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45 Cards in this Set
- Front
- Back
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What are the malignant tumors of the liver?
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Primary carcinoma (hepatocellular, cholangiocarcinoma)
Hepatoblastoma Angiosarcoma Metastatic tumors |
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What are the benign tumors of the liver?
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Focal nodular hyperplasia
Hepatic adenoma Bile duct adenomas Hemangioma |
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Focal nodular hyperplasia: define? age? key feature? contents? Associations?
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Nodular overgrowth of hepatocytes around an arterio-venous malformation
All age groups Central fibrous stellate scar Contains bile ducts Oral contraceptives (not as common as adenoma) |
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Central fibrous stellate scar
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Focal nodular hyperplasia
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Hepatic adenoma: who? associated with? complications? path? contents?
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Young women
Contraceptive use May rupture and bleed, very low risk of malignant transformation (not a precursor lesion for HCC) 'Nearly normal' histology, but can see clearly grossly No bile ducts contained |
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What gene mutation is associated with familial hepatic adenoma?
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HNF1 alpha
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What is the most common malignancy in the liver?
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Metastatic cancer from another site
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What kind of cancer metastasizes in a pattern that mimics cirrhosis?
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Breast carcinoma
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What is the most common primary liver cancer?
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Hepatocellular carcinoma
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Hepatocellular carcinoma: gender?
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Males
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HCC: similar distribution to...
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HepB
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What are causes of HCC?
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Cirrhosis from any cause
HepB, HepC Aflatoxin |
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What are the clinical features of HCC?
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Non-specific upper abdominal pain, weight loss, fatigue
Elevated serum alpha-fetoprotein in 50% |
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What tumor can make bile?
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HCC
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Where does HCC like to invade?
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Veins
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Describe the microscopic pathology of HCC.
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Looks like normal hepatocytes
Greater variability in plate thickness (normally just 1 cell, can be a lot thicker) Can get atypia at higher grade lesions |
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What is the subset of HCC?
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Fibrolamellar hepatocellular carcinoma
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Fibrolamellar HCC: age? liver type? labs? association? survival?
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25
Non-cirrhotic liver Normal serum alpha-fetoprotein level No association with chronic viral hepatitis Better survival: more indolent growth, younger and otherwise healthy patients |
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Fibrolamellar HCC: appearance?
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Single nodule
Fibrous plate formation Pale bodies in hepatocytes |
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Cholangiocarcinoma: what is it? common? prognosis?
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Adenocarcinoma resembling bile duct epithelium
Second most common primary hepatic malignancy Usually diagnosed late and survival is poor if unresectable |
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Etiologies of cholangiocarcinoma?
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Bile stasis and chronic inflammatory conditions affecting the bile ducts (PSC, parasitic infections)
Thorotrast (imaging compound) Anabolic steroids |
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Hilar cholangiocarcinoma: presentation?
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Obstruction of bile ducts, jaundice
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Peripheral cholangiocarcinoma: presentation?
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Non-specific symptoms, like abdominal pain
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Cholangiocarcinoma: microscopic pathology?
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Propensity for perineural invasion
Resembles bile duct proliferation in dense stroma |
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What is the most common benign hepatic tumor?
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Hemangioma
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Angiosarcoma: associations?
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Vinyl chloride
Thorotrast Arsenic |
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Angiosarcoma: microscopic path?
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Spindle cells
Haphazardly arranged |
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What is the hepatic analog of wilms tumor? What does it resemble?
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Hepatoblastoma
Fetal liver tissue (very high alpha-fetoprotein levels) |
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What are the neoplastic processes of the gallbladder?
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Adenoma
Carcinoma |
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What is the name for biliary calculi/gallstones?
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Cholelithiasis
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What are the 2 major type of gallstones?
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Cholesterol
Pigment (bilirubin calcium salts - in sickle cell anemia, etc.) |
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What are risk factors for gallstones?
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Ethnic group (native americans of the southwest)
Age estrogen Obesity Disorders of bile acid metabolism Hyperlipidemia |
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Give the pathogenesis of gallstone formation.
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Bile becomes supersaturated with cholesterol
Nucleation conditions are favorable: precipitates of calcium salts Cholesterol crystals remain in gallbladder long enough to form stones (Supersaturation, nucleation, stasis) |
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Typical presentation of gallstones
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Most asymptomatic
Biliary colic (RUQ pain, radiates to scapula) Inflammation (cholecystitis) |
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What are the complications of gallstones?
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Fistulas
Perforation Biliary obstruction Gallstone ileus Risk of gallbladder cancer |
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What causes acute cholecystitis?
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Obstruction of neck of gallbladder or cystic duct by gallstone
Secondary bacterial infection |
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What causes chronic cholecystitis?
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Strongly associated with gallstones, but may not be preceded by acute cholecystitis
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What is the appearance of chronic cholecystitis?
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Variable inflammatory infiltrate
Rokitansky-Aschoff sinuses |
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Clinical features of acute cholecystitis
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Severe debilitating pain
Fever |
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What are the complications of gallstones?
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Extrahepatic duct obstruction (Severe pain, cholestasis, ascending cholangitis, biliary cirrhosis)
Gallstone ileus (erodes into ileum and blocks it) Adenocarcinoma |
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What is the most common location of tumors of the biliary system?
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Gallbladder
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Gallbladder carcinoma: who? associated with? risk factor? type? presentation/
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Elderly patients, usually women
Associated with gallstones Calcification of gallbladder (porcelain gallbladder) is controversial as a risk factor Most are adenocarcinomas Usually found incidentally |
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Sclerosing choledechitis: cause? related to?
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Probably autoimmune
Primary sclerosing cholangitis |
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Post-operative stricture: presentation?
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Jaundice
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Biliary atresia: when? what?
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Neonatal period
Progressive destruction of biliary tree |
