SFP: liver tumors Flashcards
Describe a cavernous hemangioma
The most common benign neoplasm of the liver that is often asymptomatic, but can cause sudden pain if it ruptures or is thrombosed.
What is contraindicated in cavernous hemangioma
Fine needle aspiration.
How do we treat cavernous hemangioma
Observation, resection, or embolization.
Describe the gross morphology of cavernous hemangioma
Encapsulated with fibrosis and channels filled with blood.
Describe the histology of cavernous hemangioma
Large dilated blood-filled spaces lined by endothelial cells with fibrosis between the channels.
Describe nodular regenerative hyperplasia
Diffuse nodularity throughout the liver with no or minimal fibrosis.
What can be associated with nodular regenerative hyperplasia
Portal HTN, connective tissue diseases, myeloproliferative or lymphoproliferative disorders.
Describe focal nodular hyperplasia
A mass with a central scar that is often associated with arterial malformation. Not a diffuse process.
Describe histology of focal nodular hyperplasia
Bile duct proliferation, fibrosis, and large vessels with thick walls within the mass.
Describe an adenoma of the liver
Benign solitary masses that may present as pain, a mass on imaging, or as incidental.
What is associated with adenomas of the liver
Oral contraceptive pills.
Describe the histology of adenomas in the liver
Portal tracts, duct structures, and fibrous septa are all absent. The cells will be enlarged, and fat may be present.
What is the most common form of adenoma in the liver
An HNF1 alpha mutated adenoma that often occurs in women and does not have malignant potential; may have steatosis.
Which form of adenoma has malignant potential
Adenoma with beta catenin activating mutation; more common in men.
Describe the second most common form of adenoma in the liver
Inflammatory type with serum amyloid A and C reactive protein and results from a gain of function mutation in IL6ST gene and activation of STAT3 path.
Describe hepatocellular carcinoma
The most common primary malignant lesion of the liver that has a global distribution of cirrhosis.
What is hepatocellular carcinoma associated with
HBV, cirrhosis from alcohol, HCV, or hemochromatosis.
What are precursor lesions to hepatocellular carcinoma
Cellular dysplasia with small cell changes and dysplastic nodules that can be seen in cirrhosis.
What is seen on histology in hepatocellular carcinoma
Irregular hepatocytes, thickening of trabeculi, loss of reticulin network.
What are unique histologic features that may be seen with hepatocellular carcinoma
Ground glass cytoplasm, alpha 1 antitrypsin globule, Mallory hyaline.
What is pseudoglandular hepatocellular carcinoma
There looks like there is a lumen within the hepatocyte; we have to stain to confirm the cell is in fact a hepatocyte.
What marker can we use to screen for hepatocellular carcinoma
Serum AFP.
How do we treat hepatocellular carcinoma
It needs to be removed or embolized.
What is the fibrolamellar variant of HCC
A type that arises in noncirrhotic livers and occurs in a younger population (around 40) and has a better prognosis.
What is seen on histology in fibrolamellar HCC
Oncotyic hepatocytes (super pink), lamellar fibrosis, and pale bodies.
Describe cholangiocarcinoma
A malignancy arising in bile ducts that is not usually associated with cirrhosis.
What does cholangiocarcinoma present with
Painless jaundice.
What can we use to highlight cholangiocarcinoma
Mucin stain; helps us see the lumen of malignant glandular structures formed.
What is the most common malignant lesion of the liver
Metastatic lesions.
Describe metastatic lesions of the liver
They are well circumscribed nodules; they may be multiple or solitary.
Describe histology of metastatic liver tumors
They often resemble the primary origin.
