Liver Pathology #3 - Nelson Flashcards
Define hemangioma.
- Most common benign neoplasm of the liver
- Lesion consists of discrete red-blue hemorrhagic nodules composed of dilated (cavernous) endothelial lined blood filled channels
- These lesions are often an incidental discovery.
Define simple liver cyst.
- single, or a small cluster composed of atrophic bililary epithelium
- detached from the biliary tree
- not associated with polycystic kidney disease
- Usually discovered as part of an imaging study for another clinical problem, or at autopsy.
Define polycystic liver disease.
-
Multiple cysts
- often associated with polycystic kidney disease
- These cysts, along with the simple cysts, do not communicate with the biliary system.
- often associated with polycystic kidney disease
What is the most common neoplasm of the liver?
Hemangioma
Define choledochal cyst.
- congenital dilatation of the common bile duct
- usually occurring in children
What are the complications of a choledochal cyst?
- biliary obstruction
- stones
- bile duct carcinoma (cholangiocarcinoma).
What is Caroli’s disease?
- several congenital disorders resulting in intrahepatic biliary dilatations, which communicate with the biliary tree
- patients may suffer bouts of cholangitis
- several forms
- when this disorder is associated with congenital hepatic fibrosis → called Caroli’s syndrome
What is congenital hepatic fibrosis?
- non-cirrhotic fibrotic liver disease of children
- autosomal recessive inheritance
Define focal nodular hyperplasia.
- Well-demarcated lesion composed of a proliferation of all liver parenchymal elements (central veins, hepatocytes, portal triads).
- May represent a hyperplastic response to a localized vascular occlusive event
- no malignant potential
Define nodular regenerative hyperplasia.
Diffuse nonfibrosing nodular hyperplasia of the liver.
What is a characteristic of focal nodular hyperplasia that may be seen on imaging?
central scar
What is a key complication of nodular regenerative hyperplasia?
Patients may develop portal hypertension
Define hepatocellular adenoma.
Well-circumscribed benign neoplasm composed of well differentiated hepatocytes (no portal triads or central veins).
What is the characteristic population that can get hepatocellular adenoma?
- Most often occurs in young reproductive aged women, associated with prolonged use of oral contraceptives containing high estrogen content.
- Can also be seen in individuals using anabolic steroids.
What does the gross appearance of bile duct hamartoma and bile duct adenoma look like?
- Hamartoma:
- Grossly appear as single or more commonly multiple small white nodules;
- mimics metastatic carcinoma.
- Adenoma:
- Usually solitary, consisting of a benign proliferation of bile ducts;
- as with bile duct hamartoma, may grossly confuse with metastatic carcinoma.
What are the CT imaging findings of malignancies metastatic to the liver?
Usually metastases are multiple tumors but one can have solitary metastases.
How are metastatic tumors diagnosed?
CT scan + Ultrasound guided liver needle biopsy
What are the risk factors for hepatocellular carcinoma?
chronic viral hepatitis infections and exposure to toxins
What is the gross appearance of hepatocellular carcinoma?
- Can present as a solitary large mass, or with multiple nodules
- In some cases the tumor can be diffusely infiltrative.
- The tumor is typically soft and hemorrhagic.
How does HCC occurring in the USA compare to China with regard to patient population?
In areas with high endemic HBV infection (Africa and S.E. Asia), this malignancy occurs at a younger age (age 20-40).
What procedure can be used to screen for HCC?
liver ultrasound
How does the fibrolamellar variant of HCC compare with typical HCC?
- Fibrolamellar
- HCC composed of polygonal oncocytic tumor cells in nests and cords separated by lamellar fibrous stroma (FIRM)
- Occurs predominantly in young adults without cirrhosis or chronic viral hepatitis
- Better prognosis than usual HCC
- Typical
- less firm
- over age 60 in US
- Worse prognosis
What is the characteristic microscopic appearance of fibrolamellar HCC?
polygonal oncocytic tumor cells in nests and cords separated by lamellar fibrous stroma
Define cholangiocarcinoma.
carcinomas arising from intrahepatic or extrahepatic bile ducts
(Cholangiocarcinomas are virtually always adenocarcinomas)
What are some risk factors for intrahepatic cholangiocarcinoma?
viral hepatitis B and C and NAFLD
What entity would need to be excluded before one could make a diagnosis of intrahepatic choloangiocarcinoma?
adenocarcinoma metastatic to the liver
