Neoplasia of liver

Question 1

Benign, non-neoplastic hepatic lesions that develops in response to abnormal blood flow through congenital or acquired vascular abnormality.

Answer 1

Focal nodular hyperplasia

Question 2

Well-circumscribed liver mass with a central stellate scar. Microscopy shows fibrous septa radiating from the central scar, dividing the hepatic parenchyma into nodules.

Answer 2

Focal nodular hyperplasia

Question 3

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.

Answer 3

Focal nodular hyperplasia

Question 4

Benign hepatic neoplasm strongly associated with use of OCPs or anabolic steroids

Answer 4

Hepatocellular adenoma

Question 5

Subtypes of hepatocellular adenoma linked to malignant transformation

Answer 5

HNF1-alpha inactivated (minimal risk)

Inflammatory

Beta-catenin activated (high risk)

Question 6

Mutations associated with inflammatory hepatocellular adenoma

Answer 6

IL6ST
JAK1/STAT3

Question 7

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.

Answer 7

Hepatocellular adenoma

Question 8

Complication of subcapsular hepatocellular adenomas

Answer 8

Rupture causing massive intra-abdominal bleeding –> associated with estrogen levels in pregnancy

Question 9

Most common benign tumor of the liver

Answer 9

Cavernous hemangioma

Question 10

Rare complications of large cavernous hemangioma

Answer 10

Rupture with hemoperitoneum

Bile duct obstruction

Gastric compression

Question 11

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.

Answer 11

Cavernous hemangioma

Question 12

Most common primary malignancy of the liver

Answer 12

Hepatocellular carcinoma

Question 13

Metabolic disease associated with increased risk for hepatocellular carcinoma

Answer 13

Hemochromatosis
Alpha-1-AT deficiency
Alcoholic liver disease
NAFLD

Question 14

Diseases associated with lower risk for hepatocellular carcinoma

Answer 14

Wilson disease
Chronic biliary diseases

Question 15

Gene mutations associated with hepatocellular carcinoma

Answer 15

Beta-catenin (40%)
TERT gene (50-60%)

Question 16

Unusual histologic subtype of hepatocellular carcinoma that often occurs in young adults in the absence of preexisting liver disease

Answer 16

Fibrolamellar

Question 17

Genetic mutation associated with fibrolamellar hepatocellular carcinoma

Answer 17

Single deletion in chromosome 19 leading aberrant PKA activity

Question 18

Liver biopsy shows large polygonal oncocytic hypatocytes with granular cytoplasm vesicular nuclei with prominent nucleolus, and parallel lamellae of dense collagen bundles.

Answer 18

Fibrolamellar hepatocellular carcinoma

Question 19

Precursor lesions of hepatocellular carcinoma seen in chronic liver disease

Answer 19

Large cell change
Small cell change
Dysplastic nodule

Question 20

Late complications of large hepatocellular carcinoma

Answer 20

Rupture with hemorrhage

Metastasis, commonly to abdominal cavity or lungs

Question 21

Tumor marker associated with hepatocellular carcinoma (not fibrolamellar)

Answer 21

Alpha-fetoprotein

Question 22

Screening test for hepatocellular carcinoma in high risk pts

Answer 22

Ultrasound

Question 23

Liver CT with contrast shows early enhancement of tumor due to contrast uptake in the arterial phase, followed by rapid venous washout

Answer 23

Diagnostic of hepatocellular carcinoma

Question 24

Malignant vascular tumor of the liver arising from endothelial cells. Associated with exposure to vinyl chloride.

Answer 24

Angiosarcoma

Question 25

Positive vascular markers in angiosarcoma

Answer 25

ERG transcription factor
CD31
CD34
Factor VIII antigen

Question 26

Malignant hepatic tumor that consists of anastomosing vascular channels lined by atypical endothelium.

Answer 26

Angiosarcoma

Question 27

Most common cancer primaries that metastasize to the liver

Answer 27

Colon adenocarcinoma
Breast adenocarcinoma
Lung SCC or adenocarcinoma
Pancreas adenocarcinoma

Question 28

First indication of metastatic tumor to the liver

Answer 28

Unexplained increase in serum alkaline phosphatase