Liver Pathology #3 - Nelson

Question 1

Define hemangioma.

Answer 1

• 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.

Question 2

Define simple liver cyst.

Answer 2

• 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.

Question 3

Define polycystic liver disease.

Answer 3

• Multiple cysts
  
  • often associated with polycystic kidney disease
    
    • These cysts, along with the simple cysts, do not communicate with the biliary system.

Question 4

What is the most common neoplasm of the liver?

Answer 4

Hemangioma

Question 5

Define choledochal cyst.

Answer 5

• congenital dilatation of the common bile duct
• usually occurring in children

Question 6

What are the complications of a choledochal cyst?

Answer 6

• biliary obstruction
• stones
• bile duct carcinoma (cholangiocarcinoma).

Question 7

What is Caroli’s disease?

Answer 7

• 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

Question 8

What is congenital hepatic fibrosis?

Answer 8

• non-cirrhotic fibrotic liver disease of children
  
  • autosomal recessive inheritance

Question 9

Define focal nodular hyperplasia.

Answer 9

• 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

Question 10

Define nodular regenerative hyperplasia.

Answer 10

Diffuse nonfibrosing nodular hyperplasia of the liver.

Question 11

What is a characteristic of focal nodular hyperplasia that may be seen on imaging?

Answer 11

central scar

Question 12

What is a key complication of nodular regenerative hyperplasia?

Answer 12

Patients may develop portal hypertension

Question 13

Define hepatocellular adenoma.

Answer 13

Well-circumscribed benign neoplasm composed of well differentiated hepatocytes (no portal triads or central veins).

Question 14

What is the characteristic population that can get hepatocellular adenoma?

Answer 14

• 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.

Question 15

What does the gross appearance of bile duct hamartoma and bile duct adenoma look like?

Answer 15

• 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.

Question 16

What are the CT imaging findings of malignancies metastatic to the liver?

Answer 16

Usually metastases are multiple tumors but one can have solitary metastases.

Question 17

How are metastatic tumors diagnosed?

Answer 17

CT scan + Ultrasound guided liver needle biopsy

Question 18

What are the risk factors for hepatocellular carcinoma?

Answer 18

chronic viral hepatitis infections and exposure to toxins

Question 19

What is the gross appearance of hepatocellular carcinoma?

Answer 19

• 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.

Question 20

How does HCC occurring in the USA compare to China with regard to patient population?

Answer 20

In areas with high endemic HBV infection (Africa and S.E. Asia), this malignancy occurs at a younger age (age 20-40).

Question 21

What procedure can be used to screen for HCC?

Answer 21

liver ultrasound

Question 22

How does the fibrolamellar variant of HCC compare with typical HCC?

Answer 22

• 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

Question 23

What is the characteristic microscopic appearance of fibrolamellar HCC?

Answer 23

polygonal oncocytic tumor cells in nests and cords separated by lamellar fibrous stroma

Question 24

Define cholangiocarcinoma.

Answer 24

carcinomas arising from intrahepatic or extrahepatic bile ducts

(Cholangiocarcinomas are virtually always adenocarcinomas)

Question 25

What are some risk factors for intrahepatic cholangiocarcinoma?

Answer 25

viral hepatitis B and C and NAFLD

Question 26

What entity would need to be excluded before one could make a diagnosis of intrahepatic choloangiocarcinoma?

Answer 26

adenocarcinoma metastatic to the liver