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Gastrointestinal > Path-Cysts & Tumors > Flashcards

Path-Cysts & Tumors Flashcards

1
Q

most cystic lesions of the liver are of ____ origin and are grouped under the heading _____

A

developmental; fibropolycystic liver dz

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2
Q

name two non-neoplastic primary liver tumors

A

focal nodular hyperplasia & focal fatty change

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3
Q

most common liver cyst is the?

A

biliary microhamartoma (“von Meyenberg complex”)

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4
Q

the only clinical scenario where biliary microhamartomas are of clinical concern is when?

A

surgeon thinks its metastasis of another cancer

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5
Q

histological features of biliary microhamartoma

A

small meshwork of dilated and angulated ductlike structures lined by bilary epithelium (maybe with inspissated bile) embedded within fibrous stroma - cytologically bland/pale

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6
Q

symptoms of liver cysts fall into 3 categories?

A

space-occupying; portal HTN; biliary obstruction (with periodic jaundice and cholangitis)

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7
Q

space-occupying cysts of the liver might also be found in the _____, leading to ________

A

kidney; renal failure

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8
Q

side effects of a large liver cyst in polycystic kidney dz

A

compression atrophy, rupture, infection, intra-cystic bleeding

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9
Q

hydatid cysts result when a human becomes the accidental host of the?

A

canine tapeworm, Echinococcus (uncommon in US)

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10
Q

congenital hepatic fibrosis typically presents in _____ with ______ and/or _______

A

childhood or adolescence; splenomegaly and/or esophageal varices (signs of portal HTN)

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11
Q

congenital hepatic fibrosis could visually be confused for cirrhosis, but it is different in that?

A

synthetic function of the liver is preserved (LFTs normal); there are large, angulated, irregularly-shaped and anastamosing bile ducts

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12
Q

choledochal cysts are?

A

cystic malformation of the extrahepatic bile duct

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13
Q

choledochal cysts usually present in infancy with? (3 things)

A

pain, jaundice, and a palpable RUQ mass

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14
Q

tx of choledochal cysts

A

surgical, do it early!

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15
Q

focal nodular hyperplasia is?

A

nodular proliferation of hepatocytes around central abnormal artery embedded in a fibrous scar

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16
Q

FNH nodeules are thought to develop as localized overgrowth of liver parenchyma due to?

A

the anomalous arterial branch they surround

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17
Q

arteries within the center of a FNH nodule show?

A

fibromuscular hyperplasia with increased elastin and luminal narrowing

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18
Q

what are the most common benign neoplasms of the liver?

A

epithelial adenomas, mesenchymal hemangiomas

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19
Q

the majority of hepatic adenomas are (single/multiple)

A

single (2/3)

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20
Q

major risk factor for hepatic adenoma

A

young women with long-term OCP exposure (also anabolic steroids and glycogen storage dz)

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21
Q

presentation sx for hepatic adenoma

A

hepatic mass, RUQ pain, bleeding from tumor

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22
Q

risk for malignant transformation is low in ___, but significant in ____

A

women; men

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23
Q

histologic features of hepatic adenoma

A

cytologically bland hepatocytes that are slightly larger than normal, absence of portal areas, large caliber blood vessels course through

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24
Q

why is there a risk of spontaneous bleeding with hepatic adenomas?

A

the vessels that course through them are large in size and lack supportive connective tissue

25
Q

tx of hepatic adenoma

A

always excise if in men; sometimes removal of drug-cause can lead to tumor regression

26
Q

how to differentiate between metastatic tumor nodules and multiple hepatic adenomas?

A

imaging criteria should be sufficient; can also do a biopsy

27
Q

if adenomas near the surface of the liver rupture, what can happen?

A

bleeding into peritoneal cavity with life-threatening blood loss

28
Q

hepatic hemangiomas are also referred to as?

A

cavernous hemangiomas

29
Q

most hemangiomas are (single/multiple) and occur more frequently in (men/women)

A

single; women

30
Q

hepatic hemangiomas are usually asymptomatic, but when they cause discomfort it is usually?

