Account-creators
179
edits
Difference between revisions of "Liver neoplasms"
Jump to navigation
Jump to search
→Hematopoietic tumors: added a case
(→Hematopoietic tumors: added a case) |
|||
| (25 intermediate revisions by 3 users not shown) | |||
| Line 18: | Line 18: | ||
===Malignant lesions of the liver=== | ===Malignant lesions of the liver=== | ||
*[[Hepatocellular carcinoma]] (HCC) - most common malignant liver primary in adults. | *[[Hepatocellular carcinoma]] (HCC) - most common malignant liver primary in adults. | ||
*Hepatoblastoma - malignant liver primary in children. | *[[Hepatoblastoma]] - malignant liver primary in children. | ||
*Intrahepatic cholangiocarcinoma (ICC).<ref name=pmid19212669>{{Cite journal | last1 = Shirakawa | first1 = H. | last2 = Kuronuma | first2 = T. | last3 = Nishimura | first3 = Y. | last4 = Hasebe | first4 = T. | last5 = Nakano | first5 = M. | last6 = Gotohda | first6 = N. | last7 = Takahashi | first7 = S. | last8 = Nakagohri | first8 = T. | last9 = Konishi | first9 = M. | title = Glypican-3 is a useful diagnostic marker for a component of hepatocellular carcinoma in human liver cancer. | journal = Int J Oncol | volume = 34 | issue = 3 | pages = 649-56 | month = Mar | year = 2009 | doi = | PMID = 19212669 | url = http://www.spandidos-publications.com/serveFile/ijo_34_3_649_PDF.pdf?type=article&article_id=ijo_34_3_649&item=PDF}}</ref> | *Intrahepatic [[cholangiocarcinoma]] (ICC).<ref name=pmid19212669>{{Cite journal | last1 = Shirakawa | first1 = H. | last2 = Kuronuma | first2 = T. | last3 = Nishimura | first3 = Y. | last4 = Hasebe | first4 = T. | last5 = Nakano | first5 = M. | last6 = Gotohda | first6 = N. | last7 = Takahashi | first7 = S. | last8 = Nakagohri | first8 = T. | last9 = Konishi | first9 = M. | title = Glypican-3 is a useful diagnostic marker for a component of hepatocellular carcinoma in human liver cancer. | journal = Int J Oncol | volume = 34 | issue = 3 | pages = 649-56 | month = Mar | year = 2009 | doi = | PMID = 19212669 | url = http://www.spandidos-publications.com/serveFile/ijo_34_3_649_PDF.pdf?type=article&article_id=ijo_34_3_649&item=PDF}}</ref> | ||
*Combined hepatocellular carcinoma and intrahepatic cholangiocarcinoma (CHC). | *Combined hepatocellular carcinoma and intrahepatic cholangiocarcinoma (CHC). | ||
| Line 31: | Line 31: | ||
*[[Metastasis]]. | *[[Metastasis]]. | ||
*[[Cholangiocarcinoma]]. | *[[Cholangiocarcinoma]]. | ||
*[[ | *[[Liver hemangioma]]. | ||
===Tabular comparison=== | ===Tabular comparison=== | ||
| Line 71: | Line 71: | ||
! Images | ! Images | ||
|- | |- | ||
| | | [[Hepatic hemangioma]] | ||
| similar to normal liver parenchyma, red (hemorrhagic), well-circumscribed | | similar to normal liver parenchyma, red (hemorrhagic), well-circumscribed | ||
| spaces lined by benign endothelial cells | | spaces lined by benign endothelial cells | ||
| Line 105: | Line 105: | ||
| multiple, white lesions | | multiple, white lesions | ||
| variable, usu. tubular (glandular) with pseudostratified hyperchromatic nuclei | | variable, usu. tubular (glandular) with pseudostratified hyperchromatic nuclei | ||
| CK7-, [[CK20]] | | CK7-, [[CK20]]+ (colorectal), HepPar-1-, [[CK19]]- | ||
| [[colorectal carcinoma]] most common | | [[colorectal carcinoma]] most common | ||
| [[Image:Secondary_tumor_deposits_in_the_liver_from_a_primary_cancer_of_the_pancreas.jpg | thumb| center| 150px| Metastases. (WC)]] | | [[Image:Secondary_tumor_deposits_in_the_liver_from_a_primary_cancer_of_the_pancreas.jpg | thumb| center| 150px| Metastases. (WC)]] | ||
| Line 179: | Line 179: | ||
=Benign hepatic neoplasms= | =Benign hepatic neoplasms= | ||
==Bile duct hamartoma== | |||
