Liver Pathology Thursday

Question 1

Hemangioma

simple liver cyst

polycystic liver disease

most common neoplasm of liver?

Answer 1

Hemagioma is most common
incidental discovery, red-blue hemorrhagic nodules

simple liver cyst - single or small cluster. discovered on autopsy or imaging study

polycystic liver disease - many cysts, accosiated w/ PCKD, don’t communicate w/ biliary system

Question 2

choledochal cyst
complications?

Caroli’s disease

congenital hepatic fibrosis

Answer 2

choledochal cyst - congenital dilation of bile duct. can lead to obstruction, stones, carcinoma

Caroli’s disease - intrahepatic biliary dilations

congenital hepatic fibrosis - super rare, get fibrosis that isn’t cirrhosis

Question 3

focal nodular hyerplasia - imaging

nodular regenerative hyperplasia - complication?

Answer 3

focal nodular hyperplasia - hyperplasia from localized vascular event. not malignant
mass w/ stellate central scar. Star like configuration. looks like cirrhosis microscopically, but focal

nodular regenerative hyperplasia - asymptomatic non-fibrosing, may get portal hypertension. looks like cirrhosis macro, but not micro. Reticulin stain shows separation of the fibers due to hyperplasia

Question 4

hepatocellular adenoma

who gets it

Answer 4

well differentiated and circumscribed, begnin. abdominal pain from growth, bleeding from hemorrhagic necrosis
oral contraceptives cause it
Anabolic steroids

Question 5

bile duct hamartoma

bile duct adenoma

Answer 5

hamartoma - small white nodules. micro - disordered bile ducts and fibrous stroma

solitary begnign proliferation of bile duct

both look like carcinoma

Question 6

CT of metaststic malignancies

Answer 6

most tumors in liver are metastatic
usually multiple spots

Metastatic Melanoma is a bunch of black nodules, if not metastatic from the skin, look in the eye!

Question 7

risk factors of hepatocellular carcinoma
usa vs china
screening

Answer 7

rare in usa, not asia because they have more HBV (in usa, it’s in old people with cirrhosis)
risk - chronic liver disease, viral hep (B and C), toxins, cirrhosis.
it’s a large mass.
alpha fetoprotein is high, this can also be seen in the regenerative phase of cirrhosis

Question 8

fibrolamellar HCC vs typical HCC

Answer 8

usually with younger people with no cirrhosis, better outcome (but still bad).
Plate-like thick collagen fibers

Question 9

intrahepatic cholaniocarcinoma

risk factors

Answer 9

from bile ducts, usually fibrous, white and hard.
usually in old people. poor prognosis. looks like adenocarcinoa.
risk - cholangitis

Question 10

Define hepatoblastoma and angiosarcoma of the liver.

Answer 10

hepatoblastoma - it’s in kids

angiosarcoma - he said we don’t need to know it