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1. HEPATIC TUMOURS

2. Classification of primary hepatic tumors

3. Hepato Cellular Adenoma Rare common in women in reproductive age with oral contraceptive use, sex hormone therapy, and in pregnency Gross – few 4cm to 30cm partly or completely encapsulated. 10% multiple lighter or bile stained. c/s – with hemorrhage Mic – sheets of cords of hepatocytes . Lack portal tracts and bile ducts. Numerous blood vessels with thrombosis.

4. Bile Duct Adenoma Rare benign tumor small Mic. Acini lined by biliary epithelium. Hemangioma – common benign tumor. Cavernous type. Gross – solitary or Multiple Circumscribed Red purple Few mms to cms

5. History Large, cavernous bloodFilled spaces Lined by single layer of endothelium.

6. Cavernous haemangioma of the liver

7. Hepatic cysts Congenital cysts Simple cyst Hydatid cysts

8. Congenital cysts : Single or polycystic liver disease Simple cysts : Large (20cm) beneath the capsule Hydatid cysts : Hydatid cyst has already been discussed

9. Malignant hepatic tumors Hepatocellular carcinoma Incidence: High in subsaharan Africa and South East Asia (China) (2 – 8%) M:F – 4 :1 Age – 5 – 6 High in HBV & HCV infected areas. 70 – 80% cases on cirrhosis.

10. Etiopathogenesis Relation to HBV infection HBsAg positivity ( Taiwan) African & Asian Patients – 95% of cases with anti – HBc . Direct integration of HBV – DNA genome in the genome of tumor cells or HCC.

11. Relation to HCV infection A major factor to HCC. Patients having antiHBc antibodies have 3 times higher risk to HCC. HCV – cirrhosic – HCC (Higher) HBV & HCV infection act. Synergistically to predispose to HCC.

12. Relation to cirrhosis Macronodular – HCC. Post necrotic

13. Relation to Alcohol Four fold increase risk of developing HCC. Alcohol act as a co-carcinogen with HBV or HCV.

14. Mylotoxins Aflotoxin B1, from Aspergillus flavus , contaminate wheat grains or groundnuts.

15. Chemical carcinogens Butter yellow Nitrosamines

16. Miscellaneous factors Haemochromatosis α – 1 antitrypsin deficiency Prolonged immunosuppresive therapy Other types of viral hepatitis Tobacco smoking Parasitic infections – clonorchiasis and schistosomiasis

17. Pathogenesis Inactivation of tumor suppressor gene p 53 by HBV X – protein from X – gene of HBV bind to p 53

18. Expanding type – single yellow, brown, large mass, in right lobe with central necrosis, haemorrhage .

19. Multifocal type – multiple masses, 3 – 5cm

20. Infiltrating type – diffuse infiltration

21. IHC STAINS – AFP, EMA, KERATIN

22. FIBROLAMELLAR CARCINOMA Younger age group Both sex

23. Spread Intra hepatic – BD Extra hepatic – hepatic or portal vein Lung & Bones Through lymphatils Porta hepatis lymph node mediastinal and cervical lymph nodes.

24. Lab Diagnosis High serum ALK. Phosphatase serum AFP. Para neoplastic syndrome – Hypercalcemia Hypoglycemia Gynaecomastia U.S. – biopsy.

25. Cholangiocarcinoma Carcinoma from bile dcut . Older people. Jaundice ++ Exposure to throtrast , anabolic steroids, clonorchiasis , fibrocystic Disease. Gross – liver is firm to hard whitish Mic – tumor with glandular structure

26. Hepatoblastoma Rare tumor Arise from primitive hepatic parenchymal cells. Before 2yrs> in boys. Fever, Jaundice Gross – circumscribed and lobulated mass measuring 5 – 25CM c/s – haemorrhage cystic degeneration and necrosis. Mic – epithelial component – fetal hepatocytes . Mesenchymal component – fibrous tissue, cartilage, osteoid and extra medullary hematopoiesis .

27. Metastatic tumors More common Blood borne metastasis ( Portal vein or systemic vein) From – stomach Breast Lungs Colon Oesophagus Pancreas Malignant melanoma Multiple spherical Nodular White, soft or hemmorrhagic

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