Liver Tumors

Question 1

Focal Nodular Hyperplasia

How does it appear?

Answer 1

Central stellate scar, solitary lesion seen on scans and gross specimen

Question 2

Focal Nodular Hyperplasia

Treatment

Answer 2

No malignant potential, so leave it alone unless it is causing pain

Question 3

Focal Nodular Hyperplasia

Histology appearance

Answer 3

Nodular fibrotic appearance, but it is a focal area so you cannot mistake it for cirrhosis

Question 4

Nodular Regenerative Hyperplasia

What is the major symptom?

Answer 4

Portal HTN with NO cirrhosis and NO fibrosis

Question 5

Nodular Regenerative Hyperplasia

How does it appear grossly and histologically?

Answer 5

Gross: many nodules

Histo: Nodular without any fibrosis

Question 6

Hepatic Adenoma

Who is most likely to get it?

Answer 6

Young women, commonly during pregnancy or who take oral contraceptives

Question 7

Hepatic Adenoma

What is the risk of transformation? What are these tumors sensitive to?

Answer 7

Rare risk of transformation to HCC

Hormone-sensitive (estrogen)

Question 8

Hepatic Adenoma

Treatment

Answer 8

Resection indicated when bigger than 5cm (Higher risk of malignant transformation)

Stop oral contraceptives

Question 9

Hepatic Adenoma

Gross and Histological Appearance

Answer 9

Sheets and cords of normal hepatocytes with ABSENT PORTAL TRACTS

Question 10

Hemangioma

What is the pathology?

Answer 10

Most common BENIGN tumor of liver

Benign vascular channels and fibrotic tissue

No follow-up required

Question 11

Hepatoblastoma

What patients get it?

Answer 11

CHILDHOOD liver tumor

Males more common

Question 12

Hepatoblastoma

What kinds of cells are present?

Answer 12

Fetal and embryonic hepatocytes

Question 13

Hepatocellular Carcinoma

Why is the incidence currently rising?

Answer 13

HCV chronic infections

Question 14

Hepatocellular Carcinoma

Symptoms

Answer 14

Vague symptoms, so it is often more advanced by the time they present

Question 15

Hepatocellular Carcinoma

Major Risk factors

Answer 15

Cirrhosis
Alcohol
Hepatitis C
Hemochromatosis
NASH
Chronic HBV
Aflatoxin
Hereditary Tyrosinemia

Question 16

Hepatocellular Carcinoma

Pathogenesis

Answer 16

Accumulation of mutations due to repeated cycles of cell death and regeneration (chronic hepatitis)

HBV DNA incorporation into human genome

Question 17

Hepatocellular Carcinoma

What may be elevated in the blood in 50% of cases?

Answer 17

Alpha-fetoprotein

Question 18

Fibrolamellar Variant of HCC

Who gets it? What is it associated with?

Answer 18

Mostly young women

NOT associated with cirrhosis or HBV

Question 19

Fibrolamellar Variant of HCC

General gross and histological appearance

Answer 19

Tons of fibrosis

Question 20

Cholangiocarcinoma

What is it and where does it occur?

Answer 20

Malignancy of bile ducts

10% Intrahepatic

90% Extrahepatic

• Perihilar 55%
• Distal bile duct 25%
• Periampullary

Question 21

Cholangiocarcinoma

Risk Factors

Answer 21

Primary Sclerosing Cholangitis

Cirrhosis

Clonorchis sinensis

Question 22

Cholangiocarcinoma

When would Intrahepatic vs Extrahepatic be detected? Presenting symptoms

Answer 22

Intrahepatic
Detected late
Bile flow obstruction

Extrahepatic
More immediate symptoms- biliary obstruction, cholangitis, RUQ pain

Question 23

Cholangiocarcinoma

Does Intrahepatic or Extrahepatic have a better prognosis?

Answer 23

Extrahepatic

Question 24

What type of cancer is a Cholangiocarcinoma?

Answer 24

Adenocarcinoma

Question 25

Klatskin tumor

Where does it appear?

Answer 25

Type of Cholangiocarcinoma that appears PERI-HILAR, between the R and L hepatic ducts

Question 26

Metastases to Liver

What are most common for adults and kids?

Answer 26

Adults: Breast, lung, colon, pancreas

Children: Neuroblastoma, Wilm’s tumor, Rhabdomyosarcoma