Zaman 1-11-08 Gi-9 Liver Neoplasms

Front 1

There are two major types of nodular hyperplasias:

Back 1

Focal Nodular Hyperplasia and Nodular Regenerative
Hyperplasia.

Front 2

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.

Back 2

Focal Nodular Hyperplasia (FNH)

Front 3

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.

Back 3

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.

Front 4

Nodular regenerative hyperplasia
AKA

Back 4

nodular transformation of the liver

Front 5

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.

Back 5

Nodular regenerative hyperplasia

Front 6

NRH may cause portal hypertension, what lab values

Back 6

elevated alkaline
phosphatase and gamma-glutamyl transpeptidase.

Front 7

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.

Back 7

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.

Front 8

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.

Back 8

Hepatocellular Adenoma

Front 9

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).

Back 9

Hepatocellular Adenoma

Front 10

May be impossible to differentiate Hepatocellular Adenoma lesion from
WHAT (the search for blood vessel invasion).

Back 10

HCC

Front 11

HCC is a malignant neoplasm of hepatocytes.

what is considered the leading cause of HCC

Back 11

Viral hepatitis

Front 12

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 ______.

Back 12

cirrhosis

Front 13

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).

Back 13

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).

Front 14

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).

Back 14

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).

Front 15

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.

Back 15

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.

Front 16

Patients with HCC often have a very high serum ______
_________________ level (often greater than 400 ng/mL).

Back 16

alpha fetoprotein (AFP)

Front 17

Is there usually fibrosis with HCC

Back 17

There is usually no fibrosis.

Front 18

microscopic patterns found with HCC

Back 18

Trabecular pattern
tubular pattern

Front 19

Fibrolamellar Carcinoma is a variant of Hepatocellular
carcinoma occurring in young adults without WHAT;

Back 19

cirrhosis

There is no association with Hepatitis B or cirrhosis.

Front 20

Fibrolamellar Carcinoma:
IHC shows cytokeratin _ and __ positivity like regular
HCC, and also cytokeratin _ positivity.

Back 20

Fibrolamellar Carcinoma:
IHC shows cytokeratin 8 and 18 positivity like regular
HCC, and also cytokeratin 7 positivity.

Front 21

______________ is a malignant neoplasm occurring in
children less than 5 years of age.
Elevated serum alpha fetoprotein (AFP) level often
present.

Back 21

Hepatoblastoma is a malignant neoplasm occurring in
children less than 5 years of age.
Elevated serum alpha fetoprotein (AFP) level often
present.

Front 22

Seen in association with hemihypertrophy, Wilm’s,
glycogen storage disease, familial colonic polyposis.
No cirrhotic relationship unlike HCC
Associated with virilization, elevated AFP.

Back 22

Hepatoblastoma

Front 23

Epithelial types of hepatoblastoma

Back 23

fetal type: irregular laminae 2 cells thick
embryonal type: solid growth largely anaplastic small
cells.

Front 24

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.

Back 24

Adenoma

it is never connected to the duct network.

Front 25

aka von Meyenburg Complex

Back 25

Bile Duct Hamartoma

Front 26

Bile Duct WHATs are multiple, small, benign nodules
composed of dilated ductules containing bile.
May be mistaken for metastases.

Back 26

Hamartomas

Front 27

Bile Duct WHAT is a benign neoplasm usually
occurring in women in their 40's.
Patients present with pain, a mass or jaundice.

Back 27

Cystadenoma

Front 28

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.

Back 28

cystadenocarcinoma

Front 29

Cystadenocarcinoma associated with ________ like stroma
in females follow an indolent course; those that lack this
are more aggressive

Back 29

ovarian

Front 30

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.

Back 30

jaundice

Front 31

__________ 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.

Back 31

Cholangiocarcinoma

Front 32

Grossly: firmer, whiter than HCC, multi-centric. Invasion
of portal vein is not as common as in HCC.

Back 32

Cholangiocarcinoma

Front 33

A Klatskin Tumor is a _________________ arising from
the main hepatic or lobar ducts at the liver hilum.

Back 33

cholangiocarcinoma

Front 34

Cholangiocarcinomas are composed of atypical
cells in glandular or ductular arrangements which may produce ____ but not bile.

Back 34

mucin

Front 35

BDCa
often cannot be distinguished histologically from
metastatic _____________. Special stains that help are
Cam 5.2 cytokeratin and AE1 simulanteous positivity.

Back 35

adenocarcinoma

Front 36

Cholangiocarcinoma-_____ in color than
HCC

Back 36

lighter

Front 37

WHAT is a benign, very common neoplasm of
blood vessels

Back 37

Hemangioma

Front 38

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.

Back 38

Angiosarcoma

Front 39

Diff b/w Angiosarcoma and Hemangioendothelioma?

Back 39

Angiosarcoma is straighter than Hemangioendothelioma which may be staghorn

Front 40

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.

Back 40

Epitheliod HE

Front 41

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.

Back 41

Weibel-Palade

Front 42

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.

Back 42

Benign HE

Front 43

Major Risk Factors for Angiosarcoma

Back 43

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)).

Front 44

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.

Back 44

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.

Front 45

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.
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Back 45

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