Liver Pathology III Flashcards
Budd-Chiari Syndrome
Hepatic vein obstruction or thrombosis leading to ascites/hepatomegaly/abdominal pain/jaundice
What are some of the possible causes of Budd-Chiari syndrome?
– Primary myeloproliferative disorders – Inherited disorders of coagulation – Antiphospholipid syndrome – Paroxysmal nocturnal hemoglobinuria – Intra-abdominal cancers – Oral Contraceptives
What are some pathological findings with Budd-Chiari syndrome?
- Liver will be engorged with blood
- Centrilobar congestion around the central vein
What are some risks for sinusoidal obstructive syndrome?
- Bone marrow transplant
- Chemotherapy patients
- Azathioprine
Sinusoidal Obstructive Syndrome (AKA Veno-occlusive Disease)
Toxic injury to the sinusoidal endothelium with resulting fibrotic occlusion of small hepatic veins - prognosis is VERY poor
What are the clinical manifestations of sinusoidal obstructive syndrome?
Acute RUQ tenderness, hepatomegaly, ascites, weight gain, and jaundice
Acute Fatty Liver of Pregnancy
Sudden catastrophic illness occurring exclusively in the 3rd trimester - high mortality rate
• Microvesicular fatty infiltration
Focal Nodular Hyperplasia
Solitary nodule that is well demarcated with a central stellate scar found classically in young women
What is the malignant potential of focal nodular hyperplasia?
NO malignant potential
Nodular Regenerative Hyperplasia
Can be partial or diffuse transformation of the hepatic
parenchyma into small regenerative nodules in the
absence of fibrosis leading to NON-cirrhotic portal HTN
What is the liver function like in nodular regenerative hyperplasia?
Normal
Who is hepatic adenoma commonly found in?
Young women
Hepatic Adenoma
Associated with hormones and oral contraceptives and pregnancy
• Usually solitary lesions
• Cords of normal hepatocytes with absent portal tracts
What is hepatic adenoma associated with?
Glycogen storage diseases
Hemangioma
Most common benign tumor with red-blue nodules of vascular channels and fibrosis tissue
Angiosarcoma
Most common primary sarcoma of the liver
• Malignant vascular tumor
What is angiosarcoma of liver associated to exposure to?
Associated with exposure to vinyl chloride, arsenic
Hepatoblastoma
Most common malignant tumor of childhood and is found in males more than females
What is an elevated marker for hepatoblastoma?
Alpha-fetoprotein
What will be seen on histology of hepatoblastomas?
Fetal and embryonic hepatocytes
Risk factors for hepatocellular carcinoma includes all EXCEPT:
- Hepatitis C
- Alcoholic liver disease
- Hemochromatosis
- Aflatoxin
- Herpes virus
• Herpes virus
What are some risk factors for Hepatocellular Carcinoma?
• Cirrhosis (of any cause) – NASH – Alcohol – Hepatitis C – Hemochromatosis • Chronic Hepatitis B • NASH – cases reported in advanced fibrosis • Food contaminants: Aflatoxin (Africa) • Hereditary Tyrosinemia (Highest risk – 40%)
What are the features of HCC?
Single lesion that is diffusely infiltrative and can range from well to poor differentiation - there are vague clinical symptoms though
Fibrolamellar HCC Variant
Usually found in a younger female and is NOT related to cirrhosis of HBV - with areas of dense collagenous fibrosis and polygonal tumor cells
What is the prognosis for fibrolamellar HCC?
Better than HCC
Which of the following statement about hepatic adenoma is CORRECT?
- More common in males
- Contains a central stellate scar
- Associated with cirrhotic liver
- Growth is estrogen sensitive
- High rate of malignant transformation
- Growth is estrogen sensitive
Cholangiocarcinoma
Malignancy of bile ducts (in or out of the liver) - poor prognosis
Where do the cholangiocarcinomas generally occur?
90% are extra hepatic with most of these being perihilar
What are some risk factors for cholangiocarcinoma?
• Primary sclerosing cholangitis
• Congenital fibropolycystic disease of the biliary system
– Caroli’s Disease
• Cirrhosis
What type of cancer are cholangiosarcomas generally?
Adenocarcinomas
Klaskin Tumor
Perihilar/hilar extrahepatic tumor at the junction of the L and R hepatic ducts
What are the most common metastatic cancers to the liver in adults?
Breast and colon
What are the most common metastatic cancers to the liver in children?
Neuroblastoma, Wilm’s tumor and rhabdomyosarcoma
