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Clinical Pathology in Action > L17 - Liver pathology > Flashcards

L17 - Liver pathology Flashcards

1
Q

What are the conditions that predispose individuals to primary liver tumors?

A

Chronic hepatitis B and C, cirrhosis, toxin exposure (aflatoxins), metabolic conditions like hemochromatosis, and genetic predispositions.

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2
Q

What is the most common malignancy found in the liver?

A

Metastatic tumors from other primary cancers.

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3
Q

Why is the liver a frequent site for metastasis?

A

The liver has a dual blood supply from the hepatic artery and portal vein, making it highly susceptible to metastases.

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4
Q

Which primary liver carcinoma is the most common?

A

Hepatocellular carcinoma (HCC).

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5
Q

What are common sources of metastatic liver tumors?

A

Gastrointestinal tract, breast, and lung cancers.

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6
Q

What chronic viral infections significantly increase the risk of hepatocellular carcinoma?

A

Hepatitis B and C.

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7
Q

How does cirrhosis contribute to liver cancer development?

A

Cirrhosis results in liver damage and regenerative nodules, increasing cancer risk.

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8
Q

What toxin exposure is associated with hepatocellular carcinoma?

A

Aflatoxins.

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9
Q

Which metabolic condition increases the risk of liver cancer?

A

Hemochromatosis.

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10
Q

What imaging studies are commonly used to diagnose liver tumors?

A

Ultrasound, CT scans, MRI.

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11
Q

Which serum biomarker is useful for detecting hepatocellular carcinoma?

A

Alpha-fetoprotein (AFP).

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12
Q

Why is AFP not always definitive for hepatocellular carcinoma?

A

AFP levels are not elevated in all cases, and other conditions can cause elevation.

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13
Q

When might a liver biopsy be necessary for diagnosis?

A

When imaging and serum markers are inconclusive.

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14
Q

What are the primary treatment options for liver tumors?

A

Surgical resection, liver transplantation, systemic therapies.

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15
Q

When is liver transplantation a viable treatment option?

A

For patients with cirrhosis and early-stage hepatocellular carcinoma.

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16
Q

What systemic treatments are emerging for liver tumors?

A

Targeted therapies and immunotherapy.

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17
Q

When is chemotherapy typically used for liver tumors?

A

For non-resectable or metastatic tumors.

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18
Q

What is transarterial chemoembolization (TACE)?

A

A minimally invasive procedure that delivers chemotherapy directly to liver tumors.

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19
Q

What histopathological features characterize hepatocellular carcinoma?

A

Trabecular or pseudoglandular growth patterns with vascular invasion, sometimes with Mallory-Denk bodies.

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20
Q

Which cytoplasmic inclusions may be present in hepatocellular carcinoma?

A

Mallory-Denk bodies.

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21
Q

What immunohistochemistry markers help distinguish hepatocellular carcinoma?

A

HepPar-1, glypican-3, arginase-1.

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22
Q

How do metastatic liver tumors differ histologically from primary liver tumors?

A

Metastatic tumors resemble their primary cancer site.

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23
Q

Which markers help identify colorectal cancer metastases in the liver?

A

CK20 and CDX2.

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24
Q

Which markers help identify breast cancer metastases in the liver?

A

ER/PR positivity.