A. [[File:1 BDH 1 680x512px.tif|Trichrome shows fibrous spaces with dilated ducts (20X).]] | |||
B. [[File:2 BDH 1 680x512px.tif|Bizarre, ramifying tubules with dilatations (100X).]] | |||
<br> | |||
C. [[File:3 BDH 1 680x512px.tif|Bland epithelial linings (400X).]] | |||
D. [[File:4 BDH 1 680x512px.tif|Surrounding tract with tortuous bile ducts & inflammation, likely secondary to hamartomas (200X).]] | |||
Bile duct hamartomas. A. Trichrome shows fibrous spaces with dilated ducts. B. Bizarre, ramifying tubules with dilatations. C. Bland epithelial linings. D. Surrounding tract with tortuous bile ducts & inflammation, likely secondary to hamartomas. | |||
==Bile duct adenoma== | ==Bile duct adenoma== | ||
:''Should '''not''' be confused with [[bile duct hamartoma]].'' | :''Should '''not''' be confused with [[bile duct hamartoma]].'' | ||
| Line 196: | Line 206: | ||
Features: | Features: | ||
*Cystic spaces lined by a mucinous epithelium (simple columnar epithelium with a clear cytoplasm). | *Cystic spaces lined by a mucinous epithelium (simple columnar epithelium with a clear cytoplasm). | ||
*Surrounding dense ovarian like stroma. | |||
DDX: | |||
[[Biliary Intraductal Papillary Neoplasm]] | |||
*no surrounding ovarian stroma | |||
*Intraductal - connects with the biliary tree lumen. | |||
Note: | Note: | ||
*Similar to [[pancreatic mucinous cystadenoma]]. | *Similar to [[pancreatic mucinous cystadenoma]]. | ||
==Cavernous hemangioma== | |||
A. [[File:1 CAV 1 680x512px.tif|Fibrous foci with increased spaces, hepatocyte focus with nonspecific fibrotic bridge (40X).]] | |||
B. [[File:2 CAV 1 680x512px.tif|Cavernous hemangioma with flat, non-atypical endothelium (200X).]] | |||
<br> | |||
C. [[File:3 CAV 1 680x512px.tif|Tortuous bile ducts/ductules, not to be considered generalized in presence of mass (200X).]] | |||
D. [[File:4 CAV 1 680x512px.tif|Tortuous bile ductsductules, not to be considered generalized in presence of mass (200X).]] | |||
Cavernous hemangioma. A. Fibrous foci with increased spaces, hepatocyte focus with nonspecific fibrotic bridge. B. Cavernous hemangioma with flat, non-atypical endothelium. C. Tortuous bile ductules, not to be considered generalized in presence of mass. D. Tortuous bile ducts, not to be considered generalized in presence of mass. | |||
=Malignant hepatic neoplasms= | =Malignant hepatic neoplasms= | ||
| Line 300: | Line 327: | ||
**Tubular adenocarcinoma | **Tubular adenocarcinoma | ||
**Mucinous (colloid) carcinoma (often in association with the intestinal type). | **Mucinous (colloid) carcinoma (often in association with the intestinal type). | ||
====DDX==== | |||
*[[Biliary Mucinous Cystic Neoplasm]] | |||
***Epithelium is surrounded by a distinct ovarian-like stroma. | |||
====Photos==== | |||
<gallery> | |||
Image:BileDuct IntraductalPapillaryNeoplasm LP CTR.jpg|Bile Ducts - Intraductal Papillary Neoplasm - Low power (SKB) | |||
Image:BileDuct IntraductalPapillaryNeoplasm MP CTR.jpg|Bile Ducts - Intraductal Papillary Neoplasm - Medium power (SKB) | |||
Image:BileDuct IntraductalPapillaryNeoplasm HP CTR.jpg|Bile Ducts - Intraductal Papillary Neoplasm - High power (SKB) | |||
Image:BileDucts IntraductalPapillaryNeoplasm NonMucinousType LP PA.jpg|Bile Ducts - Intraductal Papillary Neoplasm - Low power (SKB) | |||
Image:BileDucts IntraductalPapillaryNeoplasm OncocyticType HP PA.jpg|Bile Ducts - Intraductal Papillary Neoplasm - High power (SKB) | |||
Image:BileDucts IntraductalPapillaryNeoplasm NonMucinousType HP2 PA.jpg|Bile Ducts - Intraductal Papillary Neoplasm - High power (SKB) | |||
</gallery> | |||
