Neoplastic Liver Disease

Question 1

What reasons do liver tumours com to the attention of patients and doctors?

Answer 1

1. epigastric fullnes or discomfort 2. palpable abdominal mass 3. incidental findings

Question 2

What are the types of liver tumours?

Answer 2

1. benign 2. malignant

Question 3

What are the types of malignant tumours?

Answer 3

1. primary 2. metastatic: spread from other organs

Question 4

Describe 2 types of benign liver tumours?

Answer 4

1. haemongioma - blood vessel tumour

2. liver cell adenomas - commonly seen in young women on oral contraceptives

Question 5

What are primary malignant tumours?

Answer 5

most arise from hepatocytes: Hepatocellular carcinoma(HCC).

Question 6

Describe types of malignant tumours?

Answer 6

1. cholangiocarcinoma - bile duct origin
2. hepatoblastomas - Liver tumour of childhood (<2yrs of age)
3. angiosarcoma - blood vessel tumours

Question 7

What is the epidemiology of hepatocellular carcinoma?

Answer 7

1. Documented prevalence for Malawi:
2. 8/100,000 in males, 0.4/100,000 in females 2. Globally 5.4% of all cancers 3. common in Asia followed by Africa 4. >85% in countries with high rates of chronic Hepatits B virus infection (HBV)

Question 8

What are the 3 major aetiological associations of neoplastic liver disease?

Answer 8

1. Viral infection: HBV, HCV
2. Chronic alcoholism
3. Food contaminants (Aflatoxins)

Question 9

What are the minor conditions associated with neoplastic liver disease?

Answer 9

1. tyrosinaemia 2. hereditary haemochromatosis

Question 10

Describe viral carcinogenesis?

Answer 10

1. Chronic liver injury with regeneration: increase in pool of cycling cells at risk of genetic changes - Mutations arise spontaneously or by environmental agents eg aflatoxins 2. HBV encodes HBx protein: regulatory protein that disrupts normal growth control of infected liver cells

Question 11

Describe the macroscopic morphology?

Answer 11

1. unifocal - one large mass
2. multifocal - several separate nodules
3. diffusely infiltrative - involving whole lobe

Question 12

Describe the microscopic morphology?

Answer 12

1. HCC - Poorly differentiated to well differentiated
2. fibrolamellar - distinctive variant that occurs in young males and has no association with HBV but has thick fibrous bands

Question 13

Describe the course of the disease?

Answer 13

progressive enlargement of primary mass - 1. mestastases 2. derangement of liver function

Question 14

Death occurs from?

Answer 14

1. cachexia 2. eosophageal variceal bleed 3. liver failure with hepatic coma 4. rupture of tumour with fatal haemorrhage