Pathology Tumors of the Liver

Question 1

Cavernous Hemangioma

• Morph
• Frequency/type

Answer 1

• Morph: solitary red-blue soft nodules usually found under the capsule of the liver; dilated blood-filled vascular channels that look like a system of caves
• Most common primary liver tumor; benign

Question 2

Nodular Hyperplasia (+Focal)

• Epi
• Morph

Answer 2

• EPI: Young-middle aged adults
• Morph: lighter; sometimes yellow; central gray-white stellate scar from which fibrous septa radiate; central scar usually contains large vessels(most commonly arterial vessels) with a hyperplastic fibromuscular layer and a narrow lumen; parenchyma between the fibrous septa has normal hepatocytes separated by thickened sinusoidal plates.

Question 3

Nodular regenerative hyperplasias

- morph

Answer 3

• Morph: nodules that cover the entire liver; normal-looking hepatocytes are surrounded by rims of atrophic hepatocytes; Fibrosis is absent

Question 4

Hepatocellular Adenoma

• Et
• Risk

Answer 4

• Et: OIC Use!

- Risk: Rupture + abdominal bleeding -> Surgical emergency

Question 5

HNF1-α Inactivated Hepatocellular Adenoma

• Genetics
• A/S
• S/S
• LabDx

Answer 5

• G: Somatic OR Gemline mutation in HNF1-a, a tumor supressor gene
• A/S: MODY3 - Diabetes Mellitus
• S/S” *Steatosis

Question 6

β-catenin Activated Hepatocellular Adenoma

• Genetics
• Path/Risk
• Et

Answer 6

• G: Activating muatation of CTNNB1 gene -> B-Cat translocation into nucleus
• Path: B-Catenin serves as TF in nucleus, and can induce tumor formation; Very high risk for malignant transformation
• OICs + Anabolic steroids in Women + Men

Question 7

Inflammatory Hepatocellular Adenoma

• Genetics/Path
• A/S
• Morph

Answer 7

• G: activating mutations in gp130, IL-6, + JAK-STAT -> Over-expression of acute phase reactants (CRP)
• non-alcoholic fatty liver disease
• Unlike the other two subtypes of adenomas, these lesions have areas of fibrotic stroma, mononuclear inflammation, ductular reactions, and prominent telangiectasias (sinusoidal dilatation).

Question 8

Hepatoblastoma

• Epi
• 5-YR survival
• Genetics/Path
• Types

Answer 8

• EPI: < 3YO;
• 80% 5 yr survival
• G: Mutation/downstreaming WNT (APC gene) Or Activation of B-Catenin
• Types: Epithelial -> small polygonal fetal cells which form acini, tubules, or papillary structures; Mixed -> Primtiove mesenchyme, osteoid, cart, or striated muscle

Question 9

Hepatocellular Carcinoma

• et
• epi
• Path/Genetics
• S/S:

Answer 9

• Et: HBV/HCV; Alcoholism; Chronic Liver Disease; Aflatoxin B1 (Aspargillus)
• Epi: Men>female; >60 YO in US; 20-40 in asains; but shifting younger in US;
• Path: Chronic Dx -> High cell turnover + Mutation accumulation; P53, CTNNB1, + IL-6/JAK-STAT Mutations;
• S/S: Ill-defined Ab pain; B S/S; awareness of ab fullness or mass; Jaundice, vericeal bleeding;

Question 10

Fibrolamellar Carcinoma

• Epi
• Morph

Answer 10

• Epi: 20-40 YO
• single large, non-encapsulated, but well circumscribed “scirrhous” tumor which is traversed by fibrous bands. Well-differentiated polygonal cells that are rich in mitochondria (oncocyte) and grow in nests or cords interspersed between parallel lamellae of dense collagen bundles.

Question 11

Cholangiocarcinoma

• EPI
• Et
• Morph
• S/S
• Prognosis

Answer 11

• EPI: Asian countries
• Et: Liver flukes; HBV/HCV; NAFL;
• Morph: noncirrhotic intrahepatic portal tract tree mass Or as a single mass; well-defined glandular or tubular structures w/ dense collagenous stroma
• S/S: Biliary Obstruction; Cholangitis; RUQ pain
• Prog: Detected late; 6 month mean survival