A. [[File:1 papillary cbd aca 1 680x512px.tif| Intraductal papillary neoplasm of common bile duct with associated invasive carcinoma.]] | |||
B. [[File:2 papillary cbd aca 1 680x512px.tif| Intraductal papillary neoplasm of common bile duct with associated invasive carcinoma.]] | |||
<br> | |||
C. [[File:3 papillary cbd aca 1 680x512px.tif| Intraductal papillary neoplasm of common bile duct with associated invasive carcinoma.]] | |||
D. [[File:4 papillary cbd aca 1 680x512px.tif| Intraductal papillary neoplasm of common bile duct with associated invasive carcinoma.]] | |||
<br> | |||
E. [[File:5 papillary cbd aca 1 680x512px.tif| Intraductal papillary neoplasm of common bile duct with associated invasive carcinoma.]] | |||
F. [[File:6 papillary cbd aca 1 680x512px.tif| Intraductal papillary neoplasm of common bile duct with associated invasive carcinoma.]] | |||
Intraductal papillary neoplasm of common bile duct with associated invasive carcinoma. A. The papillary tumor comprises mostly variably dilated acini. B. Tumor also shows areas of micropapillae. C. Some areas within the non-invasive tumor showed necrosis, with the black pyknotic nuclei amid red debris. D. Definite invasion was established low power by glands headed in perpendicular directions. E. Embedded in fibroblastic response are non-acinar walls and isolated epithelial groups. F. Also embedded in fibroblastic response are flat glands with nuclei showing loss of polarity (lack of respect for lateral intercellular borders shown by variable orientation to base of gland). | |||
Notes - | Notes - | ||
*Reflect on the known marked variation in histologic grade between different regions of individual tumors when rendering an opinion on a small biopsy specimen. | *Reflect on the known marked variation in histologic grade between different regions of individual tumors when rendering an opinion on a small biopsy specimen. | ||
*Consider the possibility of an invasive component and submit tissue generously. | *Consider the possibility of an invasive component and submit tissue generously. | ||
See also: | |||
PubCan [http://www.pubcan.org/printicdotopo.php?id=5755] | |||
==Cholangiocarcinoma== | ==Cholangiocarcinoma== | ||
| Line 323: | Line 378: | ||
*[[AKA]] ''liver metastases''. | *[[AKA]] ''liver metastases''. | ||
*[[AKA]] ''metastatic liver disease''. | *[[AKA]] ''metastatic liver disease''. | ||
==Hematopoietic tumors== | |||
A [[File:1 MM 1 Covenant 680x512px.tif|One liver core was normal (Row 1 Left 40X).]] | |||
<br> | |||
B [[File:2 MM 1 Covenant 680x512px.tif|A triad with a proliferated bile ductule, otherwise normal (Row 1 Right 400X).]] | |||
<br> | |||
C [[File:3 MM 1 Covenant 680x512px.tif|The other core showed a mass of tumor mashed against normal liver (Row 2 Left 40X).]] | |||
<br> | |||
D [[File:4 MM 1 Covenant 680x512px.tif|Tumor cells showed round to ovoid nuclei without pattern and with grey cytoplasm that proved to be CD138 positive (Row 2 Right 400X).]] | |||
<br> | |||
Plasmacytoma appearing as a tumor mass. A. One liver core was normal. B. A triad with a proliferated bile ductule, otherwise normal. C. The other core showed a mass of tumor mashed against normal liver. D. Tumor cells showed round to ovoid nuclei without pattern and with grey cytoplasm that proved to be CD138 positive. | |||
A. [[File:1 B cell lym liver 1 680x512px.tif|Apparent inflamed fibrous tract with lobular inflammatory collections in adjacent liver (Row 1 Left 40X).]] | |||
<br> | |||
B. [[File:2 B cell lym liver 1 680x512px.tif|Apparent inflamed fibrous band between two relatively hepatocyte regions (Row 1 Right 40X).]] | |||
<br> | |||
C. [[File:3 B cell lym liver 1 680x512px.tif|Apparent piecemeal necrosis with bile ductular proliferation (Row 2 Left 200X).]] | |||
