Liver Tumors Flashcards
Focal Nodular Hyperplasia
How does it appear?
Central stellate scar, solitary lesion seen on scans and gross specimen
Focal Nodular Hyperplasia
Treatment
No malignant potential, so leave it alone unless it is causing pain
Focal Nodular Hyperplasia
Histology appearance
Nodular fibrotic appearance, but it is a focal area so you cannot mistake it for cirrhosis
Nodular Regenerative Hyperplasia
What is the major symptom?
Portal HTN with NO cirrhosis and NO fibrosis
Nodular Regenerative Hyperplasia
How does it appear grossly and histologically?
Gross: many nodules
Histo: Nodular without any fibrosis
Hepatic Adenoma
Who is most likely to get it?
Young women, commonly during pregnancy or who take oral contraceptives
Hepatic Adenoma
What is the risk of transformation? What are these tumors sensitive to?
Rare risk of transformation to HCC
Hormone-sensitive (estrogen)
Hepatic Adenoma
Treatment
Resection indicated when bigger than 5cm (Higher risk of malignant transformation)
Stop oral contraceptives
Hepatic Adenoma
Gross and Histological Appearance
Sheets and cords of normal hepatocytes with ABSENT PORTAL TRACTS
Hemangioma
What is the pathology?
Most common BENIGN tumor of liver
Benign vascular channels and fibrotic tissue
No follow-up required
Hepatoblastoma
What patients get it?
CHILDHOOD liver tumor
Males more common
Hepatoblastoma
What kinds of cells are present?
Fetal and embryonic hepatocytes
Hepatocellular Carcinoma
Why is the incidence currently rising?
HCV chronic infections
Hepatocellular Carcinoma
Symptoms
Vague symptoms, so it is often more advanced by the time they present
Hepatocellular Carcinoma
Major Risk factors
Cirrhosis Alcohol Hepatitis C Hemochromatosis NASH Chronic HBV Aflatoxin Hereditary Tyrosinemia
Hepatocellular Carcinoma
Pathogenesis
Accumulation of mutations due to repeated cycles of cell death and regeneration (chronic hepatitis)
HBV DNA incorporation into human genome
Hepatocellular Carcinoma
What may be elevated in the blood in 50% of cases?
Alpha-fetoprotein
Fibrolamellar Variant of HCC
Who gets it? What is it associated with?
Mostly young women
NOT associated with cirrhosis or HBV
Fibrolamellar Variant of HCC
General gross and histological appearance
Tons of fibrosis
Cholangiocarcinoma
What is it and where does it occur?
Malignancy of bile ducts
10% Intrahepatic
90% Extrahepatic
- Perihilar 55%
- Distal bile duct 25%
- Periampullary
Cholangiocarcinoma
Risk Factors
Primary Sclerosing Cholangitis
Cirrhosis
Clonorchis sinensis
Cholangiocarcinoma
When would Intrahepatic vs Extrahepatic be detected? Presenting symptoms
Intrahepatic
Detected late
Bile flow obstruction
Extrahepatic
More immediate symptoms- biliary obstruction, cholangitis, RUQ pain
Cholangiocarcinoma
Does Intrahepatic or Extrahepatic have a better prognosis?
Extrahepatic
What type of cancer is a Cholangiocarcinoma?
Adenocarcinoma
Klatskin tumor
Where does it appear?
Type of Cholangiocarcinoma that appears PERI-HILAR, between the R and L hepatic ducts
Metastases to Liver
What are most common for adults and kids?
Adults: Breast, lung, colon, pancreas
Children: Neuroblastoma, Wilm’s tumor, Rhabdomyosarcoma
