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45 Cards in this Set

  • Front
  • Back
There are two major types of nodular hyperplasias:
Focal Nodular Hyperplasia and Nodular Regenerative
Hyperplasia.
It is a benign nodule measuring up to several centimeters
in size occurring focally in a non-cirrhotic liver.

most commonly occurs as
an incidental finding in young to middle aged women.
Focal Nodular Hyperplasia (FNH)
FNH:

Pathology: A focal, well circumscribed liver nodule
containing
a central ________ fibrous scar.
bands of fibrosis radiate from the scar and surround
lobules of hepatocytes.
large arteries, bile ducts and lymphocytic infiltrate in
the fibrous bands.
FNH:

Pathology: A focal, well circumscribed liver nodule
containing
a central stellate fibrous scar.
bands of fibrosis radiate from the scar and surround
lobules of hepatocytes.
large arteries, bile ducts and lymphocytic infiltrate in
the fibrous bands.
Nodular regenerative hyperplasia
AKA
nodular transformation of the liver
The entire liver is transformed into multiple small
nodules, but, unlike cirrhosis. the nodules are not
surrounded by fibrosis; there is minimal inflammation and
no evidence of liver cell damage.
Nodular regenerative hyperplasia
NRH may cause portal hypertension, what lab values
elevated alkaline
phosphatase and gamma-glutamyl transpeptidase.
NRH:

The entire liver is transformed into nodules of
hepatocytes.
Nodules of hepatocytes are rimmed by atrophic
hepatocytes, as seen with a _________ stain.
No bands of fibrosis.
NRH:

The entire liver is transformed into nodules of
hepatocytes.
Nodules of hepatocytes are rimmed by atrophic
hepatocytes, as seen with a reticulin stain.
No bands of fibrosis.
what is a rare benign neoplasm of
hepatocytes which arises in a non-cirrhotic liver.
It tends to occur in young women and is associated
with oral contraceptive or androgenic/anabolic steroid
use.
Hepatocellular Adenoma
More often symptomatic compared to FNH. They may
rupture and cause intraperitoneal hemorrhage if
subcapsular, especially during pregnancy.
Regression can occur with discontinuation of the drug
(OCPs).
Hepatocellular Adenoma
May be impossible to differentiate Hepatocellular Adenoma lesion from
WHAT (the search for blood vessel invasion).
HCC
HCC is a malignant neoplasm of hepatocytes.

what is considered the leading cause of HCC
Viral hepatitis
HCC is rare in North America and Western Europe, where
it comprises only about 0.5-2.0% of all cancers. 60-80%
of these cases develop in ______.
cirrhosis
However, HCC represents 20-40% of all cancers in parts
of Asia and Africa (Korea, Taiwan, Mozambique and SE
China). with a high incidence of HCC show a high
prevalence of viral Hepatitis _ infection (H_V).
However, HCC represents 20-40% of all cancers in parts
of Asia and Africa (Korea, Taiwan, Mozambique and SE
China). with a high incidence of HCC show a high
prevalence of viral Hepatitis B infection (HBV).
Areas with high rates of HBV infection from the mother at birth
(vertical transmission of HBV) gives the child a ___X increased risk
of developing HCC, which may occur without developing cirrhosis and
may occur at a young age (often age 20-40).
Areas with high rates of HBV infection from the mother at birth
(vertical transmission of HBV) gives the child a 200X increased risk
of developing HCC, which may occur without developing cirrhosis and
may occur at a young age (often age 20-40).
In lower incidence areas, most cases of HCC arise in cirrhotic
livers and show a high association with viral Hepatitis _ (H_V)
infection and alcoholic cirrhosis.
In lower incidence areas, most cases of HCC arise in cirrhotic
livers and show a high association with viral Hepatitis C (HCV)
infection and alcoholic cirrhosis.
Patients with HCC often have a very high serum ______
_________________ level (often greater than 400 ng/mL).
alpha fetoprotein (AFP)
Is there usually fibrosis with HCC
There is usually no fibrosis.
microscopic patterns found with HCC
Trabecular pattern
tubular pattern
Fibrolamellar Carcinoma is a variant of Hepatocellular
carcinoma occurring in young adults without WHAT;
cirrhosis

There is no association with Hepatitis B or cirrhosis.
Fibrolamellar Carcinoma:
IHC shows cytokeratin _ and __ positivity like regular
HCC, and also cytokeratin _ positivity.
Fibrolamellar Carcinoma:
IHC shows cytokeratin 8 and 18 positivity like regular
HCC, and also cytokeratin 7 positivity.
______________ is a malignant neoplasm occurring in
children less than 5 years of age.
Elevated serum alpha fetoprotein (AFP) level often
present.
Hepatoblastoma is a malignant neoplasm occurring in
children less than 5 years of age.
Elevated serum alpha fetoprotein (AFP) level often
present.
Seen in association with hemihypertrophy, Wilm’s,
glycogen storage disease, familial colonic polyposis.
No cirrhotic relationship unlike HCC
Associated with virilization, elevated AFP.
Hepatoblastoma
Epithelial types of hepatoblastoma
fetal type: irregular laminae 2 cells thick
embryonal type: solid growth largely anaplastic small
cells.
Bile Duct WHAT is a benign neoplasm usually found
incidentally.
It is often a sub-caspsular, single, white nodule.
Microscopic examination shows a collection of small
benign ductules with no luminal bile.
Adenoma

