What is the most common liver tumor?
Hepatic hemangioma
What is the most frequent form of primary liver cancer?
Hepatocellular carcinoma
What does a cavernous hemangioma consist of?
Dilated vascular spaces that are filled with blood and are not unlike the cavernous hemangiomas that can occur on the skin.
Histologically, what does a hepatocellular adenoma look like?
It is composed of normal looking hepatocytes arranged in sheets and cords and does not contain a normal lobular architecture
What is the term used to describe a benign glandular tumor of the liver?
Hepatic adenoma
Who tends to develop hepatic adenomas? How can they be resolved? What is the risk of having them?
Young women on oral contraceptives.
They resolve on discontinuation of OC.
They are benign but have the potential to rupture and cause intraperitoneal hemorrhage.
Globally, what is the most common visceral tumor?
Hepatocellular carcinoma
What are two risk factors for developing hepatocellular carcinoma?
Hepatitis B (C also) and cirrhosis due to alcohol abuse
Where does cholangiocarcinoma originate?
The bile duct epithelium
What are the two types of intrahepatic cholangiocarcinoma and what makes them different?
Hilar - located in the hepatic hilum region and appear as discrete masses.
Peripheral - interlobular ducts of the liver and is the MOST COMMON form of this tumor.
What is a type of endothelial tumor that may occur in the skin and soft tissue organs such as the breast and heart?
Angiosarcoma
Angiosarcoma of the liver is rare but of notable interest because of the association of occurrence after what?
Exposure to arsenic and high levels of polyvinyl chloride in the plastics industry
What is one of the most common primary sites for adenocarcinoma that metastasizes to the liver?
The colon
Infants and children with biliary atresia have progressive cholestasis with what concomitant features?
pruritis
fat-soluble vitamin deficiency
malabsorption
eventual cirrhosis w/portal HTN
What is the cause of biliary atresia?
Unknown
If biliary atresia is unrecognized, what does it lead to?
liver failure
What are congenital cystic dilations of the bile duct known as?
Choledochal cysts
What can be demonstrated in many patients with choledochal cysts?
An anomalous junction between the common bile duct and the pancreatic duct (occurs when the pancreatic duct empties into the common bile duct more than 1 cm proximal to the ampulla)
When are most patients with choledochal cysts diagnosed?
During infancy or childhood, although the condition may be discovered at any age
What is the most common type (I-IV) of choledochal cyst and what characterizes it?
Type I, saccular dilatations of the common bile duct
What is a gallstone?
Cholelithiasis - a crystalline mass formed within the gallbladder by accretion of bile components
What are some risk factors for cholelithiasis?
Fat, female, forty
How is choledocholithiasis different from cholethiasis?
The gallstones migrate into the ducts of the biliary tract.
What is an inflammatory condition characterized by retention of bile in the gallbladder and often secondary infection by intestinal microorganisms (E. coli and bacteroides spp.)?
Cholecystitis
What is acute cholecystitis most often caused by?
Cholelithiasis, especially when blockage of the cystic duct has occured
What is it called when acute cholecystitis is present without cholelithiasis? What can it result from?
Acute acalculous cholecystitis
obstructing tumors or inadequate blood supply
Which bacterias cause cholecystitis?
E. coli, klebsiella, pseudomonas, B fragilis, and enterococcus
What does acute cholecystitis look like histologically?
Ulceration of the mucosa, hemorrhage, edema, and a dense transmural infiltrate of neutrophils and mononuclear inflammatory cells
What are pigment stones made of?
Bilirubin and calcium salts. Less than 20% cholesterol
What distinguishes a cholesterol stone from a mixed?
80% or more cholesterol content
Why do cholesterol stones generally develop?
The bile contains too much cholesterol and not enough bile salts. Other factors include inability of the GB to empty and presence of additional proteins and salts in the bile.
What is cholesterolosis characterized by?
Abnormal deposition of cholesterol and triglyceride filled macrophages in the lamina propria of the gallbladder. The accumulating macrophages cause a distinctive bulge and lift the superficial epithelium overlying them.
Cholesterolosis with diffuse mucosal involvement is referred to as what?
