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Abdo Pathology > Lesson 1.3 - Malignant Hepatic Neoplasms > Flashcards

Lesson 1.3 - Malignant Hepatic Neoplasms Flashcards

1
Q

4 malignant hepatic neoplasms

A

HCC
Fibrolamellar carcinoma
Angiosarcoma
Hepatic epitheloid hemangioendothelioma

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2
Q

Most common malignant tumour and occurs most commonly in males or females

A

HCC/hepatoma

males (5:1)

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3
Q

Causes of HCC

A

Hep B&C (world)
Fatty liver, Steatohepatitis, Cirrhosis (western)
Fungi or toxins (developing)

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4
Q

HCC symptoms (3)

A

RUQ pain
weight loss
abdo swelling - ascites

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5
Q

3 forms of HCC pathologically

A

Solitary tumour
Multiple nodules
Diffuse infiltration

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6
Q

Budd-Chiari syndrome

A

HCC invades hepatic venous system

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7
Q

HCC appearance

A

Variable - hypoechoic, complex or echogenic

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8
Q

T/F calcification is uncommon with HCC

A

true

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9
Q

What is HCC indistinguishable from (3)

A

focal fat
hemangiomas
lipomas

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10
Q

A thin hypo halo-fibrous capsule may indicate

A

HCC

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11
Q

T/F

US is useful to distinguish between steatosis and hemangiomas

A

false

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12
Q

Smaller HCC nodules appearance

A

hypoechoic without necrosis

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13
Q

Larger HCC mass appearance

A

inhomogenous - necrosis and fibrosis

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14
Q

What is a subtype of HCC that shows calcifications

A

Fibrolamellar carcinoma

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15
Q

T/F

AFP levels are normal with fibrolamellar carcinoma

A

True

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16
Q

Fibrolamellar carcinoma most commonly found in what population

A

adolescents and young adults without coexisting liver disease

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17
Q

What are the two rare malignant liver tumours

A

Hemangiosarcoma (more rare)

Hepatic epitheliod

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18
Q

Of hemangiosarcoma and

hepatic epitheliod, what population(s) do these occur in and what is the echogenecity of each?

A

Hemangiosarcoma - older adults (60-70 yrs)
mixed echogenicity

Hepatic epitheliod -
adults
multiple hypoechoic nodules - large masses

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19
Q

Most common primary tumours resulting in liver mets are from

A 
Breast*
Lung*
Colon*
Stomach
Panc
GB
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20
Q

Sono appearance of mets (3)

A

Single or multifocal lesions
Diffuse
Lesion size varies

21
Q

An echogenic metastases generally arises from

A

GI tract or HCC (or other carcinomas)

22
Q

Hypovascular mets tend to show what echogenicity

A

Hypoechoic

23
Q

Hypervascular mets tend to show what echogenicity

A

Hyperechoic

24
Q

Echogenic mets may mimic what on US

A

Hemangioma

25
Q

Untreated breast, lung, gastric, panc and esophageal cancer mets to liver are generally what echogenecity

A

Hypoechoic

26
Q

Lymphoma of the liver show as

A

multiple hypoechoic masses

27
Q

Lung cancer with mets to liver typically show what sono appearance

A

Bulls eye/target - hypoechoic peripheral halo

28
Q

Calcified mets

A

Marked echogenicity with distal acoustic shadowing

29
Q

Shadowing in the liver is most often due to (4)

A

calcifications
air
stones
fat-containing lesions

30
Q

A clean shadow vs a dirty shadow

A

Clean shadow: calcifications

Dirty shadow: air

31
Q

What is the most common cause of a calcified liver tumour

A

Metastases

32
Q

Sono appearance of cystic mets (distinguishable from simple cysts) (5)

A 
Mural nodules
Thick walls
Fluid-filled
Internal septations
Extensive necrosis
33
Q

Cystic mets seen with

A 
cystadenocarcinoma (ovary & panc)
Mucinous carcinoma (colon)
necrosis - sarcomas

same as metastatic sarcomas but the last

34
Q

Infiltrative mets seen with

A

breast
lung
malignant melanoma

35
Q

Infiltrative metastatic disease may be confused with (2)

A

cirrhosis or fatty liver

36
Q

T/F infiltrative metastatic disease is difficult to appreciate on US

A

true

37
Q

Infiltrative metastatic disease sono app

A

diffuse, inhomogenous liver hard to delineate

38
Q

sarcomas

A

rare

arise from connective tissue but can spread to liver

39
Q

metastatic sarcomas

A

primary cystadenocarcinoma
mucinous carcinoma
neuroendocrine and carcinoid tumours

(same as cystic mets except last)

40
Q

CEUS contrast enhanced US

A

Non-nephrotoxic
No ionizing radiation
Determines vascularity in metastases

41
Q

Aurora sign

A

“ring down artifact”

not in liver - caused by lung parenchymal disease but may be seen when scanning liver

42
Q

One of the most common causes of hepatomegaly

A

alcohol abuse

43
Q

T/F

Reidels lobe happens more commonly in men

A

False

Reidel’s lobe most commonly happens in women

44
Q

Causes of hepatomegaly (7)

A 
Fatty liver
Hep ABC
Mono
Hemochromatosis
primary liver cancer
leukemia
lymphoma
hepatic trauma
passive liver congestion
45
Q

Purpose of US for hepatic trauma

A

used for serial monitoring

46
Q

How does hepatic trauma change and time frame

A

Fresh hemorrhage is echogenic After 1 week - hypo

After -3 weeks - indistinct

47
Q

What occurs post-surgery

A

hematoma

48
Q

Passive liver congestion is caused by

A

stasis of the blood - HV drainage compromised increasing venous pressure due to backflow

Abdo Pathology (24 decks)

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