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GI- Week 3 > Liver Nodules and Tumors > Flashcards

Liver Nodules and Tumors Flashcards

1
Q

What are the types of Nodular hyperplasia of the liver

A

1) focal
2) nodular regenerative hyperplasia

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2
Q

Describe focal nodular hyperplasia

A

these are well-demarcated but poorly encapsulated nodules that appear mostly as spontanoues mass lesions in an otherwise normal liver

Gross: central gray-white, depressed stellate scar from which fibrous septa radiate to the periphery.

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3
Q

When are focal nodular hyperplasia most common?

A

•most frequently in young to middle-aged adults.

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4
Q

Focal nodular hyperplasia has an association with _____

A

oral contraceptives

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5
Q

What is this showing?

A

focal nodular hyperplasia marked by:

Broad fibrous scar with hepatic arterial and bile duct elements

chronic inflammation present within parenchyma that lacks normal architecture due to hepatocyte regeneration.

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6
Q

What are the 3 classic histologic features of focal nodular hyperplasia?

A

abnormal architecture,

bile ductular proliferation,

malformed vessels

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7
Q

Describe nodular regenerative hyperplasia

A

•denotes a liver entirely transformed into nodules—grossly similar to micronodular cirrhosis—but without fibrosis.

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8
Q

Nodular regenerative hyperplasia can lead to what?

A

portal HTN

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9
Q

When does nodular regenerative hyperplasia typically occur?

A

Occurs in association with conditions affecting intrahepatic blood flow, including:

solid-organ (particularly renal) transplantation,

hematopoetic stem cell transplantation, and

vasculitis

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10
Q
A
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11
Q

What is this showing?

A

Nodular regenerative hyperplasia- Normally the liver cell plates (lined by dark‐staining reticulin fibers), should be of equal width—1 hepatocyte wide. In this photo there is a nodule in the center of the field in which the plates in the center of the nodule are wide and the plates at the edge are narrowed (arrows). This change, in the absence of significant fibrosis, is indicative of nodular regenerative hyperplasia.

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12
Q

Describe what is shown in this photo of nodular regenerative hyperplasia?

A

sinusoidal dilation (arrows).

NO inflammatory infiltrate or areas of necrosis.

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13
Q

The common factor in both types of hepatic nodular hyperplasia seems to be what?

A

either focal or diffuse alterations in hepatic blood supply, arising from obliteration of portal vein radicles and compensatory augmentation of arterial blood supply.

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14
Q

What is this showing?

A

Reticulin staining highlighting the nodular regenerative hyperplasia pattern- Atrophic hepatic cords on the left alternate with plump, thickened cords on the right.

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15
Q

What is this showing?

A

trichrome highlighting compressed central veins in nodular regenerative hyperplasia

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16
Q

What is the main benign neoplasm of the liver?

A

Cavernous hemangiomas

hepatocellular adenoma

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17
Q

What are the most common benign liver tumors?

A

Cavernous hemangiomas

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18
Q

What is this showing?

A

Cavernous hemangioma of the liver

Micro: Blood-filled vascular channels separated by a dense fibrous stroma.

Gross- discrete red-blue, soft nodules, usually less than 2 cm in diameter, generally located directly beneath the capsule

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19
Q

Describe hepatocellular adenomas and where they derive from

A

benign liver tumors developing from hepatocytes

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20
Q

What is this?

A

Hepatocellular Adenoma

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21
Q

What things are associated with the formation of hepatocellular adenomas?

A

oral contraceptives and anabolic steroids- Arises in normal or nearly normal liver in patients with abnormal hormonal or metabolic condition

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22
Q

How do hepatocellular adenomas appear histologically?

A

cords of hepatocytes, with an arterial vascular supply (arrow) and no portal tracts

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23
Q

What are the main malignant tumors of the liver?

A
  • Hepatoblastoma
  • Hepatocellular Carcinoma (HCC)
  • Cholangiocarcinoma (CCA)
  • Other Primary Hepatic Malignant Tumors
  • Metastasis
24
Q

What is the most common liver tumor of early childhood (<3 y/o)?– many resemble fetal liver

A

hepatoblastoma

25
Q

Describe the histo of hepatoblastoma

A

•Can be epithelial or mixed with mesenchymal elements (osteoid (favorable), cartilage)

26
Q

What causes hepatoblastomas?

