Pathogenesis of cirrhosis and liver tumors Flashcards
What’s different about the sinusoids of a cirrhotic liver?
No fenestrations!
What are the three main types of inflammation?
- Portal: Around portal tracts
- Interface: Spilling out of the focal area of inflammation into the parenchyma
- Lobular: Parenchymal inflammation
What is the process behind fibrosis of the liver?
Stellate cells in the space of disse are activated by kupffer cells, causing proliferation and production of collagen deposition
Histological appearance of a fibrotic liver:
Disappearance of lobules
bridging fibrous septa
parenchymal nodules
Features of hepatic failure
- Jaundice
- Hypoalbuminemia–>edema
- Coagulopathy
- Hyperammonemia
- Hyperestrogenemia (plamar erythema, spider aniomata, and hypogonadism+gynecomastia
What are two benign liver tumors originating from hepatocytes?
- hepatic adenoma
2. focal nodular hyperplasia
What are malignant tumors originating from hepatocytes?
- Hepatocellular carcinoma
2. Hepatoblastoma
What are the benign tumors originating from biliary epithelium? Malignant?
Benign: bile duct adenoma + biliary hamartoma
Malignant: Cholangiocarcinoma
What are benign tumors originating from mesenchyme?
Benign: hemangioma/angiomyolipoma
Malignant: Angiosarcoma
Typical pt with hepatocellular adenoma?
Female 30-40’s
What is hepatocellular adenoma associated with?
Oral contraceptive steroids
How does hepatocellular adenoma present?
RUQ mass, pain, hemorrhage
How do you diagnose hepatocellular adenoma?
CT
How do you treat hepatocellular adenoma?
Resection if it’s larger than 5 cm
What does hepatocellular adenoma look like on histology?
normal looking hepatocytes, but no bile ducts or portal tracts.
What are you most worried about with hepatocellular adenoma?
They are benign, but can cause massive intra-peritoneal hemorrhage
What is your typical pt with focal nodular hyperplasia?
All ages, more common in men
What does focal nodular hyperplasia look like on histology?
JUST LIKE CIRRHOSIS. Therefore, you need to know whether your sample is seen all over the liver or just in a single mass lesion
What is your typical pt with hepatoblastoma?
Under 5 years of age. More common in males
How does hepatoblastoma present?
Rapidly enlarging upper abdominal mass
- -Fever, N/V, diarrhea
- -Elevated AFP
- -High HCG–>virilization and precocious puberty
What are the different types of hepatoblastoma?
- Embryonic type (looks like a PNET)
- Fetal (clear cytoplasm)
- Cholangioblastic (lots of ducts)
- Mixed (stromal component with bone)
How do you treat hepatoblastoma?
Surgery + chemotherapy
What are common causes of HCC?
- Hep B
- Aflatoxin
- Hep C
- Alcoholic liver dz
- NASH
What is the MOST common cause of HCC in the US?
HCV
What are the different types of HCC?
- Solid
- Trabecular
- Acinar
- Mixed
Fibrolamellar hepatocellular Ca
no association with chronic liver disease. It has a better prognosis. Will see lots of fibrous bands
What is cholangiocarcinoma related to?
Associated with primary sclerosing cholangitis (NO relation to cirrhosis)
What serum marker is elevated in HCC? cholangiocarcinoma?
HCC=Alpha fetoprotein
cholangiocarcinoma=CEA
What are other differences btw HCC vs cholangiocarinoma?
Cholangiocarinoma:
- -no liver cell dysplasia
- -Absent bile production
- -Mucin secretion is present…can stain for this
- -On gross, looks hard and white (as opposed to soft and hemorrhagic)
- -Spreads through lymphatics
