Liver tumours and biliary pathology

Question 1

Benign Adenoma of Liver Cells

Answer 1

• A benign proliferation of liver cells
• May be multiple (adenomatosis)
• Often driven by exogenous steroids e.g. OCP, anabolic steroids
• May rupture causing haemoperitoneum

Question 2

Adenoma of bile ducts

Answer 2

• Bile duct adenoma/Von Meyenberg complex
• A benign proliferation of bile duct cells – tiny white nodules
• Look like metastases grossly: do a frozen section and can tell you if they are benign or malignant

Question 3

Haemangioma

Answer 3

• Benign tumour of blood vessel

- 1% of the population; incidental finding on liver imaging

Question 4

Focal nodular hyperplasia

Answer 4

• Tumour of blood vessel
• Hyperplastic area of the liver, too much oxygenated blood and therefore hepatocytes are massive
• Young females: 20-40; A regenerative, arterialised nodule
• More scarring, yellow in colour

Question 5

Malignant Hepatocellular carcinoma

Answer 5

• Usually arise in cirrhosis
• Composed of malignant liver cells
• Tumour may contain liver substances such as bile + antitrypsin globules
• Secrete AFP which can be detected in the blood and measured

Question 6

Cholangiocarcinoma

Answer 6

• Malignant tumour of bile duct cells
• May be due to chronic inflammation
• Primary sclerosing cholangitis (PSC)
• Liver fluke/clonorchis sinensis (parasites)
• Aggressive, difficult to resect especially at the hilum of the liver
• Firm and hard tumours

Question 7

Angiosarcoma

Answer 7

• Very rare cancer
• Aggressive tumour of blood vessels: malignant
  Strongly associated with toxins:
• Vinyl chloride (use to make records)
• Thorotrast (contrast agent)
• No treatment, palliative care

Question 8

Secondary tumours of the liver

Answer 8

• Majority of liver tumours are secondary - metastases
• Commonest sites of origin are: lung, breast, colon, pancreas
• Multiple whitish nodules

Question 9

Gallstones aetiology

Answer 9

• Excess cholesterol, bile salts, bacterial growth
• Calcification
• Slowly form a stone (calculus)

Question 10

Gallstones clinical features

Answer 10

• Up to 80% can be asymptomatic or crampy pain

Question 11

Gallstones complications

Answer 11

• Obstruction at neck of gallbladder = pain
• Obstruction at pancreatic level = pancreatitis - more severe complication
• Obstruction at common duct = jaundice
• Chronic cholecystitis
• Perforation

Question 12

Chronic cholecystitis definition

Answer 12

• Inflammation of the gallbladder due to chemical or bacterial causes
• Over time causes fibrosis and ulceration of gallbladder
• Clinical features: pain (right upper quadrant), fever, jaundice

Question 13

Chronic cholecystitis diagnosis and treatment

Answer 13

• Diagnosis: USS (ultrasound scan) only 25% are visible on x-ray
• Treatment: cholecystectomy