Liver Flashcards
benign mimics of malignancy
HCA
bile duct hamartoma
peribiliary gland hamartoma
adenomatoid tumour
malignant mimics of benign
lymphoma/leukaemia
subtle metastatic disease (lobular and signet ring ca)
low grade angiosarcoma (along sinusoids)
if nothing, look for…
amyloid
infection (CMV, schistosoma)
vasculitis
thrombi/emboli
hairy cell leukaemia
cystic fibrosis (morphology)
stellate scars
irregular bile ducts
inspissated eosinophilic material
viral hepatitis
Hep B: ground glass hepatocytes with ‘sanded’ nuclei
Hep C: lymphoid aggregates with germinal centres, granulomas
CMV: microabscesses, granulomas
granulomas
PBC
infection (viral, bacterial, fungal, parasitic)
drugs
sarcoid
foreign body (eg IV drug user)
Crohn’s
malignancy esp Hodgkins
cirrhosis
viral hepatitis
alcohol
NASH
biliary cirrhosis
autoimmune
metabolic (haemochromatosis, A1T, Wilson’s)
congestion (eg heart failure, Budd-Chiari)
causes of biliary cirrhosis
intrahepatic: PBC, PSC
extrahepatic: gallstones, IgG4, biliary atresia, choledochal cyst, tumours
non-neoplastic cysts
infection (pyogenic, amoeba, hydatids)
simple biliary cyst
polycystic liver disease
mesenchymal hamartoma
pseudocyst
enteric cysts
neoplastic cysts
mucinous cystic neoplasm
intraductal papillary neoplasm
serous cystadenoma
teratoma
cystic malignancy (incl metastases)
polycystic liver disease
PLD assoc with ADPKD (more common)
fibrocystic liver disease: autosomal recessive, often assoc with ARPKD
hepatocellular lesions
non cirrhotic: HCA, FNH, NRH, fibrolamellar HCC
cirrhotic:
macroregenerative nodule (>8mm)
dysplastic nodule (>1mm)
HCC
hepatocellular adenoma (types)
- HNF1a mutation: steatosis
- b-catenin mutation: atypia, pseudoglandular, glutamine synthetase+
- inflammatory: telangiectasia
- unspecified
clues for HCC
loss of portal tracts
unpaired arteries
plates >2 cells thick
small cell change
clone-like subpopulations (haemosiderin free)
mitoses >5/10HPF
reticulin (loss), CD34, glypican 3
biliary lesions
bile duct hamartoma (von Meyenberg complex): irregular glands in dense fibrous stroma, bile
peribiliary gland hamartoma (bile duct adenoma): uniform round ducts, less stroma, no bile
cholangiocarcinoma (atypia and mitoses cf above)
vascular lesions
cavernous haemangioma
infantile haemangioma
epithelioid haemangioendothelioma
Kaposi sarcoma
angiosarcoma
HCC vs cholangioca vs metastatic adenoca
HCC: cirrhosis, HepPar1+, pCEA/CD10 (canalicular), glypican3+
cholangioca: HMWCK, MOC31, CK19+
met ca: CK depends on site, no good markers vs cholangioca
HCC vs met large cell neuroendocrine ca
LCNEC: NE markers, CK, TTF1 in 50%
fibrolamellar HCC (pleomorphic cells)
scirrhous HCC - DDX
radiation (need Hx)
cholangiocarcinoma
epithelioid haemangioendothelioma: young, myxoid stroma, CD31+
HCC vs HCA
HCA: OCP use, no cirrhosis, uniform cells, plates <3 cells thick, intact reticulin
FNH vs HCA
FNH:
central scar
bile ductules
glutamine synthetase (GS)+ (- in all but beta-catenin HCA)
serum amyloid A (SAA)- (HCA is +)
nodular regenerative hyperplasia - features
multiple small nodules throughout liver
no fibrous septa
assoc with portal vein obstruction or vascular flow problem (eg PCV, Budd-Chiari)
GS+ (distinguishes cirrhosis)