Strawberry gallbladder
Outpouchings of the mucosa through the muscle of the gallbladder wall called what, are characteristic, but not diagnostic, feature of chronic cholecystitis?
Rokitansky-Aschoff sinuses
What term describes a calcification of the gallbladder believed to be brought on by persistent inflammation (causing scarring) due to the presence of gallstones?
Porcelain gallbladder
What condition is often the result of partial obstruction of the bile duct due to gallstones, is a medical emergency, and is caused by bacteria from the bile duct-duodenum junction?
Ascending cholangitis
What is Charcot’s triad?
A common finding in cholangitis consisting of:
abdominal pain
jaundice
fever
Secondary sclerosing cholangitis due to extrahepatic biliary obstruction will show what microscopically?
Onion skin like, concentric peri-ductal fibrosis. It is indistinguishable from primary sclerosing cholangitis.
The majority of all carcinomas of the gallbladder are found to be what type?
Well differentiated adenocarcinoma
What does adenocarcinoma look like histologically?
Tubular glands similar to those seen in colonic adenocarcinoma. Can be papillary, goblet cell types and well to poorly differentiated.
What is a possible complication of acute pancreatitis?
Abscess formation
80% of pancreatitis is caused by either of what two conditions?
Alcohol abuse (chronic pancreatitis) gallstones (acute)
What is the gross appearance of chronic pancreatitis?
The pancreas is shrunken and fibrotic. The main duct is dilated and filled with calcified secretions
What is the microscopic appearance of chronic pancreatitis?
Enzymatic fat necrosis
Inflammatory infiltrate
Hemorrhage
Vessels with necrotic walls
What do you call a peri-pancreatic fluid collection containing high concentrations of pancreatic enzymes within a defined fibrous wall and lacking an epithelial lining? Why is it called that?
Pseudocyst
Because it has no epithelial lining
What is the microscopic appearance of a pancreatic pseudocyst?
No epithelial lining
cholesterol clefts
fresh and clotted blood
hemosiderin laden macrophages
What are pancreatic abscesses most commonly associated with?
Pancreatic pseudocysts that have become infected
What enteric organisms and pathogens are pancreatic abscesses most likely to contain?
E. coli Klebsiella pneumoniae Enterococcus faecalis Staphylococcus aureus Pseudomonas aeruginosa Proteus mirabilis Streptococcus spp.
What are three benign tumors of the pancreas?
solid pseudopapillary adenoma
serous cystadenoma
mucinous cystadenoma
What are three malignant tumors of the exocrine pancreas?
Adenocarcinoma
Mucinous cystadenocarcinoma
Solid pseudopapillary cystadenocarcinoma
What pancreatic tumor is typically round, well demarcated, 2-17cm, with solid and cystic areas, often with hemorrhage noted on cut sections?
Solid pseudopapillary tumor
Under the microscope, what does a solid pseudopapillary tumor consist of?
Sheets of cells which usually have uniform nuclei and eosinophilic or clear cytoplasm with PAS positive eosinophilic cytoplasmic inclusions
What kind of tumor is almost always associated with women (>90%)?
Solid pseudopapillary
What is the most frequent cystic tumor of the pancreas?
Mucinous cystadenoma
What is the gross and microscopic appearance of a mucinous cystadenoma?
Gross- cysts filled with mucin
Micro- many empty appearing cells
What type of tumor has a characteristic honeycombed appearance?
Serous cystadenoma
What is a genetic condition in which cysts may develop in the pancreas as well as the liver and kidney and tumors known as hemangioblastomas may be found in different organs including the cerebellum, spinal cord, kidney and retina?
Von Hippel-Lindau syndrome
What tumor is associated with Von Hippel-Lindau syndrome and cafe au lait
Serous cystadenoma
What are the histologic features of serous cystadenoma?
Small cysts which are lined by ciliated cuboidal epithelium
What is the most common type of pancreatic cancer?
Adenocarcinoma
What part of the pancreas do adenocarcinomas arise from?
Exocrine component, usually the ducts (99%)
How serious is pancreatic cancer?
Fourth most common cause of cancer death in the world.
