Difference between revisions of "Liver neoplasms"

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Liver neoplasms (view source)

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→‎Hepatic adenoma: split out
(→‎Hepatic adenoma: split out)
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==Hepatic adenoma==
==Hepatic adenoma==
*[[AKA]] ''hepatocellular adenoma'', abbreviated ''HCA''.
*[[AKA]] ''hepatocellular adenoma'', abbreviated ''HCA''.
===General===
{{Main|Hepatic adenoma}}
*Grow under the influence of sex hormones.
**Associated with ''[[oral contraceptive pill]]'' (OCP) use<ref name=Ref_WMSP221>{{Ref WMSP|221}}</ref><ref name=pmid221698>{{Cite journal  | last1 = Rooks | first1 = JB. | last2 = Ory | first2 = HW. | last3 = Ishak | first3 = KG. | last4 = Strauss | first4 = LT. | last5 = Greenspan | first5 = JR. | last6 = Hill | first6 = AP. | last7 = Tyler | first7 = CW. | title = Epidemiology of hepatocellular adenoma. The role of oral contraceptive use. | journal = JAMA | volume = 242 | issue = 7 | pages = 644-8 | month = Aug | year = 1979 | doi =  | PMID = 221698 }}</ref> - may regress with discontinuation.
**May rupture in [[pregnancy]].
*Usually diagnosed by radiology.
 
===Gross===
Features:<ref>STC S.20, 19 Jan 2009.</ref>
*Often subcapsular location.
*Well circumscribed, but not encapsulated.
 
===Microscopic===
Features:
*Sheets or cords of cells with mild variation of cell and nuclear size.<ref name=Ref_PBoD923>{{Ref PBoD|923}}</ref>
*Cords of cells upto 3 cells thick.<ref>STC S.19, 19 Jan 2009.</ref>
*Cells may have cytoplasmic clearing due to glycogen or be pale - '''obvious if seen'''.
*Vascular - large arteries, dilated thin-walled veins.
 
Negatives:
*No bile ducts.
*No portal tracts.
*No cirrhosis!  If cirrhosis is present it isn't a hepatic adenoma - '''important'''.
 
DDx:
*Well-differentiated [[hepatocellular carcinoma]].<ref>SN. 29 May 2009.</ref>
**Hepatic adenoma is differentiated from ''well-differentiated HCC'' by its architecture; adenomas have cords of cells upto 3 cells thick & have preserved reticulin architecture.
*[[Focal nodular hyperplasia]].
 
====Images====
<gallery>
Image:Hepatic_adenoma_low_mag.jpg | Hepatic adenoma. (WC/Nephron)
Image:Hepatic_adenoma_low_mag_reticulin.jpg | Hepatic adenoma - reticulin. (WC/Nephron)
</gallery>
www:
*[http://www.ajronline.org/cgi/content-nw/full/182/6/1520/FIG3 Hepatic adenoma (ajronline.org)].
*[http://radiographics.rsna.org/content/22/5/1023.figures-only Series of liver micrographs including hepatic adenoma (radiographics.rsna.org)].
 
====Subclassification====
Based on molecular changes:<ref>{{Cite journal  | last1 = Katabathina | first1 = VS. | last2 = Menias | first2 = CO. | last3 = Shanbhogue | first3 = AK. | last4 = Jagirdar | first4 = J. | last5 = Paspulati | first5 = RM. | last6 = Prasad | first6 = SR. | title = Genetics and imaging of hepatocellular adenomas: 2011 update. | journal = Radiographics | volume = 31 | issue = 6 | pages = 1529-43 | month = Oct | year = 2011 | doi = 10.1148/rg.316115527 | PMID = 21997980 }}</ref><ref name=pmid21883740>{{Cite journal  | last1 = Sasaki | first1 = M. | last2 = Yoneda | first2 = N. | last3 = Kitamura | first3 = S. | last4 = Sato | first4 = Y. | last5 = Nakanuma | first5 = Y. | title = Characterization of hepatocellular adenoma based on the phenotypic classification: The Kanazawa experience. | journal = Hepatol Res | volume = 41 | issue = 10 | pages = 982-8 | month = Oct | year = 2011 | doi = 10.1111/j.1872-034X.2011.00851.x | PMID = 21883740 }}</ref>
#Inflammatory hepatic adenoma.
#*[[AKA]] ''telangiectatic adenoma''.<ref>{{Cite journal  | last1 = Maylee | first1 = H. | last2 = Harada | first2 = K. | last3 = Igarashi | first3 = S. | last4 = Tohda | first4 = G. | last5 = Yamamoto | first5 = M. | last6 = Ren | first6 = XS. | last7 = Osawa | first7 = T. | last8 = Hasegawa | first8 = Y. | last9 = Takahashi | first9 = N. | title = Case of telangiectatic/inflammatory hepatocellular adenoma arising in a patient with primary sclerosing cholangitis. | journal = Hepatol Res | volume = 42 | issue = 6 | pages = 611-8 | month = Jun | year = 2012 | doi = 10.1111/j.1872-034X.2011.00962.x | PMID = 22568458 }}
</ref>
#*Associated with obesity.{{fact}}
#Hepatocyte nuclear factor 1 alpha-mutated hepatic adenoma.
#*Inactivating mutation.
#Beta-catenin-mutated hepatic adenoma
#*Activating mutation.
#Unclassified hepatic adenoma.
 
Note:
*Beta-catenin is considered an oncogene.
 
===IHC===
*AFP -ve. (???)
*HNF1alpha +ve/-ve.
*Beta-catenin +ve/-ve.


==Hepatobiliary mucinous cystadenoma==
==Hepatobiliary mucinous cystadenoma==
Michael
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