Tumours of the liver, gallbladder and pancreas Flashcards
What are the key features of a benign tumour?
Locak displacement
No metastases
Pathology by:
Pushing borders
Slow growth
Resembles normal tissue
What are the key features of malignant tumours?
Local invasion
Distant metastases
Pathology:
Infiltrative
Rapid growth
Highly abnormal cells
What are the three cell types found within the liver?
Hepatocyte
Endothelial cell
Cholangiocyte
What are the key benign tumours found in the liver?
Hepatocyte adenoma
Intraductal papillary neoplasm (from cholangiocytes)
Haemangioma (from endothelial cells)
What are the different types of malignant tumours found in the liver?
Hepatocellular carcinoma
Cholangiocarcinoma (cholangiocytes)
Angiosarcoma (endo)
What are the risk factors for hepatocellular adenoma?
Oral contraceptive pill
Anabolic steroids
Pregnancy
Obesity
Conditions - glycogen storage disease, hemochromatosis, beta-thallassaemia
What is the typical clinical presentation of hepatocellular adenoma?
Mostly incidental
Female
Larger adenoma with risk of haemorrhage or bleeding -> large enough to cause pain
Lower risk of abdominal pain
What is the typical prognosis of hepatocellular adenoma?
Minor risk of malignant transformation
What is the key pathology grossly of hepatocellular adenoma?
Soft, well-circumscribed, tan coloured tumour
Is a solid tumour of malignant hepatocytic cells
What is the key histology of hepatocellular adenoma?
Sheets of bland hepatocytic cells without normal portal triads/tracts
What are the key clinical differentials for hepatocellular adenoma?
Malignancy
FNH - focal nodular hyperplasia - non neoplastic
What are the new concepts in the classification of hepatocellular adenoma?
Historically = pathomolecular characteristics
2023 - 4 subtypes based on pathology
Exon 3 beta-catening activating mutation associated with higher risk of malignancy
What is the relevant epidemiology of hepatocellular carcinoma?
Makes up 90% of primary malignant liver tumours
6th most common cancer
More common in Asia and Africa
What are the key causes/risk factors for hepatocellular carcinoma?
90% occur in cirrhotic liver
Hepatitis B, Hepatitis C,
Alcohol
FLD
Hereditary haemochromatosis
Aflatoxin (fungal toxin)
What is the typical presentation of hepatocellular carcinoma?
Asymptomatic - excpet CLD - usually found by surveillance of these at risk individuals
Upper abdo pain, palpable mass, weight loss
What is the key gross pathology of hepatocellular carcinoma?
Round, soft, bulging, tan, green (due to bile production) and haemorrhagic
Often multiple tumours
What is the key histology of hepatocellular carcinoma?
Abnormal hepatocytic cells in mostly trabceular arrangements
With intervening endothelial lined spaces, bile production
What are the future changes expected in hepatocellular carcinoma?
Increasing incidence - due to FLD in western world
Molecular classicaition -> allow personalised treatment
Improved outcomes - due to locoregional and systemic therapies.
What is cholangiocarcinoma?
Adenocarcinoma (malignant) of the billiary tree
Glands produce mucin
What are the different groups of cholangiocarcinoma based on anatomy?
Intrahepatic - iCCA
Perihilar - left, right or common hepatic duct - pCCA
Distal - common bile duct onwards - dCCA
What is the key epidemiology of cholangiocarcinoma?
Rare than hepatocellular carcinoma
Poor prognosis with 5yrs survival 7-20%
What are the key causes/risk factors for cholangiocarcinoma?
Inflammation of the bile duct epithelium and bile stasis
Cirrhosis, Hepatitis B+C
Alcohol + smoking
Liver flukes (parasites)
Malformations of bile ducts
Common bile duct strictures and stones
What is the key presentation of cholangiosarcoma?
Intrahepatic - vague, insidious, late presentation
Perihilar and distal - jaundice, itch, abdominal pain, weight loss, fever
What are the gross pathology of cholangiocarcinomas?
Intrahepatic - expansile, firm, white tumours with scalloped margin
Perihilar and distal - infiltrating, ill-defined, fibrous tumour
What is the key histology of a cholangiocarcinoma?
Abnormal glands/tubules with mucin prodcution assocaited with stroma
What are the classifications within intrahepatic cholangiocarcinoma?
Small duct: nodular growth with small glands with no or minimal mucin - tends be be FGFR2 and IDH alterations
Large duct: periductal infiltrating or intraductal - similar to pCCA and dCCA - tends to be TP53, KRAS mutations
What are the key features of liver secondary tumours?
More common than primary
Due to dual blood supply and fenestrated endothelium
Typically from intrabdominal organs via portal venous drainage
Large bowel, breast, lung carcinoma are the most common primary.
What is the key epidmiology of gallbadder carcinoma?
Rare, more common in females
Typically related to gallstones and chronic cholecystitis
What is the key clinical presentation of gallbladder carcinoma?
Incidental
Late stage = abdo pain, N/V, jaundice, weight loss -> poor outcome
What is the key pathology of a gallbladder carcinoma?
Thickened wall
Gallstones >3cm
What is the key histology of gallbladder carcinoma?
90% are adenocarcinomas - gland forming with mucin production
Irregular glands in fibrous stroma
What are the different primary cell types in the pancreas that can become cancerous?
Acinar cell - exocrine
Ductal cells
Endocrine cells
What is the most commont type of pancreatic cancer?
Pancreatic ductal adenocarcinoma
Gland forming mucin production tumour
What is the key epidemiology for pancreatic ductal adenocarcinoma?
12 most common but 7th leading cause of death
What are the key risk factors for pancreatic cancer?
Most = smoking
Type 2 diabetes mellitus
Chronic pancreatitis including hereditary
Family history
What are the key symptoms of pancreatic ductal adenocarcinoma?
Late symptoms - 85% inoperable at presentation
Abdominal or back pain, jaundice, weight loss
Diabetes mellitus, N/V, poor appetite, thromboses, Trousseaus sign
What is the key gross pathology of pancreatic cancer?
Ill-defined
Infiltrative
Firm and fibrous tumour
Commonest in head of pancreas
What is the key histology of the pancreas?
Abnormal glands associated with prominent stroma (fibrous tissue)
What is the key prognosis of pancreatic ductal adenocarcinoma?
Poor with 5yrs survival of 6-8%
Surgery is the only curative option
No systemic treatments
No personalised treatment protocols but clinical trials for immunotherapy and stroma modifying drugs
What is the key pathology of pancreatic neuroendocrine neoplasms?
Rare tumors from endocrine cells
Mostly well differentiated, potentially malignant, slow progression = NETs
Poorly differentiated are rare and highly aggressive = NECs = neuroendocrine carcinomas
What are the key causes of pancreatic neuroendocrine tumours?
Mostly sporadic
FH -> cancer
Elevated BMI
Diabetes
Cigarrete smoking
Elevated alcohol consumption
MEN1
What is the key clinical presentation of pancreatic neuroendocrine tumours?
Non-function - incidental, abdo pain or mets
Functional - insulin production presents with hypoglycaemia -> insulinoma
What is the key gross pathology of pancreatic neuroendocrine tumours?
Well cricmscribed
Solid
Pale or tan
Occuasionaly cystic
What is the key histology of pancreatic neuroendocrine tumours?
Organois architectural patterns
Commonly nested or trabecular.
