Tumours of the Liver & Gallbladder Pathology Flashcards
What cells and structures make up the liver parenchyma and portal tracts (green)?
parenchyma:
- hepatocytes
portal tracts:
- bile ducts
- blood vessels
- fibroblasts
- inflammatory cells
What are the 2 different types of liver tumours?
primary tumours:
- can be benign or malignant
- can arise from hepatocytes or bile ducts or other cells
secondary tumours
What is an adenoma of liver cells?
What often causes them and what happens if they rupture?
a benign proliferation of liver cells
there may be multiple (adenomatosis)
it is often driven by exogenous steroids (e.g. OCP, anabolic steroids)
may rupture and cause haemoperitoneum
What is an adenoma of the bile duct?
How can they be identified?
a bile duct adenoma is also known as von Meyenberg complex
a benign proliferation of bile duct cells
they are tiny white nodules, but look like metastases grossly
a frozen section is needed to tell if they are benign or malignant
What % of the population has a haemangioma?
What is this?
found in 1% of the population and is an incidental finding on liver imaging
it is a collection of small blood vessels that form a lump under the skin
sometimes called “strawberry marks” as the surface of the haemangioma looks like a strawberry
What is focal nodular hyperplasia?
Who tends to be affected?
it is a regenerative arterialised nodule seen in young females (20-40)
it is a benign tumour of the liver that is usually asymptomatic
it rarely grows or bleeds
When does hepatocellular carcinoma occur?
How do its causes vary across the world?
it usually arises in cirrhosis
it has an increasing incidence worldwide:
- East - hepatitis C / hepatitis B
- West - cirrhosis due to fatty liver disease or alcohol
What is hepatocellular carcinoma comprised of?
How can it be detected?
it is composed of malignant liver cells and may contain liver-origin substances
(e.g. bile, antitrypsin globules)
it secretes AFP which can be detected in the blood and measured
What is a cholangiocarcinoma?
What may cause it?
a malignant tumour of bile duct cells
it may be due to chronic inflammation
(PSC, liver fluke [clonorchis sinensis])
What are the 2 different types of cholangiocarcinoma?
what is the main problem with this kind of tumour?
it can be central/hilar or peripheral
it is aggressive and difficult to resect, especially at the hilum of the liver
What is angiosarcoma and what is it associated with?
an aggressive tumour of blood vessels
it is strongly associated with toxins:
- Vinyl chloride - records
- Thorotrast - contrast agent
What are the commonest sites of secondary tumours of the liver?
what do these look like?
the majority of liver tumours are secondary (metastases) from:
- lung
- breast
- colon
- pancreas
presents as multiple whiteish nodules
they may replace a large volume of the liver before liver function is compromised
What is involved in surgery for a metastatic carcinoma of the liver?
ultrasound, heat, tissue glue and clips to prevent haemorrhage
intra-operative ultrasound allows you to see where you are cutting
What is the aetiology and risk factors for gallstones?
aetiology:
- cholesterol, bile salts, bacterial growth and calcification
- slowly forms a stone (calculus)
risk factors:
- female
- middle aged
- overweight
