L14- GIT Pathology VII (liver cancer) Flashcards
(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.
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
describe liver hemangioma appearance (histology)
blood-filled vascular channels separated via dense fibrous stroma
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
1- oral contraceptives
2- anabolic steroids
3- spontaneous hemorrhage
4- malignant transformation
5- can be fatal in pregnancy
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)
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
Hepatic adenoma subtypes: -list them -affects men or women more -key feature -risk of HCC transformation (indicate most common subtype)
- *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
Hepatic Adenoma (benign epithelial neoplasm):
- (1) gross appearance
- (2) histological appearance
1- pendulous mass arising from liver
2- cords of hepatocytes with arterial vascular supply and no portal tracts
Hepatic Adenoma Tx (benign epithelial neoplasm)
-stop causative medicine
Resection indicated for:
- Sxs
- large >5cm or increasing size
- uncertain Dx
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
(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
FNH (benign, non-neoplastic mass):
- (1) gross appearance
- (2) histological appearance
(focal nodular hyperplasia)
1- lobulated contours, central stellate scar
2- broad fibrotic scar with surrounding inflammation and lobular disarray due to hepatocyte regeneration
list the common malignant tumors of the liver
- HCC: variants include fibrolamellar HCC
- cholangiocarcinoma
- hepatoblastoma
- metastasis: commonly from colon cancer
(1) is the most common liver tumor in neonates / young children. It appears around (2) age and is found more in (males/females).
1- hepatoblastoma
2- 18 mos (anywhere from birth to 40 mos)
3- males, slightly
Hepatoblastoma:
- (1) clinical Sxs
- (2) is often elevated as an indicator
- (rapid/slow) growth
- (good/poor) prognosis
- spreads to (5) often
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
list the syndromes / diseases associated with Hepatoblastoma
- *Beckwith-Wiedemann syndrome (disorder increasing risk of childhood cancer: encephalopathy, macroglossia)
- *Down syndrome
- familial polyposis coli
- hemihypertrophy
- renal malformation
- various cytogenetic abnormalities
describe the morphology of all types of Hepatoblastoma
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
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)
1- cirrhosis 2- HepB virus 3- Taiwan, Mozambique, China 4- males 5- adults (children with metabolic liver disease)
list the HCC risk factors
-*cirrhosis (any etiology)
- HepB, HepC
- hemochromatosis
- alcoholic cirrhosis
- AAT deficiency
- aflatoxin
- NAFLD (non-alcoholic fatty liver disease)
HCC morphology:
- (uni-/multi-)focal
- (patchy/diffuse) infiltration
- (3) color in comparison to normal surrounding tissue
- often invades (4) type locations
1- both unifocal and multifocal
2- diffuse infiltration
3- paler
4- vascular channels –> portal vein, Inf. vena cava
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
1- any level of differentiation
2- trabecular, sinusidal, pseudoacinar pattern
3- bile production
4- cytoplasmic inclusions
5- cirrhosis
HCC clinical features:
- (1) are the main characteristics to describe HCC features
- (2) are the classic Sxs
- (3) in serum can be an indicator
1- not uniform, usually masked by underlying liver disease
2- upper abdominal pain, fatigue, cachexia
3- elevated AFP, 60-75% cases
HCC:
- (1) investigations
- (2) Tx
- (3) prognosis
1- FNAC (fine needle aspiration cytology), biopsy
2- resection, ablation, transplant
3- non-cirrhotic liver has better prognosis
Fibrolamellar variant of HCC, list the key unique features separate from HCC (hint- ~4 facts)
- younger age of onset
- no association with HepB, cirrhosis
- AFP normal
- outcome similar to non-cirrhotic HCC
Fibrolamellar variant of HCC, describe histology / morphology
- single hard tumor: fibrous bands transversing thru it = scirrhous
- well-differentiated polygonal cells in cords/nests – separated by fibrous septa
(1) is a malignancy of the biliary tree, arising from (intra/extra)-hepatic ducts. AFP is (normal/elevated).
1- cholangiocarcinoma (CCA)
2- both (depends on type)
3- normal AFP
list CCA risk factors
(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)
CCA:
- (1) gross appearance
- (2) histological apperance
1- multifocal cholangiocarcinoma: pale, patchy, maybe hemorrhage
2- invasive malignant glands in reactive sclerotic stroma
CCA clinical features:
- (1) sxs
- (2) may be evident for extended periods
- spread / metastasis is (more/less) likely than HCC
- (good/poor) prognosis
1- malaise, weight loss, jaundice, cholangitis
2- clinically silent
3- more likely to spread
4- poor prognosis
describe the Sxs of cholangitis
Charcot Triad: jaundice, fever, RUQ pain
(progresses to —->)
Reynold’s Pentad: charcot triad + hypotension, mental status changes (both via Sepsis)
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
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
