Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pathology Post Midterm > Module 2: GI: Liver Tumors and Gallbladder > Flashcards

Module 2: GI: Liver Tumors and Gallbladder Flashcards

1
Q

The next topic for discussion is Liver Tumors. First tumor to discuss is Hemangioma, which is a benign tumor that will be discussed. What are the main features that need to be known.

A
  1. Most common liver tumor
  2. More prevalent in females
  3. Asymptomatic; incidental finding
  4. Vast majority require no treatment (However there are situations that you take out the tumor)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Moving onto the malignant tumors of the liver. The first is hepatic (liver cell) adenoma. What is the etiology of these tumors?

A

Oral contraceptive/anabolic steroids and glycogen storage diseases
–most common in young women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What investigations should be done for hepatic adenoma?

A

Normal AFP, AST, ALT
–Biopsy
usually solitary and ill -defined (Without capsule)
proliferation of benign hepatocytes (plates greater than 2 cells thick)
Isolated arteries
No bile duct differentiation — absence of portal tracts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What treatments are needed for hepatic adenoma?

A

Stop causative medication and resect tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are complications associated with hepatic adenoma?

A 
Shock 
Intraparenchyml hemorrhage (which can be fatal in pregnancy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The next benign tumor of the liver to be discussed his Focal Nodular Hyperplasia. What is the etiology?

A

Idiopathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is seen on histology for focal nodular hyperplasia?

A
  • –Ill-defined area with a cirrhosis-like appearance and typically has a characteristic central stellate scar
  • –Proliferation of all 3 elements: benign hepatocytes (greater than 3 cells thick) & fibrous septa with inflammatory cells, bile ductules and prominent (Thick-walled) arteries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the non-neoplastic features of focal nodular hyperplasia?

A

Reactive/reparative process due to localized vascular abnormalities

  • –mistaken for HCC and adenoma
  • no malignant transformation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Next tumor of the liver is a malignant tumor in children called Hepatoblastoma. What are the pre-disposing conditions for hepatoblastoma?

A 
#1 liver tumor in children (around 18 months with M predominance) 
---associated with Beckwith-Wiedemann Syndrome, Down syndrome, familial polyposis coli, hemihypertrophy and renal malformation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the pathogenesis for hepatoblastoma?

A

Single/multiple heterogeneous masses with rapid growth and poor prognosis

  • -spreads to lungs, LN and peritoneum
  • -patient presents with hepatomegaly or abdominal mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the morphological features of hepatoblastoma?

A 
Epithelial Type: 
--fetal (Best prognosis) 
---mixed embryonal and fetal
--macrotrabecular 
Mixed Epithelial and Mesenchymal Type 
--osteoid or cartilaginous differentiation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What investigations are done for hepatoblastoma?

A

AEP elevated (if negative, more aggressive)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

The next malignant tumor to be discussed in the liver is Hepatocellular Carcinoma (HCC) aka Hepatoma. What are associated risk factors

A

Most common malignant tumor worldwide with M preponderance

  • –Most commonly due to a background of cirrhosis: Alcohol and Hep C/B and Hemochromatosis
  • -Exceptions: Aflatoxin from aspergillus (old nuts) goes straight to HCC no cirrhotic intermediate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the pathogenesis for HCC?

A

Solitary/multiple nodules that typically arise in a background of cirrhosis (mimics liver mets)

  • -trabecular type= nests and cords of hepatocytes
  • -Fibrolamellar Type: most common in young adults
  • –no association with viral hepatitis or cirrhosis
  • -Best prognosis of all types
  • -single hard tumor with fibrous bands
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the clinical presentation for HCC?

A

Symptoms of cirrhosis
Fatigue
Cachexia
Bloody Ascites (because it spreads via blood via portal and hepatic vein)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is seen on biopsy for a patient with HCC?

A

Biopsy most accurate
–Dont biopsy if its greater than 2 centimeters
(risk of spread, then just do excision/transplant)

17
Q

HCC arises from what?

A

Arises from hepatic stem cells

–secrete bilirubin = jaundice and well differentiated in function

18
Q

What is the tumor marker used for HCC?

A

AFP
–very high
–useful for follow up
Also seen very high in Yolk Sac Tumors (germ cell tumors) and heptoblastoma in kids

19
Q

What are complications of HCC?

A

Hematogenous spread
Invades vessels (bloody)
Completely bypasses lymph nodes (so does renal cell, follicular carcinoma of thyroid, gestational/non-gestational choriocarcinoma
Spreads to lungs, veins and bones

20
Q

How can metastasis to the liver be differentiated from HCC?