A

•Frequent activation of WNT pathway, association with APC/Familial adenomatous polyposis

27
Q

What is the prognosis of hepatoblastomas

A
  • Untreated is fatal – malignant!
  • Surgery and chemo = 80% 5-year survival
28
Q

What is this?

A

hepatoblastoma

29
Q

What is this?

A

hepatoblastoma with Tumor cells resembling hepatocytes arranged in trabeculae and plates.

Foci of extramedullary hematopoiesis are also present

30
Q

hepatocellular carcinoma has a high association with what diseases?

A

Hep B and Hep C, chronic liver disease

  • Also seen with aflaotoxin and alcohol
  • Synergistic effect
31
Q

T or F. Cirrhosis is mandatory for hepatocarcinognesis of HCC

A

F.

32
Q

What mutations are common in HCC?

A

•Activation of β-catenin and inactivation of p53 are the two most common early mutational events.

•Increased alpha fetal protein (50%)

33
Q

What is this?

A

Hepatocellular Carcinoma (HCC)

34
Q

What is this?

A

Fibrolamellar (variant) HCC

35
Q

How common are Fibrolamellar (variant) HCCs?

A

•constituting less than 5% of HCCs

36
Q

When are Fibrolamellar HCCs common?

A

•85% occur under the age of 35 years and without gender predilection or identifiable pre-disposing conditions

37
Q
A
38
Q
A
39
Q

What is the second most common primary malignant tumor of the liver after HCC?

A

Cholangiocarcinoma (CCA)

40
Q

Where do Cholangiocarcinoma (CCA) arise?

A

It is a malignancy of the biliary tree, arising from bile ducts within and outside of the liver.

41
Q

•All risk factors for cholangiocarcinomas cause what?

A

chronic inflammation and cholestasis

42
Q

What is a Klatskin tumor?

A

A Klatskin tumor (or hilar cholangiocarcinoma) is a cholangiocarcinoma (cancer of the biliary tree) occurring at the confluence of the right and left hepatic bile ducts.

43
Q

Premalignant lesions for cholangiocarcinoma are also known, the most important of which are what?

A

biliary intraepithelial neoplasias (low to high grade, BilIN-1, -2, or -3).

44
Q

What are some associated diseases with CCA?

A

liver flukes such as Opisthorchis and Clonorchi

PSC

45
Q

What are liver flukes?

A

Liver flukes are parasites

46
Q

What is this?

A

Cholangiocarcinoma (= adenocarcinoma, they often produce mucin)

•Most are well- to moderately differentiated with clearly defined glandular/tubular structures lined by malignant epithelial cells

47
Q

How do CCAs behave?

A

•They typically incite marked desmoplasia. Lymphovascular invasion and perineural invasion are both common

48
Q

What is this?

A

Intrahepatic Cholangiocarcinoma

49
Q

What are some other primary heptic malignant tumors?

A
  • angiosarcomas
  • epitheliod hemangioendotheliomas
  • hepatic lymphomas
  • hepatosplenic delta-gamma T cell lymphoma
50
Q

Angiosarcoma of the liver resembles those occurring elsewhere and has historical associations with ____, _____, and ______

A

vinyl chloride, arsenic, or Thorotrast

51
Q

Epithelioid hemangioendothelioma, another form of endothelial malignancy, has a much more variable prognosis than the almost uniformly fatal angiosarcoma.

A

Hepatosplenic delta-gamma T cell lymphoma, most common in young adult males, has a predilection for hepatic and splenic sinusoids as well as the marrow.

52
Q

Hepatic lymphomas are primarily diseases of middle aged men and are seen, albeit rarely, in association with what?

A

hepatitis B and C, HIV, and PBC. Most are diffuse large B-cell lymphomas , followed by MALT lymphomas

53
Q

What is this?

A

METS to the liver (secondary tumor)

54
Q

T or F. Involvement of the liver by metastatic malignancy is far more common than primary hepatic neoplasia

A

T.

55
Q

What are the sources of primary tumors that commonly MET to the liver?

A

•colon, breast, lung, and pancreas

GI- Week 3 (15 decks)

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