Sketchy Path: Liver Tumors and HCC

Question 1

What are the three common histological features of Focal Nodular Hyperplasia of the liver?

Answer 1

Abnormally Large Central Artery
Spoke Wheel pattern on contrast
Stellate Scar

Question 2

What differentiate FNH from hepatic adenoma’s?

Answer 2

FNH contain bile ductules while hepatic adenomas do not

Remember around the hyperplastic star pattern is normal tissue architecture

Question 3

What gender is more likely to get FNH?

Answer 3

Female

Question 4

What is the most common benign liver mass?

Answer 4

Hepatic Hemangiomas

Question 5

What do hepatic hemangiomas look like?

Answer 5

Dilated vascular spaces filled with blood

Question 6

Why are hepatic hemangiomas fragile?

Answer 6

Only lined by a single layer of epithelium (Adventitia) and do not have smooth muscle

Question 7

On histology, what does a hepatic hemangioma look like?

Answer 7

Dilated cystic spaces filled with RBC

Described as cavernous

Question 8

What is contraindicated in patients with hepatic hemangiomas?

Answer 8

Fine Needle Biopsy

Contrast MRI to rule our cancer

Question 9

Hepatic Adenoma is associated with what?

Answer 9

Oral Contraceptives/Pregnancy/ Anabolic Steroids

Estrogen makes the adenoma grow

Question 10

Women are adivised not to get pregnant until after hepatic adenoma is removed due to what complication?

Answer 10

Grow and rupture causing serious bleeding

Mortality rate in pregnant women is 60%

Question 11

Oral Contraceptives can cause which liver mass?

Answer 11

Hepatic Adenoma

Question 12

In what tumor does the cessation of steroids/OCP regress the tumor?

Answer 12

Hepatic Adenoma

Question 13

Besides OCP, Hepatic Adenoma are assc with what other condition?

Answer 13

Von Gierke’s (Type 1 GSD)

Type 3 GSD

Question 14

Hepatic adenoma on histology?

Answer 14

Sheets of large hepatocytes filled with glycogen; VERY VASCULAR with no bile ductules (like FNH)

Question 15

Which benign tumor has an increase risk of HCC?

Answer 15

Hepatic Adenoma

Question 16

What are the most common mets to the liver?

Answer 16

Lung and Colon

Question 17

What is the most common malignant primary cancer of the liver?

Answer 17

HCC

Question 18

Can you get HCC from alcohol or NAFLD without cirrhosis?

Answer 18

yes

Question 19

World Wide what is the largest cause of HCC?

Answer 19

Hepatitis B

Question 20

What toxin increases the risk of HCC?

Answer 20

Alfatoxin (Aspergillas)

Question 21

Alfatoxin causes what mutation?

Answer 21

p53 mutation

Question 22

Exposure to what dye causes an increase risk of HCC?

Answer 22

Azo dyes
(rare do to modern regulations)

Question 23

Well organized forms of HCC have what specific feature on histology?

Answer 23

Pseudo-canaculi

globs of bile containing canaculi

Question 24

What is one hint that a patient with previous cirrhosis developed HCC?

Answer 24

Sudden decompensation

encephalopathy, fever, spont bacterial peritonitis

Question 25

Occlusion of the hepatic vein causing congestion of the live is called __________.

Answer 25

Budd-Chiari Syndrome

Question 26

What is the common triad of budd-chiari?

Answer 26

Abd pain
Ascites
Hepatomegaly on PE

Question 27

Patients with Cirrhosis are monitored for HCC by checking what marker?

Answer 27

AFP

Question 28

Angiosarcoma is a rare malginant neoplasm arising from what cells?

Answer 28

vascular endothelial cells

Question 29

Angiosarcomas express what marker?

Answer 29

CD31

Question 30

What is the common cause of death of those with angiosarcoma?

Answer 30

Liver Failure

Hemorrhage

Question 31

What toxins are assc with angiosarcoma?

Answer 31

Arsenic
Polyvinyl chloride (PVC)
Thorotrast/Thorium Dioxide (early radiocontrast dye)