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Git Pathology > Liver Cancer, Gall Bladder > Flashcards

Liver Cancer, Gall Bladder Flashcards

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1
Q

Major risk factors of hepatocellular carcinoma

A

HBV
HCV
Aflatoxin
Alcoholic cirrhosis
Nash
Nafld

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2
Q

Minor risk factors for hepatocellular carcinoma

A

Hemochromatosis
Wilson’s disease
Alpha - 1 - antitrypsis deficiency
Glycogen storage disorder
Cigarette smoking
Alcohol consumption

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3
Q

How HBV creates soil for cancer

A
  1. Continuous necrosis and regeneration
  2. Activate protooncogenes
  3. HBV -x proteins inhibit tumour suppressor genes
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4
Q

Genetic factors in HCC

A
  1. Inactivation of tumour suppressor genes (T53 )
  2. Activation of k Ras
  3. Activation of c myc
  4. Activate telomerase
  5. Activation of AKT / WN T pathway
  6. Mutation in tumor suppressor genes
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5
Q

Hepatocellular adenoma associated with —— —- ——- cause HCC

A

Beta catenin

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6
Q

What are the precursor lesions causing HCC

A

Hepatic cellular adenoma with ↑ b- catenin
Cellular dysplasi

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7
Q

Three morphological gross patterns

A
  1. Unifocal
  2. Multifocal
  3. Diffusely infiltrative
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8
Q

Why is there yellowish brown discoloration of tumor cells

A

Due to bile producing tumor cells

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9
Q

Hall mark of HCC

A

Bile producing tumor cells

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10
Q

Microscopically three gradation of tumor

A

l. Well differentiated.
2, moderately differentiated
3. Poorly differentiated

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11
Q

Globular hyaline structures

A

Alpha-feto-protein
Alpha - 1 - anti trypsin
Mallory hyalines

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12
Q

Features of poorly differentiated HCC

A

Pleomorphic
Bizarre cells

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13
Q

Features of moderately differentiated cells

A
  1. ↑ fibrosis
  2. ↑ clear cell variety due to increased glycogen
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14
Q

Features of well differentiated HCC

A

Bile producing turnor cells
Pseudo glandular pattern (malignant cells around the lumen resemble glands )
Malignant cells arranged in trabecular pattern

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15
Q

Clinical features of HCC

A

Upper abdominal pain
Fatigue
Weight loss
Malaise
Liver enlarged
Increased AFP

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16
Q

Marker of choice to differentiate between HCC and fibro lamellar variant

A

AFP

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17
Q

Most sensitive and specific marker for normal and neoplastic hepatocytes

A

Hepatocyte - paraffin-1 (for diagnosing HCC )

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18
Q

Tumor marker for fibrolamellar variant

A

Neurotensin

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19
Q

What are Mallory hyaline body es

A

Eosinophilia intracytoplasmic inclusions of keratin filaments

20
Q

Is fibro lamellar variant associated with HBV

A

No

21
Q

Satellite nodules

A

Contiguous spread through hepatic vessels in HCC

22
Q

Which liver cancer is more common 2º or 1°

A

2° (from breast, colon, lung )

23
Q

Location of klatskin tumors

A

Junction of right and left hepatic ducts

24
Q

Klatskin tumor is the commonest subtype of:- —- ——

A

Cholangio carcinoma

25
Q

Angie sarcoma of liver is caused by exposure to

A

Vinyl chloride (plastic pipes )

26
Q

Paraneo plastic syndromes associated with HCC

A

Hyper calcemia ( parathyroid hormone like protein )
Erythrocytosis (erythropoetin)
Polycythemia
Hypuglycemia (insulin like factor)

27
Q

How to distinguish between early HCC and dysplastic modules

A

Glypican -3

28
Q

Neoplasms with alpha fetoprotein

A

HCC
Non seminomatous germ cell tumors (yolk sac tumors )

29
Q

Non neoplastic false positive alpha - fetoprotein

A

Cirrhosis
Hepatitis
Normal pregnancy
Fetal distress
Fetal death
Fetal neural defects

30
Q

Most common benign tumor of liver

A

Hemangiuma

31
Q

2nd most common malignant hepatic turnor

A

Cholangio carcinoma

32
Q

Site of cholangio carcinoma

A

Anywhere in the biliary tree inside liver

33
Q

Risk factors of cholangio carcinoma

A

Primary sclerosing chlongitis
HCV
Liver fluke chronic infection
Use of thorotrast (earlier used in radiography of biliary tree )
Congenital fibro polycystic diseases of biliary system such as Carol i disease

34
Q

Cholangio carcinoma are mainly intro or extra hepatic

A

Extra hepatic (90 %)

35
Q

Extra hepatic forms of CCA

A

Klatskin tumor - junction of right & left hepatic ducts
Distal bile duct turnor - near ampulla of vater

36
Q

Metastatic tumors appear as (gross )

A

Metastatic modules with umblicated masses

37
Q

Why is there central umblication in metastatic tumors

A

Necrosis and haemovrage in central area of nodule

38
Q

Microscopy of CCA

A

Aden carcinoma

39
Q

Microscopy of metastatic tumors

A

Similar to 1° tumor

40
Q

Lab findings in metastatic tumors

A

↑ alp

41
Q

Rick factors gall bladder cancer

A

Gall stones
Chronic inflammation
Calcification of gall bladder
Ulcerative colitis
K Ras
p53
DNA repair genes

42
Q

Gross of gall bladder carcinoma

A

Diffusely infiltrating / exophytic growth

43
Q

Microscopy of gallbladder carcinoma

A

Aden carcinoma

44
Q

Lab findings of Aden carcinoma of gall bladder

A

Alp ↑

45
Q

Most common symptom of gall bladder

A

Biliary colic
Abdominal pain
Anorexia

Git Pathology (6 decks)

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