Hepatocellular carcinoma

Epidemiology

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Etiology

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• Hepatitis C is most associated with hepatocellular carcinoma in the United States t
  • Needle sharing…?

Pathophysiology

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Clinical features

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Diagnostics

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Differential diagnostics

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Metastatic liver disease

• Most common malignant liver lesion
• Typical primary tumor sites: gastrointestinal tract (colon, stomach, pancreas), lung, and breast
• The most common cause of liver metastases is colorectal cancer, which spreads directly from the colon or superior rectum through the portal venous system to the liver.

Hepatic angiosarcoma

• Etiology: associated with exposure to vinyl chloride, arsenic, or thorium dioxide
• Clinical features
  • Nonspecific (abdominal pain, weight loss, jaundice, ascites, anemia)
  • Can manifest acutely with hypotension and abdominal pain (indicating hemorrhage)
• Diagnostics
  • Histology: endothelial cells positive for PECAM-1 (CD31)
• Prognosis
  • Poor (∼ 6 months)
  • Often metastatic at time of diagnosis, high recurrence rate

Benign liver tumors

Hepatocellular adenoma

• Epidemiology
  • Uncommon, benign liver tumor
  • Young women
  • Associated with estrogen exposure (eg, OCPs) & anabolic steroid use
• Clinical
  • Often asymptomatic
  • Abdominal pain (due to hepatomegaly, bleeding, or necrosis)
  • Life-threatening intraabdominal bleeding (due to tumor rupture)
• Pathology
  • Solitary, well-circumscribed, unencapsulated liver mass
  • Sheets or plates of benign hepatocytes
  • Prominent arteries without portal tracts or interlobular bile ducts
  • Hemorrhage & necrosis

Focal nodular hyperplasia

Treatment

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