroids

3- spontaneous hemorrhage
4- malignant transformation

5- can be fatal in pregnancy

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4
Q

Hepatic Adenomas (benign epithelial neoplasm):

  • (1) is the main presentation with one of the following Sxs: (2), (3), (4)
  • (5) is another way of diagnosis
  • (6) is importantly normal in serum
  • (7) is the main risk / complication (depending on subtype)
A

1- Acute
2- abdominal pain
3- episodic pain / discomfort
4- shock and hemorrhage into tumor or peritoneal cavity

5- incidental on imaging
6- normal serum AFP (α-fetoprotein)
7- HCC

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5
Q 
Hepatic adenoma subtypes:
-list them
-affects men or women more
-key feature
-risk of HCC transformation
(indicate most common subtype)
A
  • *Hepatocyte nuclear factor 1α mutation:
  • women mostly
  • rich in fat
  • minimal risk of HCC
  • β-catenin mutation:
  • women 60%, 40% men
  • cytologic atypia
  • *high risk of HCC

IL-6 receptor pathway mutation:

  • mostly women
  • sinusoidal dilatation
  • 5-10% HCC risk
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6
Q

Hepatic Adenoma (benign epithelial neoplasm):

  • (1) gross appearance
  • (2) histological appearance
A

1- pendulous mass arising from liver

2- cords of hepatocytes with arterial vascular supply and no portal tracts

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7
Q

Hepatic Adenoma Tx (benign epithelial neoplasm)

A

-stop causative medicine

Resection indicated for:

  • Sxs
  • large >5cm or increasing size
  • uncertain Dx
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8
Q

FNH (benign, non-neoplastic mass):

  • some association with (1), but less than in an hepatic adenoma (or adenomas in general)
  • affects (males/females) most
  • usually a (small/large) (solitary/multiple) hyperplastic nodule(s)
  • (5) appearance on CT, MRI
  • (6) indicates resection
A 
(focal nodular hyperplasia)
1- oral contraceptives
2- females (4:1)
3- small (may be large)
4- solitary
5- central scar
6- symptomatic or uncertain diagnosis
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9
Q

FNH (benign, non-neoplastic mass):

  • (1) gross appearance
  • (2) histological appearance
A

(focal nodular hyperplasia)
1- lobulated contours, central stellate scar

2- broad fibrotic scar with surrounding inflammation and lobular disarray due to hepatocyte regeneration

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10
Q

list the common malignant tumors of the liver

A
  • HCC: variants include fibrolamellar HCC
  • cholangiocarcinoma
  • hepatoblastoma
  • metastasis: commonly from colon cancer
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11
Q

(1) is the most common liver tumor in neonates / young children. It appears around (2) age and is found more in (males/females).

A

1- hepatoblastoma
2- 18 mos (anywhere from birth to 40 mos)
3- males, slightly

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12
Q

Hepatoblastoma:

  • (1) clinical Sxs
  • (2) is often elevated as an indicator
  • (rapid/slow) growth
  • (good/poor) prognosis
  • spreads to (5) often
A

1- hepatomegaly / abdominal mass + rarely jaundice
2- elevated AFP (α-fetoprotein), 80-90% of cases
3- rapid growth
4- poor prognosis
5- lungs, LNs, peritoneum

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13
Q

list the syndromes / diseases associated with Hepatoblastoma

A
  • *Beckwith-Wiedemann syndrome (disorder increasing risk of childhood cancer: encephalopathy, macroglossia)
  • *Down syndrome
  • familial polyposis coli
  • hemihypertrophy
  • renal malformation
  • various cytogenetic abnormalities
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14
Q

describe the morphology of all types of Hepatoblastoma

A

Epithelial Type:

  • fetal cells; resembles fetal liver
  • embryonic cells: smaller, rounder, fusiform cell arranges in rosettes / cords / ribbons

Mixed epithelial-mesenchymal Type:

  • epithelium with mesenchymal element
  • fibrous tissue
  • osteoid or cartilagionous differentiation
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15
Q

HCC:

