1. Metastatic Tumor
1.1. More common than primary tumor
1.2. Multiple nodular metastases
1.3. Commonly from Breast , lung or Colon
1.3.1. although it can come from any site of the body!
1.4. Liver weight can exceed several kilograms!
2. Hepatocellular Carcinoma (HCC)
2.1. Epidemology
2.1.1. Most common Primary maligant tumor of the liver
2.1.2. Male predominace
2.1.3. 85% of cases in counteries with high rate of HBV infection
2.1.4. HBV carrier
2.1.4.1. from his infected mother (vertical transmission) " has 200-fold increas risk of HCC by Adulthood
2.2. Causes of HCC:
2.2.1. Chroniv Viral Hepatitis B & C
2.2.2. Cirrhosis
2.2.3. Chronic alcoholism
2.2.4. Food contamination
2.2.4.1. Aflatoxins.
2.2.4.1.1. # aflatoxins: A = aspergellus Fla = Flavus toxins = toxins :)
2.2.4.2. from aspergillus flavus.
2.2.4.3. in moldy grains and peanuts.
2.2.5. other:
2.2.5.1. Tyrosinemoa
2.2.5.2. Hereditary Hemochromatosis
2.3. Clinical features
2.3.1. ill defined upper abdominal pain
2.3.2. Malaise & fatigue
2.3.3. weight loss
2.3.3.1. common feature in all malignant tumors
2.3.4. feeling of abdominal fullness
2.3.5. in many cases, the enlarged liver is palpable
2.3.6. jaundice and fever are uncommon
2.4. Morphology
2.4.1. Grossly it maybe :
2.4.1.1. Unifocal mass
2.4.1.2. Multifical
2.4.1.3. diffusely infiltrative cancer
2.4.1.4. All the above three may cause liver enlargment
2.4.1.5. All patternsn of HCC have strong propensity of invasion of vascular channels.
2.4.1.5.1. may invade the portal vein => occlusion of portal ciculation
2.4.1.5.2. it may invade inferior vena cava
2.4.1.5.3. it even may extend to the right side of the heart !!
2.4.2. #Usaully " no always!" - Primary tumor = Unifocal - Mestastases = Multi-focl
2.4.3. Microscopically
2.4.3.1. HCC range from well differentiated to highly anaplastic undifferentiated.
2.4.3.1.1. well to moderate
2.4.3.1.2. poorly differentiated
2.5. Labratory studies:
2.5.1. Elevates serum alpha-fetoprotein in 50% to 75% of pt. with HCC
2.6. Death Usually occurs from:
2.7. Fibro-lamellar Carcinoma
2.7.1. variant of HCC
2.7.2. charachterstics
2.7.2.1. in Young male and Adult female.
2.7.2.2. No association with HBV or Cirrhosis
2.7.2.3. Has better prognosis
2.7.3. Morphology
2.7.3.1. Grossly
2.7.3.1.1. single large, hard "scirrhous" tumor with fibrous band
2.7.3.2. Microscopically
2.7.3.2.1. Well differentiated
2.7.3.2.2. polygonal cells growing in nest or cords
2.7.3.2.3. separated by Parallel Lamellae of dense collagen Bundles
3. General features
3.1. Mostly metastatic tumors
3.2. Primary carcinoma of the liver relatively uncommon
4. Cholangiocarcinoma
4.1. less common than HCC
4.2. malignancy of the biliary tree arising from the bile ducts
4.3. Risk factors
4.3.1. Primary sclerosing cholangitits
4.3.2. congenital fibro-polycytic diseases of the biliary system
4.3.2.1. important examples:
4.3.2.1.1. Caroli disease
4.3.2.1.2. choledochal
4.3.3. previous exposure to Thorotrast
4.3.3.1. #Thorotrast: formerly used in Radiology of biliary tracts
4.3.4. in the orient (East) incidance are higher due to chronic infection of the biliary tract by liver fluke (Opisthorchis sinensis)
4.4. Morphology
4.4.1. Grossly
4.4.1.1. inta-hepatic Cholangiocarcinoma = Treelike tumorous mass the within the liver Or massive tumor nodules
4.4.1.2. Lymphatic and vascular invasion are commom
4.4.2. Microscopic
4.4.2.1. Adenocarcinoma
4.4.2.2. mostly well to moderatly differentiated
4.4.2.3. Rarly bile stained
4.4.2.3.1. because the differentiated bile duct epithelium does not synthesize bile
4.4.2.4. Mixed varients occur, in which element if both HCC and Cholangiocarcinoma are present.
4.5. Prognosis
4.5.1. intra-hepatic Cholangiocarcinoma Usually detected late
4.5.2. poor
4.5.3. median time from diagnosis to death is 6 months
4.5.4. Rx: aggressive surgery
4.6. alpha-fetoprotein is NOT elevated!
5. Hepatoblastoms
5.1. rare
5.2. Most common liver tumor of young Children
6. angiosarcoma
6.1. rare
6.2. Tumor of the blood vessels
6.3. Risk factors
6.3.1. Vinyl chloride
6.3.2. Thorostrast exposure
6.4. morohology
6.4.1. Pleomorphic endotheilal cells with large hyperchromatic nuclei
6.4.2. Gaint cells
6.4.3. spindle shaped cells
6.4.4. Cirrosis is present in 20% to 40% of the cases