Path-Cysts & Tumors Flashcards
most cystic lesions of the liver are of ____ origin and are grouped under the heading _____
developmental; fibropolycystic liver dz
name two non-neoplastic primary liver tumors
focal nodular hyperplasia & focal fatty change
most common liver cyst is the?
biliary microhamartoma (“von Meyenberg complex”)
the only clinical scenario where biliary microhamartomas are of clinical concern is when?
surgeon thinks its metastasis of another cancer
histological features of biliary microhamartoma
small meshwork of dilated and angulated ductlike structures lined by bilary epithelium (maybe with inspissated bile) embedded within fibrous stroma - cytologically bland/pale
symptoms of liver cysts fall into 3 categories?
space-occupying; portal HTN; biliary obstruction (with periodic jaundice and cholangitis)
space-occupying cysts of the liver might also be found in the _____, leading to ________
kidney; renal failure
side effects of a large liver cyst in polycystic kidney dz
compression atrophy, rupture, infection, intra-cystic bleeding
hydatid cysts result when a human becomes the accidental host of the?
canine tapeworm, Echinococcus (uncommon in US)
congenital hepatic fibrosis typically presents in _____ with ______ and/or _______
childhood or adolescence; splenomegaly and/or esophageal varices (signs of portal HTN)
congenital hepatic fibrosis could visually be confused for cirrhosis, but it is different in that?
synthetic function of the liver is preserved (LFTs normal); there are large, angulated, irregularly-shaped and anastamosing bile ducts
choledochal cysts are?
cystic malformation of the extrahepatic bile duct
choledochal cysts usually present in infancy with? (3 things)
pain, jaundice, and a palpable RUQ mass
tx of choledochal cysts
surgical, do it early!
focal nodular hyperplasia is?
nodular proliferation of hepatocytes around central abnormal artery embedded in a fibrous scar
FNH nodeules are thought to develop as localized overgrowth of liver parenchyma due to?
the anomalous arterial branch they surround
arteries within the center of a FNH nodule show?
fibromuscular hyperplasia with increased elastin and luminal narrowing
what are the most common benign neoplasms of the liver?
epithelial adenomas, mesenchymal hemangiomas
the majority of hepatic adenomas are (single/multiple)
single (2/3)
major risk factor for hepatic adenoma
young women with long-term OCP exposure (also anabolic steroids and glycogen storage dz)
presentation sx for hepatic adenoma
hepatic mass, RUQ pain, bleeding from tumor
risk for malignant transformation is low in ___, but significant in ____
women; men
histologic features of hepatic adenoma
cytologically bland hepatocytes that are slightly larger than normal, absence of portal areas, large caliber blood vessels course through
why is there a risk of spontaneous bleeding with hepatic adenomas?
the vessels that course through them are large in size and lack supportive connective tissue
tx of hepatic adenoma
always excise if in men; sometimes removal of drug-cause can lead to tumor regression
how to differentiate between metastatic tumor nodules and multiple hepatic adenomas?
imaging criteria should be sufficient; can also do a biopsy
if adenomas near the surface of the liver rupture, what can happen?
bleeding into peritoneal cavity with life-threatening blood loss
hepatic hemangiomas are also referred to as?
cavernous hemangiomas
most hemangiomas are (single/multiple) and occur more frequently in (men/women)
single; women
hepatic hemangiomas are usually asymptomatic, but when they cause discomfort it is usually?
RUQ discomfort or fullness
what is the Kasabach-Merritt syndrome?
a consumptive coagulopathy developing in children with giant hemangiomas (severe thrombocytopenia, hypofibinogenemia, elevated FDPs, fragmentation of RBCs
grossly, hepatic hemangiomas look?
red-brown, spongy, may be hemorrhage, scarring, or calcification
microscopically, hepatic hemangiomas are composed of?
cavernous vascular spaces of varying size lined by a single layer of flat endothelium and filled with blood
vascular compartments are separated by _____ and may contain _____
thin fibrous (connective tissue) septae; thrombi
what may happen as a consequence of thrombosis in hepatic hemangiomas?
collagenous scarring or fibrous nodules
what is the primary sx of HCC?
only sx of underlying liver dz; perhaps progressive to decompensated cirrhosis
serum concentration of this fetal glycoprotein is elevated in HCC
alpha-fetoprotein (but this is neither sensitive or specific) – it is monitored in pts with cirrhosis and a rise may indicate HCC development
angiosarcoma is a (common/rare) (benign/malignant) mesenchymal tumor of the liver
rare; malignant
in HCC, trabeculae are (thinner/thicker) than in a cirrhotic liver
thicker; 5-6 layers instead of 2
in patients with poor overall liver function, ___ is a poor treatment for HCC
surgical resection
instead of surgical removal of the HCC tumor, pts often undergo ______ or _______
radiofrequency ablation; transarterial chemo embolization
what happens in TACE?
major artery supplying tumor is catheterized and embolic microspheres impregnated with a chemo tx drug are injected
how does TACE damage the HCC tumor?
obstruction of blood flow; chemotx
what is the goal of TACE?
shrink the tumor so that the patient can become a liver transplant candidate
this slow-growing HCC variant occurs in a younger age group and has a better prognosis, partly because it is not associated with cirrhosis
fibrolamellar HCC
what does fibrolamellar HCC look like histologically?
thick plates of atypical hepatocytes with granular eosinophilic cytoplasm alternating with dense bands of collagen
infantile hemangioendothelioma is a?
low grade vascular tumor arising in infants
hepatoblastoma is an ______ cancer common in pediatric population
epithelial (or mixed epithelial/mesenchymal)
the epithelial pattern of hepatoblastoma is classified into what three categories, with increasing severity (decreasing prognosis)
fetal; embryonal (more immature); small cell undiff (worst prognosis)
epidemiology of hepatoblastoma
rare; most common malignant liver tumor in children; males > females; median age at dx is 18 months
tx of hepatoblastoma; cure rate
surgical resection + adjuvant chemo; almost always a complete cure
lab values seen in hepatoblastoma
vast majority show markedly elevated alpha-fetoprotein
these factors make the liver a common site for metastases
- nutrient rich dual blood supply + 2. humoral growth factors from pancreas
when leukemia or lymphoma involves the liver, it often causes?
diffuse liver enlargement without discrete nodules
when sx of liver mets are present, they tend to be ______
nonspecific (liver enlargement, ascites, jaundice, fever, weight loss, malaise, abdominal discomfort)
lab findings with liver mets
not that helpful; may see anemia, leukocytosis, high bilirubin/cholestatic enzymes if compresses bile ducts
tx of liver mets is usually _______, and constists of?
palliative; physical or chemical tumor ablation (cryotherapy, RF ablation, alcohol injection, embolization)
in the setting of liver mets, paraffin-embedded tissue-based molecular microarray tests are most helpful in _________, though they are intended to _____
excluding potential primary sites; classify tumors by matching gene expression patterns
