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GI Final > Liver Cysts > Flashcards

Liver Cysts Flashcards

1
Q

primary liver tumor categories

A

non-neoplastic and neoplastic

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2
Q

neoplastic primary liver tumors

A

focal nodular hyperplasia and focal fatty change with focal fatty sparing (super rare and probably don’t need to know)

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3
Q

primary neoplastic liver tumors in adults

A

adenoma, HCC, cholangiocarinoma (epithelial)

hemangioma, (epithelioid hemangioendothelioma), angiosarcoma (mesenchymal)

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4
Q

cystic lesions of the liver

A

most are congenital - fibropolycystic liver disease

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5
Q

secondary metastatic liver tumors

A

hematopoietic malignancy and solid organ malignancy (tumors represent metastasis or origin)

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6
Q

benign entities

A

biliary microhamartoma, isolated cysts/polycystic liver disease, hepatic ademona, hemangioma

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7
Q

malignant entities

A

hepatocellular carcinoma, angiosarcoma, metastatic tumors

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8
Q

liver cysts that are asymptomatic

A

biliary microhamartoma

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9
Q

symptomatic liver cysts

A

space-occupying lesion - isolated cyst or polycystic liver disease (with or without kidney cysts)

parasitic cysts and hydatid cyst (liver)

biliary obstruction with periodic jaundice and cholangitis - choledochal cysts

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10
Q

fibropolycystic liver disease

A

a broad spectrum of inherited liver disease with shared embryologic maldevelopment as an etiology

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11
Q

biliary microhamartoma

A

less common lesions, in 6% of population, usually found incidental at autopsy or during surgeries. could potentially metastasize to liver

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12
Q

biliary microhamartoma histopathology

A
  • multi cystic lesions near portal tracts (periportal) that contain bile
  • small meshwork of cytologically bland, angulated duct like structures embedded within a fibrous stroma
  • contain greenish brown inspissated bile in duct lumen
  • cyst is lined by biliary type epithelium (cuboidal) and other side has mesothelium - same as liver surface
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13
Q

polycystic liver disease inheritance and gene affected

A

autosomal dominant - defect in ADPKD1 gene on chrom 16

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14
Q

polycystic liver disease population affected

A

75% age 70 + , women may present during pregnancy

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15
Q

polycystic liver disease histology

A

multiple unilocular cystic lesions resembling solitary cysts, lined by cuboidal to flat biliary epithelium, contains thin straw colored fluid

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16
Q

hepatic adenoma

A

benign epithelial neoplasm

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17
Q

hepatic adenoma risk factors

A

oral contraceptive use, anabolic steroids, glycogen storage disease

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18
Q

hepatic ademona population affected

A

females more than males, esp during child bearing years, women <10% are malignant, males up to 50% malignant

19
Q

hepatic ademona histology

A
  • hepatocytes with minimal atypic arranged in 1-2 cell thick cords
  • no mitotic figures
  • no portal areas
  • large caliber vessels with little supporting stroma (bleeding risk (into peritoneal cavity) if rupture or compressed by other tissue!) / associated thrombi
20
Q

treatment for hepatic ademona

A
  1. many will regress following withdrawal of steroids, contraceptive, affecting agent
  2. consider resecting symptomatic or if >5cm
  3. adenomas in men have a higher risk for malignant transformation and could be excised
21
Q

hepatic adenoma presentation

A

hepatic mass or RUQ pain, spontaneous bleeding is common and may be life threatening

22
Q

multiple adenomas

A

stop affecting agents, may need to be resected if cysts persist

23
Q

most common primary hepatic tumor

A

hemangioma

24
Q

Hemangioma

A

benign tumor of mesenchymal/vascular origin, clusters of blood-filled cavities lined by flattened endothelial cells

25
Q

hemangioma populations affected

A

adults >children

women>men

26
Q

do we biopsy hemangioma?

A

no because risk of hemorrhage!

27
Q

histology of hemangioma

A

sponge-like dilated vascular channels on lower power view

cavernous vascular spaces filled with blood, separated by thin connective tissue septa, on high power view

may see thrombi since hemangioma are blood stasis - may see fibrous scarred nodules

28
Q

hepatocellular carcinoma HCC

A

primary malignant tumor of the liver

29
Q

etiology of hepatocellular carcinoma

A

usually develops in the setting of chronic liver disease/cirrhosis

suspicion increased in patients with previously compensated cirrhosis who become decompensated

30
Q

alpha-fetoprotein AFP

A

glycoprotein that is normally produced during gestation by the fetal liver (cancer will restart secreting this protein)

serum concentration elevated in patients with HCC

31
Q

how to spot progression of cirrhosis to hepatocellular carcinoma

A

surveillance imaging and serial AFP measurements, but elevated AFP may also be seen in patients with chronic liver disease without HCC (so not diagnostic but helps the probability)

32
Q

hepatocellular carcinoma histology

A

HCC with thick cell plates and atypical cells - large, dark, pleomorphic nuclei, increased nuclear to cytoplasmic ratio, 6-10 cell plate hepatic thickness

33
Q

HCC treatment

A

resection, but often hard to resect

-radiofrequency ablation or TACE

34
Q

TACE

A

transarterial chemo embolization

embolic microspheres with chemo drug injected
obstruct blood supply and treat with chemo

shrinks the tumor to allow resection or to be a transplant candidate

35
Q

aggressive malignant disease of mesenchymal origin (endothelium of blood vessels)

A

angiosarcoma

36
Q

most common malignant mesenchymal tumor of the liver

A

angiosarcoma - but still rare as 2% of primary liver cancers

37
Q

Angiosarcoma etiology

A

associated with exposure to environmental carcinogens including arsenic, vinyl chloride, and thorium dioxide as well as anabolic steroids

38
Q

angiosarcoma patient population

A

older individuals, most patients who get the tumors don’t have the etiology exposures

39
Q

angiosarcoma prognosis

A

very poor with rapid progression, high rate of recurrence and metastasis, and resistance to chemotherapy and radiation

40
Q

angiosarcoma histology

A

high power view shows atypicl endothelial cells with enlarged hyperchromatic nuclei (which create strong anastomoses of vascular channels) infiltrating the surrounding hepatic tissue in a destructive pattern

41
Q

liver metastases in cirrhotic liver

A

metastases rarely develop in a cirrhotic liver; therefore, a tumor found within a cirrhotic liver is HCC until proven otherwise

most common hepatic malignant tumors are secondary! so why are mets in the liver? they don’t develop there initially! metastatic tumors are more common than primary, resemble tumor or origin

42
Q

why do metastases happen in the liver?

A
  • nutrient rich dual blood supply
  • humoral growth factors from pancreas
  • common sites of origin with colon, stomach, pancreases, breast, lung, skin/eye
43
Q

when leukemia or lymphoma involve the liver

A
  • leukemia and lymphoma cause diffuse liver enlargement without discrete nodules and infiltration of liver parenchyma by tumor cells
  • atypical lymphoid infiltrate in sinusoids

GI Final (27 decks)

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