Neoplasia of liver Flashcards
Benign, non-neoplastic hepatic lesions that develops in response to abnormal blood flow through congenital or acquired vascular abnormality.
Focal nodular hyperplasia
Well-circumscribed liver mass with a central stellate scar. Microscopy shows fibrous septa radiating from the central scar, dividing the hepatic parenchyma into nodules.
Focal nodular hyperplasia
Hepatic lesion with prominent bile ductular reaction, absent interlobular bile ducts, no atypia, and lacks normal portal tracks. Septa divide into nodules of normal appearing hepatocytes.
Focal nodular hyperplasia
Benign hepatic neoplasm strongly associated with use of OCPs or anabolic steroids
Hepatocellular adenoma
Subtypes of hepatocellular adenoma linked to malignant transformation
HNF1-alpha inactivated (minimal risk)
Inflammatory
Beta-catenin activated (high risk)
Mutations associated with inflammatory hepatocellular adenoma
IL6ST
JAK1/STAT3
Well-defined tan liver mass with areas of hemorrhagic necrosis. Microscopy shows disorganized hepatocyte cords without normal lobular architecture. Prominent arterial vessels and draining veins are present, but interlobular ducts and portal tracts are absent.
Hepatocellular adenoma
Complication of subcapsular hepatocellular adenomas
Rupture causing massive intra-abdominal bleeding –> associated with estrogen levels in pregnancy
Most common benign tumor of the liver
Cavernous hemangioma
Rare complications of large cavernous hemangioma
Rupture with hemoperitoneum
Bile duct obstruction
Gastric compression
Discrete, red-blue, soft, subscapular nodules of the liver. Microscopy shows dilated, thin-walled vascular channels separated by dense fibrous stroma. Biopsy is contraindicated due to risk of bleed.
Cavernous hemangioma
Most common primary malignancy of the liver
Hepatocellular carcinoma
Metabolic disease associated with increased risk for hepatocellular carcinoma
Hemochromatosis
Alpha-1-AT deficiency
Alcoholic liver disease
NAFLD
Diseases associated with lower risk for hepatocellular carcinoma
Wilson disease
Chronic biliary diseases
Gene mutations associated with hepatocellular carcinoma
Beta-catenin (40%)
TERT gene (50-60%)
Unusual histologic subtype of hepatocellular carcinoma that often occurs in young adults in the absence of preexisting liver disease
Fibrolamellar
Genetic mutation associated with fibrolamellar hepatocellular carcinoma
Single deletion in chromosome 19 leading aberrant PKA activity
Liver biopsy shows large polygonal oncocytic hypatocytes with granular cytoplasm vesicular nuclei with prominent nucleolus, and parallel lamellae of dense collagen bundles.
Fibrolamellar hepatocellular carcinoma
Precursor lesions of hepatocellular carcinoma seen in chronic liver disease
Large cell change
Small cell change
Dysplastic nodule
Late complications of large hepatocellular carcinoma
Rupture with hemorrhage
Metastasis, commonly to abdominal cavity or lungs
Tumor marker associated with hepatocellular carcinoma (not fibrolamellar)
Alpha-fetoprotein
Screening test for hepatocellular carcinoma in high risk pts
Ultrasound
Liver CT with contrast shows early enhancement of tumor due to contrast uptake in the arterial phase, followed by rapid venous washout
Diagnostic of hepatocellular carcinoma
Malignant vascular tumor of the liver arising from endothelial cells. Associated with exposure to vinyl chloride.
Angiosarcoma
Positive vascular markers in angiosarcoma
ERG transcription factor
CD31
CD34
Factor VIII antigen
Malignant hepatic tumor that consists of anastomosing vascular channels lined by atypical endothelium.
Angiosarcoma
Most common cancer primaries that metastasize to the liver
Colon adenocarcinoma
Breast adenocarcinoma
Lung SCC or adenocarcinoma
Pancreas adenocarcinoma
First indication of metastatic tumor to the liver
Unexplained increase in serum alkaline phosphatase