<br> | |||
D. [[File:4 B cell lym liver 1 680x512px.tif|Apparent portal inflammation with unaffected interlobular bile duct (Row 2 Right 200X).]] | |||
<br> | |||
E. [[File:5 B cell lym liver 1 680x512px.tif|Apparent lobular infiltrate with small masse.]] | |||
<br> | |||
F. [[File:6 B cell lym liver 1 680x512px.tif|Proof is at high power. All cells are similar to macrophages but are too closely crowded to be macrophages. The monomorphism (one type of cell) should inspire immunohistochemical stains, which showed the patient had a B cell lymphoma.]] | |||
<br> | |||
B cell lymphoma mimicking hepatitis with fibrosis. A. Apparent inflamed fibrous tract with lobular inflammatory collections in adjacent liver. B. Apparent inflamed fibrous band between two relatively hepatocyte regions. C. Apparent piecemeal necrosis with bile ductular proliferation. D. Apparent portal inflammation with unaffected interlobular bile duct. E. Apparent lobular inflammation with collections a bit too large for usual lobular inflammation. F. Proof is at high power. All cells are similar to macrophages but are too closely crowded to be macrophages. The monomorphism (one type of cell) should inspire immunohistochemical stains, which showed the patient had a B cell lymphoma. | |||
[[File:5 02965636298621 sl 1.png|Malignant B cell lymphoma, NOS, in a 63 year old man’s liver]] | |||
[[File:5 02965636298621 sl 2.png|Malignant B cell lymphoma, NOS, in a 63 year old man’s liver]] | |||
[[File:5 02965636298621 sl 3.png|Malignant B cell lymphoma, NOS, in a 63 year old man’s liver]] | |||
[[File:5 02965636298621 sl 4.png|Malignant B cell lymphoma, NOS, in a 63 year old man’s liver]] | |||
[[File:5 02965636298621 sl 31.png|Malignant B cell lymphoma, NOS, in a 63 year old man’s liver]] | |||
[[File:5 02965636298621 sl 6.png|Malignant B cell lymphoma, NOS, in a 63 year old man’s liver]] | |||
<br> | |||
Malignant B cell lymphoma, NOS, in a 63 year old man’s liver. No other specimens were available for further classification. A. Tumor expands a triad and occupies parenchymal regions. B. Bounding a bile duct, modestly sized round to reniform lymphoid cells, many without nucleoli, accompany small round lymphocytes. Some of the larger cells have clefts (arrows). C. CD3 stain shows many of the lymphoid cells are intercalated reactive T cells. D. Ki67 shows less than half the tumor cells, mostly the larger ones, are in proliferative phase, arguing against the notion of a high grade B cell lymphoma. E. CD79A establishes B cell phenotype (CD20 was also positive). F. That the tumor cells are BCL2 positive evinces B cell neoplasia. The cells were CD10, BCL6, and cyclin D1 negative, militating against mantle cell lymphoma and CLL, with no follicular origin identified. | |||
[[File:4 89735893919405 sl 1.png| High grade B cell lymphoma involving liver]] | |||
[[File:4 89735893919405 sl 2.png| High grade B cell lymphoma involving liver]] | |||
[[File:4 89735893919405 sl 3.png| High grade B cell lymphoma involving liver]] | |||
[[File:4 89735893919405 sl 4.png| High grade B cell lymphoma involving liver]] | |||
[[File:4 89735893919405 sl 5.png| High grade B cell lymphoma involving liver]]<br> | |||
High grade B cell lymphoma involving liver in a 77 year old woman. A. A band of cancer abuts fibrotic liver with steatosis. B. Cancer cells show primitive, round to ovoid, variably sized, dark nucleoli and an aberrant mitoses. Cytoplasm is scant. C. Cancer cells are CD79a positive. D. Most cancer cell nuclei were positive for Ki-67, overall about 80%. E. A minority of cancer cells are CD10 positive. | |||
=See also= | =See also= | ||