Liver Nodules and Tumors Flashcards
(28 cards)
What are the main types of benign hepatic nodules/tumors?
Nodular hyperplasias:
- focal nodular hyperplasia
- nodular regenerative hyperplasia
Cavernous hemangioma
Hepatocellular adenoma:
- HNF1-α
- inflammatory
- β-catenin
What is the most common benign neoplasm of the liver?
-cavernous hemangioma
What is focal nodular hyperplasia?
benign nodular hyperplasia of the liver
- typcially single, well demarcated lesion w/ central scar
- “maplike pattern”
What is nodular regenerative hyperplasia?
benign nodular hyperplasia of the liver
- typically multiple nodules
- appears like cirrhosis, but lacks fibrous septa
What is cavernous hemangioma of the liver?
benign neoplasm of the liver
- asymptomatic
- has life threatening risk of hemorrhage
What are the subtypes of the hepatic adenomas?
HNF1-α:
- fatty change with no atypia
- mostly female
- minimal risk of transformation
β-catenin activated:
- associated with oral contraceptives and anaboic steroids
- males and females
- high risk of transformation
Inflammatory:
- most common hepatic adenoma (40-50%)
- associated with metabolic syndrome
- mimics focal nodular hyperplasia
What are the main types of malignant tumors of the liver?
Primary hepatic tumors:
- hepatoblastoma
- hepatocellular carcinoma
- colangiocarcinoma
Metastasis:
- colon
- breast
- lung
- pancreas
What is the most common liver tumor of early childhood?
-hepatoblastoma
What are the types of malignant liver tumors?
- hepatocellular carcinoma
- cholangiocarcinoma
- angiosarcome
- lymphoma
- metastasis
What is the most common primary liver tumor?
-hepatocellular carcinoma
What is the most common liver tumor of any origin?
-tumor metastasis to the liver is significanlty more common that primary liver tumors
How does hepatoblastoma present?
- typicaly asymptomatic
- jaudice and pruritis if symptomatic
- abdominal swelling typcial presenting sign
- typically not detected until metastasis has already occured
What is the most common cause of HCC?
-HBV and HCV
What feature is most associated with development of HCC?
What are common causes?
80% of HCC arises in the setting of cirrhosis:
- HBV/HCV
- alcoholic liver disease
- NASH
- hemochromatosis
- Wilson disease
- α-1 anittrypsin deficiency
- hepatic autoimmune disease (PBC/PSC)
With no cirrhosis:
- aflatoxin (Aspergillus toxin)
- transformation of adenomas
- HBV
What cause of HCC is odd in that it can cause HCC both w/ and w/o cirrhosis?
-HBV
How does HCC present?
typcially asympomatic itself or its symtpoms are masked by underlying liver disease
- weight loss
- anorexia
- hepatomegaly
- RUQ tenderness
- jaundice
- ascites
What serum marker is used to screen for HCC?
α-fetoprotein (AFP)
How is HCC treated?
- typically resistant to chemotherapy
- non-cirrhotic livers -> resection
- cirrhotic livers -> liver transplant
- ablation in tumors that cannot be resected and do not qualify for transplant
How does HCC metastasize?
Where?
hematogenous metastasis
most commonly to the lungs
What feature can be useful in differentiating HCC from metastatic tumors of the liver?
- HCC is typically a single mass
- metastasis is typically many mases
What is cholangiocarcinoma?
adenocarcinoma of the intrahepatic (intrahepatic CCA) or extrahepatic (biliary CCA) trees
Whrere is cholangiocarcinoma most common?
sourtheast Asia (endemic liver fluke)
What are risk factors for cholangiocarcinoma?
- liver fluke (**significant especially in Asia)
- fibropolycystic liver disease
- primary sclerosing cholangitis (PSC)
- chronic inflammatory conditions of the bile ducts
- hepatolithasis
- HBV and HCV
What are common locations of colangiocarcinoma development within the biliary tree?
- biliary hilum -> Klatskin tumors (most common site)
- extrahepatic (20-30%)
- intrahepatic (5-10%)
