Liver Pathology III

Question 1

Budd-Chiari Syndrome

Answer 1

Hepatic vein obstruction or thrombosis leading to ascites/hepatomegaly/abdominal pain/jaundice

Question 2

What are some of the possible causes of Budd-Chiari syndrome?

Answer 2

– Primary myeloproliferative disorders 
– Inherited disorders of coagulation
– Antiphospholipid syndrome
– Paroxysmal nocturnal hemoglobinuria 
– Intra-abdominal cancers
– Oral Contraceptives

Question 3

What are some pathological findings with Budd-Chiari syndrome?

Answer 3

• Liver will be engorged with blood

- Centrilobar congestion around the central vein

Question 4

What are some risks for sinusoidal obstructive syndrome?

Answer 4

• Bone marrow transplant
• Chemotherapy patients
• Azathioprine

Question 5

Sinusoidal Obstructive Syndrome (AKA Veno-occlusive Disease)

Answer 5

Toxic injury to the sinusoidal endothelium with resulting fibrotic occlusion of small hepatic veins - prognosis is VERY poor

Question 6

What are the clinical manifestations of sinusoidal obstructive syndrome?

Answer 6

Acute RUQ tenderness, hepatomegaly, ascites, weight gain, and jaundice

Question 7

Acute Fatty Liver of Pregnancy

Answer 7

Sudden catastrophic illness occurring exclusively in the 3rd trimester - high mortality rate
• Microvesicular fatty infiltration

Question 8

Focal Nodular Hyperplasia

Answer 8

Solitary nodule that is well demarcated with a central stellate scar found classically in young women

Question 9

What is the malignant potential of focal nodular hyperplasia?

Answer 9

NO malignant potential

Question 10

Nodular Regenerative Hyperplasia

Answer 10

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

Question 11

What is the liver function like in nodular regenerative hyperplasia?

Answer 11

Normal

Question 12

Who is hepatic adenoma commonly found in?

Answer 12

Young women

Question 13

Hepatic Adenoma

Answer 13

Associated with hormones and oral contraceptives and pregnancy
• Usually solitary lesions
• Cords of normal hepatocytes with absent portal tracts

Question 14

What is hepatic adenoma associated with?

Answer 14

Glycogen storage diseases

Question 15

Hemangioma

Answer 15

Most common benign tumor with red-blue nodules of vascular channels and fibrosis tissue

Question 16

Angiosarcoma

Answer 16

Most common primary sarcoma of the liver

• Malignant vascular tumor

Question 17

What is angiosarcoma of liver associated to exposure to?

Answer 17

Associated with exposure to vinyl chloride, arsenic

Question 18

Hepatoblastoma

Answer 18

Most common malignant tumor of childhood and is found in males more than females

Question 19

What is an elevated marker for hepatoblastoma?

Answer 19

Alpha-fetoprotein

Question 20

What will be seen on histology of hepatoblastomas?

Answer 20

Fetal and embryonic hepatocytes

Question 21

Risk factors for hepatocellular carcinoma includes all EXCEPT:

• Hepatitis C
• Alcoholic liver disease
• Hemochromatosis
• Aflatoxin
• Herpes virus

Answer 21

• Herpes virus

Question 22

What are some risk factors for Hepatocellular Carcinoma?

Answer 22

• 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%)

Question 23

What are the features of HCC?

Answer 23

Single lesion that is diffusely infiltrative and can range from well to poor differentiation - there are vague clinical symptoms though

Question 24

Fibrolamellar HCC Variant

Answer 24

Usually found in a younger female and is NOT related to cirrhosis of HBV - with areas of dense collagenous fibrosis and polygonal tumor cells

Question 25

What is the prognosis for fibrolamellar HCC?

Answer 25

Better than HCC

Question 26

Which of the following statement about hepatic adenoma is CORRECT?

1. More common in males
2. Contains a central stellate scar
3. Associated with cirrhotic liver
4. Growth is estrogen sensitive
5. High rate of malignant transformation

Answer 26

4. Growth is estrogen sensitive

Question 27

Cholangiocarcinoma

Answer 27

Malignancy of bile ducts (in or out of the liver) - poor prognosis

Question 28

Where do the cholangiocarcinomas generally occur?

Answer 28

90% are extra hepatic with most of these being perihilar

Question 29

What are some risk factors for cholangiocarcinoma?

Answer 29

• Primary sclerosing cholangitis
• Congenital fibropolycystic disease of the biliary system
– Caroli’s Disease
• Cirrhosis

Question 30

What type of cancer are cholangiosarcomas generally?

Answer 30

Adenocarcinomas

Question 31

Klaskin Tumor

Answer 31

Perihilar/hilar extrahepatic tumor at the junction of the L and R hepatic ducts

Question 32

What are the most common metastatic cancers to the liver in adults?

Answer 32

Breast and colon

Question 33

What are the most common metastatic cancers to the liver in children?

Answer 33

Neuroblastoma, Wilm’s tumor and rhabdomyosarcoma