Pathology of the GI Tract- Liver and Gallbladder (7)

Question 1

What are 3 benign lesions of the liver?

Answer 1

focal nodular hyperplasia (FNH), cavernous hemangioma of the liver, hepatocellular adenoma

Question 2

why do focal nodular hyperplasia lesions occur?

Answer 2

due to altered blood flow that leads to hyperplastic changes in hepatocytes

Question 3

what is the common age group of focal nodular hyperplasia?

Answer 3

young to middle aged adults

Question 4

what is the highly characteristic features of FNH?

Answer 4

they are usually single, well demarcated lesions with a CENTRAL SCAR that lacks a capsule

Question 5

what is the most common benign neoplasm of the liver?

Answer 5

cavernous hemangioma of the liver

Question 6

what are the characteristics of cavernous hemangioma of the liver?

Answer 6

they seem to affect females more than males; they are usually asymptomatic, but can present as a life threatening intraabdominal emergency for hemorrhage due to subcapsular location

Question 7

who is most likely to get a hepatocellular adenoma?

Answer 7

in young women and is strongly associated with the use of oral contraceptives and anabolic steroids; the incidence has increased in the past decade due to obesity and metabolic syndrome

Question 8

what are the three molecular subtypes of hepatocellular adenoma?

Answer 8

1. HNF1-alpha inactivated adenomas 2. inflammatory adenomas 3. B-catenin activated adenomas

Question 9

which molecular subtype of hepatocellular adenoma is most likely for malignant transformation?

Answer 9

b-catenin activated adenomas

Question 10

what is the most common liver tumor of early childhood?

Answer 10

hepatoblastoma

Question 11

what are is hepatoblastoma associated with?

Answer 11

familial adenomatous polyposis and beckwith-wiedemann syndrome

Question 12

what are the two types of hepatoblastoma?

Answer 12

epithelial type and mixed epithelial and mesenchymal type

Question 13

where is HCC most common?

Answer 13

asia and sub-saharan africa where chronic HBV infection is common; the incidence is also rising in western countries due to HCV and metabolic syndrome

Question 14

what are 8 important underlying factors to consider in HCC?

Answer 14

HBV, HCV, alcohol, alpha-1 anti trypsin deficiency, hemochromatosis, NAFLD/metabolic syndrome, wilson disease, precursor lesions (adenomas)

Question 15

what is another unique risk of developing HCC?

Answer 15

aflatoxins (found on crops from fungi which are abundant in warm and humid regions in the world)

Question 16

what is a distinctive variant of HCC that occurs in the absence of preexisting liver disease?

Answer 16

fibrolamellar carcinoma

Question 17

what are the characteristics of fibrolamellar carcinoma?

Answer 17

no gender predilection; presents as single large, hard “scirrhous” tumor with fibrous bands

Question 18

where is intrahepatic cholangiocarcinoma very common and why?

Answer 18

southeast asian countries such as Thailand, Laos, and Cambodia–> liver fluke infestation is endemic here

Question 19

what are 4 risks for development of biliary tract neoplasms?

Answer 19

fibropolycystic liver disease, PSC, infestation by liver flukes, and hepatolithiasis

Question 20

what are the common histologic features associated with intrahepatic cholangiocarcinoma?

Answer 20

malignant epithelial cells embedded in an abundant fibrous stroma; lymphovascular and perineural invasion

Question 21

what are angiosarcomas of the liver associated with?

Answer 21

historical associations with vinyl chloride, arsenic, or Thorotrast

Question 22

what are hepatic lymphomas associated with?

Answer 22

middle aged men, associated with hepatitis B and C, HIV, and PBC