A

RUQ discomfort or fullness

31
Q

what is the Kasabach-Merritt syndrome?

A

a consumptive coagulopathy developing in children with giant hemangiomas (severe thrombocytopenia, hypofibinogenemia, elevated FDPs, fragmentation of RBCs

32
Q

grossly, hepatic hemangiomas look?

A

red-brown, spongy, may be hemorrhage, scarring, or calcification

33
Q

microscopically, hepatic hemangiomas are composed of?

A

cavernous vascular spaces of varying size lined by a single layer of flat endothelium and filled with blood

34
Q

vascular compartments are separated by _____ and may contain _____

A

thin fibrous (connective tissue) septae; thrombi

35
Q

what may happen as a consequence of thrombosis in hepatic hemangiomas?

A

collagenous scarring or fibrous nodules

36
Q

what is the primary sx of HCC?

A

only sx of underlying liver dz; perhaps progressive to decompensated cirrhosis

37
Q

serum concentration of this fetal glycoprotein is elevated in HCC

A

alpha-fetoprotein (but this is neither sensitive or specific) – it is monitored in pts with cirrhosis and a rise may indicate HCC development

38
Q

angiosarcoma is a (common/rare) (benign/malignant) mesenchymal tumor of the liver

A

rare; malignant

39
Q

in HCC, trabeculae are (thinner/thicker) than in a cirrhotic liver

A

thicker; 5-6 layers instead of 2

40
Q

in patients with poor overall liver function, ___ is a poor treatment for HCC

A

surgical resection

41
Q

instead of surgical removal of the HCC tumor, pts often undergo ______ or _______

A

radiofrequency ablation; transarterial chemo embolization

42
Q

what happens in TACE?

A

major artery supplying tumor is catheterized and embolic microspheres impregnated with a chemo tx drug are injected

43
Q

how does TACE damage the HCC tumor?

A

obstruction of blood flow; chemotx

44
Q

what is the goal of TACE?

A

shrink the tumor so that the patient can become a liver transplant candidate

45
Q

this slow-growing HCC variant occurs in a younger age group and has a better prognosis, partly because it is not associated with cirrhosis

A

fibrolamellar HCC

46
Q

what does fibrolamellar HCC look like histologically?

A

thick plates of atypical hepatocytes with granular eosinophilic cytoplasm alternating with dense bands of collagen

47
Q

infantile hemangioendothelioma is a?

A

low grade vascular tumor arising in infants

48
Q

hepatoblastoma is an ______ cancer common in pediatric population

A

epithelial (or mixed epithelial/mesenchymal)

49
Q

the epithelial pattern of hepatoblastoma is classified into what three categories, with increasing severity (decreasing prognosis)

A

fetal; embryonal (more immature); small cell undiff (worst prognosis)

50
Q

epidemiology of hepatoblastoma

A

rare; most common malignant liver tumor in children; males > females; median age at dx is 18 months

51
Q

tx of hepatoblastoma; cure rate

A

surgical resection + adjuvant chemo; almost always a complete cure

52
Q

lab values seen in hepatoblastoma

A

vast majority show markedly elevated alpha-fetoprotein

53
Q

these factors make the liver a common site for metastases

A
  1. nutrient rich dual blood supply + 2. humoral growth factors from pancreas
54
Q

when leukemia or lymphoma involves the liver, it often causes?

A

diffuse liver enlargement without discrete nodules

55
Q

when sx of liver mets are present, they tend to be ______

A

nonspecific (liver enlargement, ascites, jaundice, fever, weight loss, malaise, abdominal discomfort)

56
Q

lab findings with liver mets

A

not that helpful; may see anemia, leukocytosis, high bilirubin/cholestatic enzymes if compresses bile ducts

57
Q

tx of liver mets is usually _______, and constists of?

A

palliative; physical or chemical tumor ablation (cryotherapy, RF ablation, alcohol injection, embolization)

58
Q

in the setting of liver mets, paraffin-embedded tissue-based molecular microarray tests are most helpful in _________, though they are intended to _____

A

excluding potential primary sites; classify tumors by matching gene expression patterns

Gastrointestinal (40 decks)

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