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25
What molecular mutations have been identified in hepatocellular carcinoma?
TP53 and CTNNB1 mutations.
26
Why is genomic sequencing important in liver cancer research?
It helps identify targetable genetic alterations.
27
What role does immunotherapy play in liver cancer treatment?
Checkpoint inhibitors are being investigated for treatment.
28
What is the most important factor in determining if a liver tumor is primary or metastatic?
Histological features and immunohistochemistry markers.
29
What is the first diagnostic question when a liver mass is identified?
Is the mass primary or metastatic?
30
What is the most common primary malignancy of the liver?
Hepatocellular carcinoma (HCC).
31
What is a common presenting symptom of hepatocellular carcinoma?
Right upper quadrant pain.
32
What additional symptom may suggest liver malignancy?
Unintentional weight loss.
33
How does chronic hepatitis B increase liver cancer risk?
By integrating into the host genome and promoting oncogenesis.
34
What is a common imaging finding in hepatocellular carcinoma?
A solitary mass with arterial enhancement.
35
What is the main determinant for surgical resection in hepatocellular carcinoma?
Tumor localization and absence of vascular invasion or metastasis.
36
Why might liver transplantation be preferred over resection in some cases?
It treats both the tumor and underlying liver disease.
37
What is the management approach for metastatic liver disease?
Systemic chemotherapy, targeted therapy, or surgical resection in select cases.
38
Which primary cancer most commonly metastasizes to the liver?
Colorectal cancer.
39
Why is colorectal cancer prone to liver metastasis?
The liver receives portal circulation from the gastrointestinal tract.
40
What histopathological features characterize hepatocellular carcinoma?
Trabecular or pseudoglandular growth patterns with vascular invasion, sometimes with Mallory-Denk bodies.
41
What is the prognosis for untreated hepatocellular carcinoma?
Poor prognosis, with survival often measured in months.
42
How does early detection impact hepatocellular carcinoma outcomes?
Improves survival and treatment success.
43
What is a key limitation of liver transplantation for hepatocellular carcinoma?
Limited availability of donor organs.
44
What imaging feature suggests metastatic liver tumors?
Multiple nodular lesions without arterial enhancement.
45
What are the common symptoms of metastatic liver disease?
Fatigue, weight loss, abdominal pain, jaundice.
46
Why is jaundice a symptom of advanced liver cancer?
Due to bile duct obstruction from tumor growth.
47
What does vascular invasion in hepatocellular carcinoma indicate?
Indicates aggressive disease and worse prognosis.
48
Which patients are at highest risk for hepatocellular carcinoma?
Patients with chronic hepatitis B/C, cirrhosis, and metabolic disorders.
49
How does non-alcoholic fatty liver disease (NAFLD) contribute to liver cancer?
It causes chronic inflammation and fibrosis, increasing cancer risk.
50
What is a characteristic finding of liver cirrhosis on imaging?
Nodular liver surface and altered echotexture.
51
How is liver fibrosis assessed non-invasively?
Elastography or serum fibrosis markers.
52
What lifestyle modification reduces hepatocellular carcinoma risk?
Reducing alcohol intake and maintaining a healthy weight.
53
How does obesity contribute to liver cancer risk?
It increases inflammation and insulin resistance, contributing to liver cancer.
54
What is the significance of the Milan criteria in liver transplantation?
Defines eligibility for liver transplantation in HCC patients.
55
What are the Milan criteria for liver transplantation?
A single tumor ≤5 cm or up to 3 tumors ≤3 cm, no vascular invasion or metastasis.
56
Which population has a higher risk of aflatoxin-related liver cancer?
Populations in regions with high aflatoxin-contaminated food exposure.
57
What is the relationship between diabetes and liver cancer?
Diabetes increases insulin resistance and promotes liver inflammation.
58
What is a key factor in distinguishing hepatocellular carcinoma from metastatic liver cancer?
Histological and immunohistochemical analysis.
59
Why is early screening important in high-risk populations for hepatocellular carcinoma?
It allows early intervention, improving survival rates.
60
How often should high-risk individuals undergo liver cancer screening?
Every 6 months with ultrasound ± AFP testing.
61
How are multiple liver metastases usually treated?
Multiple liver metastases are typically treated with systemic therapies, including chemotherapy or targeted therapies. In some cases, transarterial chemoembolization (TACE) or liver transplantation may be considered.
62
What surgical procedure is sometimes used for isolated liver metastases?