it is never connected to the duct network.
aka von Meyenburg Complex
Bile Duct Hamartoma
Bile Duct WHATs are multiple, small, benign nodules
composed of dilated ductules containing bile.
May be mistaken for metastases.
Hamartomas
Bile Duct WHAT is a benign neoplasm usually
occurring in women in their 40's.
Patients present with pain, a mass or jaundice.
Cystadenoma
Microscopic examination of Cystadenoma shows multilocular cysts lined by
benign single layer of cuboidal or tall columnar mucin-
containing cells as opposed to _________________ which
have intestinal type cells with goblet and paneth cells.
Mitotic activity is also seen in the malignancy. Benign and
malignant areas may co-exist.
cystadenocarcinoma
Cystadenocarcinoma associated with ________ like stroma
in females follow an indolent course; those that lack this
are more aggressive
ovarian
4-Bile Duct Carcinoma ( Cholangiocarcinoma ) :
Clinically: Most cases are over 60 years old with
abdominal pain, weight loss, but no obstructive ________
like BD Cystadenocarcinoma.
There is no association with HBV infection. That seen in
Western Africa may be HCV related.
jaundice
__________ is a malignant neoplasm of
intrahepatic bile ducts. lntrahepatic cholangiocarcinoma
may arise from bile ducts of any size from the large
hilar bile ducts to the small peripheral hepatic bile
ductules.
Cholangiocarcinoma
Grossly: firmer, whiter than HCC, multi-centric. Invasion
of portal vein is not as common as in HCC.
Cholangiocarcinoma
A Klatskin Tumor is a _________________ arising from
the main hepatic or lobar ducts at the liver hilum.
cholangiocarcinoma
Cholangiocarcinomas are composed of atypical
cells in glandular or ductular arrangements which may produce ____ but not bile.
mucin
BDCa
often cannot be distinguished histologically from
metastatic _____________. Special stains that help are
Cam 5.2 cytokeratin and AE1 simulanteous positivity.
adenocarcinoma
Cholangiocarcinoma-_____ in color than
HCC
lighter
WHAT is a benign, very common neoplasm of
blood vessels
Hemangioma
WHAT is a malignant neoplasm of blood vessels.
These are rare neoplasms seen most commonly in males
in 6-7th decade.
The symptoms include abdominal pain, jaundice, GI
hemorrhage, anemia.
Angiosarcoma
Diff b/w Angiosarcoma and Hemangioendothelioma?
Angiosarcoma is straighter than Hemangioendothelioma which may be staghorn
Associated with OCP use in females.
Clinically confused with Budd-Chiari syndrome.
Microscopically the tumor cells are plump tuft like
endothelial cells infiltrating sinusoids with
fibrothrombotic occlusions.
EM shows Weibel-Palade bodies.
Epitheliod HE
A vessel in a tumor containing many
small dense bodies within endothelial
cells on either side of the lumen
(L). These are ___________ bodies
although the distinctive internal
structure cannot be resolved at this
magnification.
Weibel-Palade
aka Infantile HE. 87% cases seen in less than 6 months
of age.
Can be part of Beckwith-Wiedman syndrome.
May show elevated AFP.
High mortality rate due to hepatic failure, CHF or
hyperconsumptive coagulapathy (Kasabach-Merritt
syndrome).
No anastamosing vessels are seen; lumen is small or
collapsed; highly cellular lobular configurations are seen.
TX: Radiation, steroids, IFN, embolization, surgical
excision.
Benign HE
Major Risk Factors for Angiosarcoma
a. Thorotrast latency of 20-40 years.
b. Vinyl Chloride exposure (in making PVC) 16.9 year
exposure to tumor time. Tumor is hemorrhagic, necrotic,
multicentric with cystic degeneration and fibrosis.
Invariably fatal. No metastasis unlike regular AS.
c. Chronic arsenic exposure (occupational risk of
Vintners; iatrogenic in "Fowler's Solution" (KH2AsO4)).
Metastases to the liver are more common than primary
liver neoplasms.
Primary malignant tumors of gallbladder, extrahepatic
bile ducts, pancreas and stomach frequently involve the
liver by direct extension.
In a series of 8455 adult autopsies patients with an
assortment of malignancies had 39% mets to the liver.
Metastases to the liver are more common than primary
liver neoplasms.
Primary malignant tumors of gallbladder, extrahepatic
bile ducts, pancreas and stomach frequently involve the
liver by direct extension.
In a series of 8455 adult autopsies patients with an
assortment of malignancies had 39% mets to the liver.
Colon carcinoma often have few nodules which calcify.
Well differentiated SCCa result in soft nodules.
Lung and Breast Ca are medium sized without extensive
necrosis or hemorrhage..
Miliary mets are seen typically with breast, stomach, or
prostate carcinoma.
Metastatic breast carcinoma treated with chemo results
in a coarsely lobulated liver (hepar lobatum) also seen in
syphillis.
Curiously, cirrhotic livers do not contain mets.
Metastatic carcinoid is particularly amenable to resection
unlike other tumors which can only be palliated by
surgery.
66
Colon carcinoma often have few nodules which calcify.
Well differentiated SCCa result in soft nodules.
Lung and Breast Ca are medium sized without extensive
necrosis or hemorrhage..
Miliary mets are seen typically with breast, stomach, or
prostate carcinoma.
Metastatic breast carcinoma treated with chemo results
in a coarsely lobulated liver (hepar lobatum) also seen in
syphillis.
Curiously, cirrhotic livers do not contain mets.
Metastatic carcinoid is particularly amenable to resection
unlike other tumors which can only be palliated by
surgery.
66