  • mostly related to (1) cases
  • global distribution is related to (2) and highest incidences in (3)
  • mostly in (males/females) and in (children/adults)
A 
1- cirrhosis
2- HepB virus
3- Taiwan, Mozambique, China
4- males
5- adults (children with metabolic liver disease)
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16
Q

list the HCC risk factors

A

-*cirrhosis (any etiology)

  • HepB, HepC
  • hemochromatosis
  • alcoholic cirrhosis
  • AAT deficiency
  • aflatoxin
  • NAFLD (non-alcoholic fatty liver disease)
17
Q

HCC morphology:

  • (uni-/multi-)focal
  • (patchy/diffuse) infiltration
  • (3) color in comparison to normal surrounding tissue
  • often invades (4) type locations
A

1- both unifocal and multifocal
2- diffuse infiltration
3- paler
4- vascular channels –> portal vein, Inf. vena cava

18
Q

HCC histological features:

  • (poorly/well)-differentiated
  • (2) describe the pattern
  • (3) production by tumor cells are represented by (4)
  • (5) is found in adjacent liver parenchyma
A

1- any level of differentiation
2- trabecular, sinusidal, pseudoacinar pattern

3- bile production
4- cytoplasmic inclusions

5- cirrhosis

19
Q

HCC clinical features:

  • (1) are the main characteristics to describe HCC features
  • (2) are the classic Sxs
  • (3) in serum can be an indicator
A

1- not uniform, usually masked by underlying liver disease

2- upper abdominal pain, fatigue, cachexia

3- elevated AFP, 60-75% cases

20
Q

HCC:

  • (1) investigations
  • (2) Tx
  • (3) prognosis
A

1- FNAC (fine needle aspiration cytology), biopsy

2- resection, ablation, transplant

3- non-cirrhotic liver has better prognosis

21
Q

Fibrolamellar variant of HCC, list the key unique features separate from HCC (hint- ~4 facts)

A
  • younger age of onset
  • no association with HepB, cirrhosis
  • AFP normal
  • outcome similar to non-cirrhotic HCC
22
Q

Fibrolamellar variant of HCC, describe histology / morphology

A
  • single hard tumor: fibrous bands transversing thru it = scirrhous
  • well-differentiated polygonal cells in cords/nests – separated by fibrous septa
23
Q

(1) is a malignancy of the biliary tree, arising from (intra/extra)-hepatic ducts. AFP is (normal/elevated).

A

1- cholangiocarcinoma (CCA)
2- both (depends on type)
3- normal AFP

24
Q

list CCA risk factors

A

(cholangiocarcinoma)
*none for Intra-hepatic, mostly

Extra-hepatic:

  • sclerosing cholangitis (PSC)
  • cystic dilatations / malformations of biliary system
  • gallstone
  • chemicals: benzidine, nitroamines
  • parasitic infections (clonorchis sinensis, optisthorchis /// note leads to cholangitis initially)
25
Q

CCA:

  • (1) gross appearance
  • (2) histological apperance
A

1- multifocal cholangiocarcinoma: pale, patchy, maybe hemorrhage

2- invasive malignant glands in reactive sclerotic stroma

26
Q

CCA clinical features:

  • (1) sxs
  • (2) may be evident for extended periods
  • spread / metastasis is (more/less) likely than HCC
  • (good/poor) prognosis
A

1- malaise, weight loss, jaundice, cholangitis

2- clinically silent

3- more likely to spread

4- poor prognosis

27
Q

describe the Sxs of cholangitis

A

Charcot Triad: jaundice, fever, RUQ pain
(progresses to —->)
Reynold’s Pentad: charcot triad + hypotension, mental status changes (both via Sepsis)

28
Q

Liver ranks (1) among common locations for metastasis, usually with (single/multiple) lesions.

  • (3) CAs are most common
  • (4) are other CA causes
  • (5) are the childhood causes
A

1- 2nd, behind and usually after LN invasion
2- multiple (sometimes single, resection can occur)

3- Adenocarcinomas in GIT (colon, stomach, pancreas), breast, lung
4- neuroendocrine tumors, melanomas
5- neuroblastoma, Wilm’s tumor, leukemia

DERS (GIT) (21 decks)

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