A

In metastasis to the liver there is no background of cirrhosis (has a capsule and decreased liver function due to cirrhosis)

21
Q

In regards to metastasis to the liver, what is the most common source of metastasis?

A

Colon is most common source

22
Q

Metastasis is the most common cause of cancer in what two organs?

A

Liver and Brain

23
Q

What is seen on histology for metastasis to the liver?

A

Shows cells of original tumor

24
Q

What is the patient presentation with metastasis to the liver?

A

Asymptomatic for liver, symptomatic of primary tumor

–proceeds to jaundice and impaction of synthetic functions of liver

25
Q

What is the AFP valve in metastasis?

A

Normal because liver function is normal

–unaffected parenchyma

26
Q

Next topic to be discussed is Cholangiocarcinoma ,which is carcinoma of the bile duct origin (intra or extra hepatic). What are some features of this carcinoma?

A

Extra-hepatic hilar cholangiocarcinoma = Klatskin Tumor

  • seen in older adults with normal AFP
  • -poor prognosis (death within 6-12 months)
  • adenocarcinoma with extensive fibrosis
27
Q

What is cholangiocarcinoma associated with?

A

Sclerosing Cholangitis
Caroli’s Disease (Cystic dilations of biliary system)
Gallstones
Chemicals (thorotrast, benzidene, nitrosamines)
Parasitic Infections (Clonorchis sinensis and Opisthorchis viverini)

28
Q

What is the presentation for a patient with cholangiocarcinoma?

A

Patients typically have non-cirrhotic livers and present with obstructive symptoms

  • -Jaundice, cholangitis (Charcot’s Triad: jaundice, fever and chills), malaise and weight loss
  • -Raynaud Pentad: Charcot’s triad + hypotension + change in mental status
29
Q

Next topic to discuss is gallstones (Cholelithiasis). What is the etiology for gallstones?

A

Cholesterol Stones (80%)(cholesterol monohydrate):
–6 F’s: female, fat (obesity), forty, fertile, fair skin and family history
–common in western/developed countries
Pigment Stones (20%)(calcium bilirubin salts):
–chronic hemolytic anemias (HS, B-thalassemia, and Sickle Cell Disease), Biliary Infections, GI disorders
–common in Asians and Rural communities

30
Q

What are the signs and symptoms of a patient with gallstones (cholelithiasis)?

A

70-80% asymptomatic; can experience

–constant or coliky pain after a fatty meal in the RUQ that radiates to the scapula, nausea and vomiting

31
Q

What is the best investigation for gallstones?

A

Gallbladder ultrasound

HIDA scan

32
Q

What are complications of gallstones?

A
  1. Acute cholecystitis: inflammation of the gallbladder due to a stone in the cystic duct causing obstruction of flow
    - -patients will have severe pain RUQ (positive murphy’s sign), nausea, vomiting and fevers (Virchows triad: fever, chilis and jaundice)
    - -can be a surgical emergency due to risk of perforation and peritonitis
  2. Chronic Cholecystitis: can be due to repeated bouts of acute cholecystitis and overlaying bacteria
    - –thickening of the gallbladder wall
    - -Porcelain gallbladder: dystrophic calcification in the wall of the gallbladder — this can develop into gallbladder adenocarcinoma
  3. Acute Cholangitis (Acute inflammation of the wall of the bile duct due to obstruction of the common bile duct)
  4. Acute Pancreatitis: due to obstruction of the common bile duct
  5. Empyema of gallbladder
  6. Fistula between gallbladder and duodenum, stone then comes out and goes into the ileocecal valve
33
Q

Finally lets discuss Carcinoma of the gallbladder. Who gets this and what is the etiology?

A

Older females
–cholesterol gallstones most common predisposing factor
-chronic inflammation of the gallbladder – porcelain gallbladder
–other causes: chronic salmonella typhi and chronic liver fluke infections
Adenocarcinoma is a KRAS mutation
Squamous is a p53 mutation

34
Q

What is the presentation for carcinoma of the gallbladder?

A

Present when its already too late

–Jaundice, weight loss, anorexia in late stage

35
Q

Gallbladder cancer spreads where first?

A

Invasion of the liver first site of metastasis

–then regional lymph nodes

36
Q

What tumor marker is used in gallbladder carcinoma?

A

CA19-9 is tumor marker

–also seen in pancreatic and cholangio

37
Q

What is seen on histology for gallbladder carcinoma?

A

Adenocarcinoma with malignant glands most common

–biopsy being the best investigation

38
Q

In regards to morphology what is the most common?

A

Exophytic

–infiltrative

Pathology Post Midterm (50 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions