Tumors & Tumorous Conditions

Most common benign: cavernous hemangioma

- red blue soft nodule, < 2 cm d

- beneath the capsule

Significance : - not to be mistaken for metastatic tumors

- blind percutaneous biopsy
Nodular Hyperplasia

= Solitary / multiple hyperplastic nod in noncirr liver

2 conditions: - Focal nodular hyperplasia
- Nodular regenerative hyperplasia
FNH : - well-demarcated but poorly encapsulated, many cms d
- lighter (yellow)
- central gray-white, depressed stellate scar radiate
fibrous septa
- central scar : large vessels (artery)
NRH: - entire liver, roughly spherical nod, in absence of fibrosis
- Mic: Plump hcyte are surrounded by rims of atr cells
FNH: - spontaneous mass lesion
- young to middle aged
- excellent prognosis

NRH: - ass w. portal hypertension

Adenoma

- Young women: oral contraceptive

- Significance: - mistaken for HCC
- subcaps rupture (during pregnancy)
- rare HCC

Morphology

- pale, yellow tan, bile stained nodules

- beneath capsule 30 cm d.
- well demarcated, encapsulation may not be present
Malignant Tumors

Liver & Lung: most often involved in metastatic spread

2 rare

- Hepatoblastoma: - young childhood, fatal if not resected

var: - epithelial type
- mixed epithelial & mesenchymal type

- Angiosarcoma: exposure: vinyl chloride, arsenic

- thorotrast
Primary Carcinoma o/t Liver

2 types: - HCC (hepatoma): 90% of primary

- Cholangiocarcinoma

- Primary: most common visc mal tumor

- Asia: 150/100,000
- M : F = 8 : 1 (high inc), 2 : 1 3 : 1 (low inc)

- Strongly linked to HBV

- Vertical transmission 200 x risk HCC by adulthood
- Western: HCV Chr Inf & Alcohol
- Influences HCC, not related to Cholangiocarcinoma
Pathogenesis

- HBV X protein : role transactivator of cell. & viral promoters

- activation growth promoting genes: - insulin like gro fac II
- rec ins like gro fac I
- + suppressor gene p53
- Aflatoxin intercalate into DNA mutagenic adduct with guanosine
- Cirrhosis HCV, Alc, hemochromatosis

Universal vaccination of children incidence of HCC

Morphology

- Unilateral, Multifocal, diffusely infiltrative

- HCC: paler than surrounding, green hue
- CC : rarely bile stained
- Vascular invasion long snake like
Fibrolamellar carcinoma

- Young M & F adult (20-40 yr)

- No association w HBV / cirrhosis
- Better prognosis

Microscopic

- Well diff polygonal cells in nests / cord

- Lamellae of dense collagen bundles

Therapy : Surgical resection

Cholangiocarcinoma

- Resemble adenocarcinoma in other part

- Hematogenous met: Lung, bones (vert), adr, brain
- Lymph node met: perihilar, peripanc,paraaortic a/b
diaph
- 50% CC
- less freg in HCC
Clinic

- Upper abd pain, malaise, fatigue, weigh loss, mass, fullness

- Palpated, jaundice, fever, g.I / esoph variceal bleeding
- fetoprotein : 60-70%
- False pos: yolk sac
- cirr, liv nec, chr htis,
- normal preg, fetal distress or death,
- fetal neural tube defects: anencephaly, spina bifida

Most valuable : Radiologic, USG, angiography, CT, MRI

Death Cachexia
G.I. / esophageal variceal bleeding
Liver failure + Hepatic coma
Rupture

Metastatic Tumors

- Far mor common than primary

- Breast, Lung, Colon
- Nodule blood supply >> central necrosis & Umbilication
Carcinoma Gallbladder

F > M, 7 th decade
Gall stones : 60-70% cases irritative / inf

Morphology

- Infiltrating
- Exophitic

By the time discovered have invaded the liver

Clinic

Indistinguisable with cholelithiasis

Carcinoma o/t Extrahepatic Bile Ducts

- Painless, prog deepening jaundice

- Older, more freq in man
- Gallstones: 1/3 cases

Morphology

- Most : adenocarcinoma

Clinic
- Jaundice
- Decoloration os stools, nausea, vomiting, weight loss
- Heatomegaly : 50% cases
- Palpable gallbladder : 25% cases
Pancreas
Pancreatic Carcinoma

- non-neoplastic epithelium adenoma invasive ca.

- precursor: pancreatic intraepithelial neop (PanIN)

Pathogenesis

- elderly, black > white

- smoking, diet rich in fat
- chr pancreatitis, DM
Morphology

- 65% in head, 15% in body, 5% in tail, 20% diffusely

- ductal adenocarcinoma
- head obs bile duct distention of biliary tree
jaundice
- body & tail: obs (-) silent large, widely disseminated

Clinic

- silent, jaundice
- migratory thrombophlebitis plat agg fac & procoagulant