Liver Nodules and Tumors Flashcards

1
Q

What are the main types of benign hepatic nodules/tumors?

A

Nodular hyperplasias:

  • focal nodular hyperplasia
  • nodular regenerative hyperplasia

Cavernous hemangioma

Hepatocellular adenoma:

  • HNF1-α
  • inflammatory
  • β-catenin
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2
Q

What is the most common benign neoplasm of the liver?

A

-cavernous hemangioma

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3
Q

What is focal nodular hyperplasia?

A

benign nodular hyperplasia of the liver

  • typcially single, well demarcated lesion w/ central scar
  • maplike pattern
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4
Q

What is nodular regenerative hyperplasia?

A

benign nodular hyperplasia of the liver

  • typically multiple nodules
  • appears like cirrhosis, but lacks fibrous septa
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5
Q

What is cavernous hemangioma of the liver?

A

benign neoplasm of the liver

  • asymptomatic
  • has life threatening risk of hemorrhage
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6
Q

What are the subtypes of the hepatic adenomas?

A

HNF1-α:

  • fatty change with no atypia
  • mostly female
  • minimal risk of transformation

β-catenin activated:

  • associated with oral contraceptives and anaboic steroids
  • males and females
  • high risk of transformation

Inflammatory:

  • most common hepatic adenoma (40-50%)
  • associated with metabolic syndrome
  • mimics focal nodular hyperplasia
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7
Q

What are the main types of malignant tumors of the liver?

A

Primary hepatic tumors:

  • hepatoblastoma
  • hepatocellular carcinoma
  • colangiocarcinoma

Metastasis:

  • colon
  • breast
  • lung
  • pancreas
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8
Q

What is the most common liver tumor of early childhood?

A

-hepatoblastoma

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9
Q

What are the types of malignant liver tumors?

A
  • hepatocellular carcinoma
  • cholangiocarcinoma
  • angiosarcome
  • lymphoma
  • metastasis
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10
Q

What is the most common primary liver tumor?

A

-hepatocellular carcinoma

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11
Q

What is the most common liver tumor of any origin?

A

-tumor metastasis to the liver is significanlty more common that primary liver tumors

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12
Q

How does hepatoblastoma present?

A
  • typicaly asymptomatic
  • jaudice and pruritis if symptomatic
  • abdominal swelling typcial presenting sign
  • typically not detected until metastasis has already occured
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13
Q

What is the most common cause of HCC?

A

-HBV and HCV

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14
Q

What feature is most associated with development of HCC?

What are common causes?

A

80% of HCC arises in the setting of cirrhosis:

  • HBV/HCV
  • alcoholic liver disease
  • NASH
  • hemochromatosis
  • Wilson disease
  • α-1 anittrypsin deficiency
  • hepatic autoimmune disease (PBC/PSC)

With no cirrhosis:

  • aflatoxin (Aspergillus toxin)
  • transformation of adenomas
  • HBV
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15
Q

What cause of HCC is odd in that it can cause HCC both w/ and w/o cirrhosis?

A

-HBV

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16
Q

How does HCC present?

A

typcially asympomatic itself or its symtpoms are masked by underlying liver disease

  • weight loss
  • anorexia
  • hepatomegaly
  • RUQ tenderness
  • jaundice
  • ascites
17
Q

What serum marker is used to screen for HCC?

A

α-fetoprotein (AFP)

18
Q

How is HCC treated?

A
  • typically resistant to chemotherapy
  • non-cirrhotic livers -> resection
  • cirrhotic livers -> liver transplant
  • ablation in tumors that cannot be resected and do not qualify for transplant
19
Q

How does HCC metastasize?

Where?

A

hematogenous metastasis

most commonly to the lungs

20
Q

What feature can be useful in differentiating HCC from metastatic tumors of the liver?

A
  • HCC is typically a single mass
  • metastasis is typically many mases
21
Q

What is cholangiocarcinoma?

A

adenocarcinoma of the intrahepatic (intrahepatic CCA) or extrahepatic (biliary CCA) trees

22
Q

Whrere is cholangiocarcinoma most common?

A

sourtheast Asia (endemic liver fluke)

23
Q

What are risk factors for cholangiocarcinoma?

A
  • liver fluke (**significant especially in Asia)
  • fibropolycystic liver disease
  • primary sclerosing cholangitis (PSC)
  • chronic inflammatory conditions of the bile ducts
  • hepatolithasis
  • HBV and HCV
24
Q

What are common locations of colangiocarcinoma development within the biliary tree?

A
  • biliary hilum -> Klatskin tumors (most common site)
  • extrahepatic (20-30%)
  • intrahepatic (5-10%)
25
Q

How does cholangiocarcinoma present?

A

Varies depending on location

Intrahepatic:

-very likely to be asymptomatic and detected only incidentally

Extrahepatic:

  • cholestasis signs
  • Courvoisier sign
26
Q

What is Courvoisier sign?

A

-painlessly enlarged gallbaldder

-painless jaundice

  • acholic/pale stools
  • dark urine
  • pruritis

typically indicates obstruction of biliary tree by a mass:

  • most commonly head of pancreas
  • also within the biliary tree
27
Q

What factors are associated with angiosarcoma development in the liver?

A
  • vinyl chloride
  • arsenic
  • Thorotrast

prevalence of exposure to these compounds has decreased significantly and so has the prevalence of hepatic angiosarcoma

28
Q

What subtypes of lymphoma present in the liver?

What risk factors are associated with their development?

A
  • diffuse large B-cell lymphoma (most common)
  • MALT

Risk factors:

  • HBV and HCV
  • HIV
  • primary biliary cholangitis (PBC)