Liver Path 2: Cholestatic and Neoplastic Disease

Question 1

What are 3 complications of cirrhosis?

Answer 1

Decreased synthetic and clearance function.
Portal hypertension.
Hepatocellular carcinoma.

Question 2

Will blocking just the right or just the left hepatic duct cause cholestasis?

Answer 2

Nope. Blocking both, or blocking the CBD will, though.

Question 3

Will blocking the cystic duct cause cholestasis?

Answer 3

Nope.

Question 4

What is a choledochal cyst?

Answer 4

Congenital malformation of bile ducts (or cystic duct) -> true diverticulum (all layers).

Question 5

What are 3 bad things about choledochal cysts?

Answer 5

Stasis -> stone formation.
Twisting -> duct occlusion.
Can develop dysplasia -> adenocarcinoma.

Question 6

What’s porcelain gallbladder? Significance?

Answer 6

Diffuse calcification of gallbladder - radiodense on x-ray.

Pathophysiology unclear, but porcelain gallbladders have increased risk of adenocarcinoma.

Question 7

What’s a Klatskin tumor?

Answer 7

A cholangiocarcinoma that occurs right at the L and R hepatic duct bifurcation, causing cholestasis.
(a cholangiocarcinoma is an adenocarcinoma of the duct epithelium)

Question 8

Is cholangiocarcinoma associated with cirrhosis? (Associations?)

Answer 8

Nope. Cholangiocarcinomas have no association with underlying liver disease (except for…. PSC?).
(associated with PSC and liver flukes)

Question 9

Does cholangiocarcinoma cause cholestasis?

Answer 9

Nope - not unless it invades the main ducts.

Question 10

Aside from inflammation, what problem can bacteria (esp. gut-derived gram negs) in the biliary tree cause?

Answer 10

Bacteria can cause intrahepatic stone formation. Bacteria deconjugate bilirubin -> precipitation.

Question 11

Review: What’s the treatment for PBC?

Answer 11

Ursodiol.

Not steroids… they don’t work.

Question 12

Does PBC recur after transplant?

Answer 12

Yes.

Question 13

Does PSC recur after transplant? What if the patient has had a colectomy for UC?

Answer 13

It can…

It recurs less if a patient has had a colectomy for UC… suggesting some relationship.

Question 14

Review: What’s the histology buzzword for PSC?

Answer 14

“Onion skin” fibrosis of ducts.

Question 15

How can PSC cause cholestasis before cirrhosis?

Answer 15

Biliary sludge.

Question 16

What’s the most common type of malignancy in a non-cirrhotic liver?

Answer 16

Metastatic tumor - most commonly from the GI.

Question 17

Are primary liver tumors common?

Are most benign or malignant?

Answer 17

They’re quite rare, but over 90% are malignant (most are carcinoma).

Question 18

A clonal, bleeding mass with “benign appearing hepatocytes” and no mitoses is taken from the liver… what might it be?

Answer 18

Hepatocellular adenoma

Question 19

Is hepatocellular adenoma a precursor to hepatocellular carcinoma?

Answer 19

Nope. Not at all.

Question 20

A stellate scar in the middle of a nodules that aren’t bile stained. What could it be?

Answer 20

Focal nodular hyperplasia. It’s benign.

It’s kind of a… focal cirrhosis.

Question 21

What do bile duct adenomas look like?

Answer 21

They look like mets… small white, firm nodule grossly.
Histologically - bile ducts with lymphocytic infiltrate.
Completely benign.

Question 22

Big malformed blood vessels in liver…

Answer 22

Hemangioma. Benign.

Question 23

What’s an eichonicocus?

Answer 23

Cyst(s) from parasites - the “scolex” (scary worm mouth things) can be seen in histology.

Question 24

Big picture about what causes hepatocellular carcinoma (HCC)?

Answer 24

Anything that causes cirrhosis can cause HCC.

HBV, though, can cause HCC prior to cirrhosis.

Question 25

2 prognostic factors in HCC?

Answer 25

Vascular invasion

Differentiation

Question 26

How is diagnosis of angiocarcinoma made?

Answer 26

Cells growing in sinusoids.. but mainly with immunohistochemistry.