Surgical resection or liver resection is sometimes used for isolated liver metastases, particularly when the metastases are limited to a single site and can be completely removed.
63
What is the primary goal of local ablative techniques for liver tumors?
The primary goal of local ablative techniques, such as radiofrequency ablation (RFA) and microwave ablation (MWA), is to destroy the tumor tissue while preserving surrounding healthy liver tissue, offering a minimally invasive alternative to surgery.
64
What are examples of local ablative therapies for liver tumors?
Examples of local ablative therapies for liver tumors include radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation. These techniques are used to destroy tumors by heat or cold without the need for surgery.
65
What are the two types of blood supply to the liver?
The hepatic artery (oxygenated blood) and the portal vein (nutrient-rich blood from the GI tract).
66
What is the functional unit of the liver?
The hepatic lobule.
67
Why is the liver able to regenerate after partial excision?
Because the liver has a remarkable regenerative capacity up to a certain extent.
68
What makes the liver vulnerable to drug toxicity?
Its role in detoxifying and metabolising substances makes it susceptible to injury by toxic metabolites.
69
Which two organs are primarily involved in drug metabolism?
The liver and kidneys.
70
What vitamin requires liver activation?
Vitamin D.
71
What are the two types of epithelial cells in the liver?
Hepatocytes and biliary epithelial cells.
72
What histological feature distinguishes normal liver tissue from cirrhotic liver tissue?
Cirrhotic liver shows nodular regeneration separated by fibrous bands, unlike the smooth architecture of normal liver.
73
What physical signs can indicate chronic liver disease during a clinical exam?
Ascites, jaundice, and distended superficial abdominal veins (caput medusae).
74
What is the significance of a segmental liver blood supply in surgery?
It allows safe removal of specific segments without compromising the rest of the liver. Hepatocytes.
75
What is the main cell type involved in liver parenchyma?
Cholangiocarcinoma.
76
Which major cancer type arises from the biliary epithelium?
Metastatic adenocarcinoma (usually from gastrointestinal or breast cancer).
77
What is the most likely diagnosis if a liver tumour forms glandular structures?
Hepatitis B virus (HBV).
78
What infection is linked to liver cancer risk even without cirrhosis?
Aflatoxin is a fungal toxin that can cause DNA damage leading to hepatocellular carcinoma, especially in areas with poor food storage.
79
How is aflatoxin exposure related to liver cancer development?
Thorotrast, a historical radiological contrast agent.
80
Which environmental exposure was historically linked to cholangiocarcinoma?
Fatty liver appears smooth and greasy, while cirrhotic liver is nodular and firm.
81
What is the appearance of a fatty liver compared to a cirrhotic liver?
Hemochromatosis, Wilson disease, alpha-1 antitrypsin deficiency.
82
Which metabolic diseases are associated with liver fibrosis and cirrhosis?
Mutation affecting copper excretion leads to Wilson disease.
83
What genetic defect leads to copper accumulation in the liver?
Kayser-Fleischer rings around the cornea.
84
What physical sign is associated with Wilson disease?
Women are somewhat protected pre-menopause due to iron loss through menstruation.
85
How does haemochromatosis typically differ between men and women?
Heart, pancreas, joints, and skin.
86
Which organs besides the liver are affected in haemochromatosis?
To protect tissues from protease damage during inflammation.
87
What is the function of alpha-1 antitrypsin?
Early-onset emphysema, especially in non-smokers.
88
What is the effect of alpha-1 antitrypsin deficiency on the lungs?
Primary biliary cholangitis (PBC).
89
What liver disease is characterised by patchy inflammation around bile ducts?
Progression to liver cirrhosis and liver failure.
90
What serious complication can arise from primary biliary cholangitis?
Caput medusae (dilated superficial abdominal veins).
91
What clinical symptom can indicate severe portal hypertension?
Disrupted architecture prevents coordinated function despite the presence of hepatocytes.
92
Why might fibrosis make liver function ineffective even if cells are present?
Hepatitis B infection.
93
What risk factor for hepatocellular carcinoma is expected to decrease with vaccination programmes?
Hepatitis B and hepatitis C.
94
What two infections are most important for liver cancer development worldwide?
Due to the rising rates of obesity and diabetes,
95
Why might non-alcoholic fatty liver disease (NAFLD) be a growing concern for liver pathology?
NAFLD is becoming a major cause of chronic liver disease.
96
What type of liver pathology presents with a soft, enlarged, greasy liver?
Steatosis (fatty liver).

Clinical Pathology in Action (19 decks)

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