Syspath 10 Lecture4 Liver Tumors

57 y.o former IVDU with known chronic hepatitis C cirrhosis 57 y.o former IVDU with known chronic hepatitis C cirrhosis found to have a mass in the liverfound to have a mass in the liver

Etiology of HCCEtiology of HCC• Common causes: Common causes: HBVHBV

HCVHCV Aflatoxin BAflatoxin B AlcoholAlcohol

• Rare causes: Rare causes: Contraceptive & Anabolic SteroidsContraceptive & Anabolic Steroids

Metabolic diseasesMetabolic diseases Storage diseasesStorage diseases Vinyl ChlorideVinyl Chloride Older ageOlder age

Some Facts about HCCSome Facts about HCC

• One of the most common cancers in the worldOne of the most common cancers in the world• Represents 80% of primary malignant liver Represents 80% of primary malignant liver

tumorstumors• 80% associated with HBV and / or HCV80% associated with HBV and / or HCV• Relative risk in HBsAg + about 200Relative risk in HBsAg + about 200• Cirrhosis present in 90%Cirrhosis present in 90%• Male predominance (4 to 8:1)Male predominance (4 to 8:1)• Incidence increase with ageIncidence increase with age

Rising Incidence of HCCA Byproduct of the Hepatitis C Epidemic

• Incidence of HCC- 1976-1980: 1.4/100,000

- 1991-1995: 2.4/100,000

• Mortality: 41%• Significant shift to younger (40-60) age group

• Approx. 3.9 million in U.S. infected with Hepatitis C- Infected in 1960’s and 1970’s

- After 20 yr, HCC will develop in 1.9-6.7%

El-Serag, NEJM 1999

Hepatocellular CarcinomaHepatocellular Carcinoma

Non-cirrhotic liver with HCC

Intrahepatic cholangiocarcinomaIntrahepatic cholangiocarcinoma

Intrahepatic Bile Duct CarcinomaIntrahepatic Bile Duct Carcinoma

• Resembles carcinoma of extrahepatic biliary tree

• Less frequent than HCC

• F:M ratio 1:1 (F more ?)

• No relation to cirrhosis

• Rarely invades portal vein

• Hypovascular

• Associated conditions:

primary sclerosing cholangitis, liver flukes, hepatolithiasis, fibrocystic liver disease, chronic hepatitis C, Thorotrast.

HCC vs CholangiocarcinomaHCC vs Cholangiocarcinoma

Cirrhosis Yes No

Underlyingdisease

Cirrhosis,HBV,HCV, ALD,others

PSC, C. sinensis,cystic disease,hepatolithiasis,Thorotrast

Increasedserum level

AFP CEA, CA19.9

Histology Trabecular Glandular

Immunostain Heppar 1, AFP,poly CEA

CK7 +, CK20 -

Angiosarcoma

Benign Neoplasms

• Cavernous hemangiomas – most common

• Hepatic Adenomas

• Focal Nodular Hyperplasia

Metastatic Colon Ca

Focal Nodular Hyperplasia