2. LIVER PATHOLOGYLIVER PATHOLOGY
Focal liver lesionsFocal liver lesions
– Tumor-like lesions and tumorsTumor-like lesions and tumors
Liver transplantationLiver transplantation
Diseases of gallbladder and bile ductsDiseases of gallbladder and bile ducts
– Diseases of gall bladderDiseases of gall bladder
– Diseases of extrahepatic bile ductsDiseases of extrahepatic bile ducts
– TumorsTumors
7. II. Non parasiticII. Non parasitic
C.C. Systemic biliary dilatativeSystemic biliary dilatative
1. Without choledochus cyst1. Without choledochus cyst
(„simple” Caroli disease)(„simple” Caroli disease)
2. With choledochus cyst2. With choledochus cyst
D. OtherD. Other
1.1. Traumatic, infarctusTraumatic, infarctus
2. Duodenal duplication2. Duodenal duplication
3.3. Tumors with cystTumors with cyst
•• cystadenoma/-carcinomacystadenoma/-carcinoma
•• mesenchymal hamartomamesenchymal hamartoma
•• giant cavernous haemangiomagiant cavernous haemangioma
•• teratomateratoma
•• otherother
4.4. PeliosisPeliosis
*Witzleben, G. L., Ruchelli, E.*Witzleben, G. L., Ruchelli, E.
Classification of liver cystsClassification of liver cysts
32. Characteristics of HCCCharacteristics of HCC
5% of malignant tumors5% of malignant tumors
564 000564 000 new cases annuallynew cases annually
(in 2000) and similar death(in 2000) and similar death
Incidence is dubbled in the pastIncidence is dubbled in the past
20 yrs (Japan, USA, Sweden,20 yrs (Japan, USA, Sweden,
France)France)
7.7. in malesin males
9.9. in femelsin femels
Characteristic geographyCharacteristic geography
Etiological factors:Etiological factors: HBV, HCVHBV, HCV,,
AFB1 (80%), alkohol etcAFB1 (80%), alkohol etc
Unknown
35%
HBV/HDV
5%
HBV
15%
HCV
45%
Koff RS, et al.Koff RS, et al. ViralViral Hepatitis.Hepatitis. 2nd ed. 1994.2nd ed. 1994.
35. p53p53
((p53, p14p53, p14 ARFARF
, MDM2), MDM2)
wntwnt
((ββ-catenin-catenin))
RB1RB1
((p16p16 INK4aINK4a
,, p15p15 INK4bINK4b
,, RB1RB1, CDK4,, CDK4,
cyclin D1)cyclin D1)
Most common altered pathways in HCCMost common altered pathways in HCC
Edamoto et al. Int.J.Cancer 2003.106:334-341Edamoto et al. Int.J.Cancer 2003.106:334-341
Suriawinata A. and Ruliang Xu, Seminars in liver Disease, 2004Suriawinata A. and Ruliang Xu, Seminars in liver Disease, 2004
36. Classification of tumors of bile duct and gall bladderClassification of tumors of bile duct and gall bladder
originorigin))
Intrahepatic cholangiocarcinoma (ICC)Intrahepatic cholangiocarcinoma (ICC)
(synonim: cholangiocellular carcinoma)(synonim: cholangiocellular carcinoma)
•• peripheralperipheral ((CK7CK7+, CK20-)+, CK20-)
•• hilar (Klatskin tumor)hilar (Klatskin tumor)
from d. hepaticus (bifurcatio)from d. hepaticus (bifurcatio)
(CK7+/CK20+)(CK7+/CK20+)
Extrahepatic bile duct carcinomaExtrahepatic bile duct carcinoma (EBDC)(EBDC)
CK7CK7++
/CK20/CK20++
Gallbladder carcinomaGallbladder carcinoma
CK7CK7++
/CK20/CK20++
ICC osztályozása a májtumor TNM szerint; EBDC osztályozása „saját” TNM szerintICC osztályozása a májtumor TNM szerint; EBDC osztályozása „saját” TNM szerint
Cabibi et al. P.R.P., 2001, 22:114-23; Okuda et al. J. Gastroent.Hepatol. 2002, 17:1049-55Cabibi et al. P.R.P., 2001, 22:114-23; Okuda et al. J. Gastroent.Hepatol. 2002, 17:1049-55
37. Most common metastaticMost common metastatic
liver tumorsliver tumors
Gastrointestinal tract, gallbladder,Gastrointestinal tract, gallbladder,
bile ducts , pancreasbile ducts , pancreas
LungLung
KidneyKidney
BreastBreast
MelanomaMelanoma
neuroendocrinneuroendocrin
42. Case reportCase report
54 y male54 y male
Jaundice, 3 wJaundice, 3 weekeekss
CT: enlarged tumor like alteration in the headCT: enlarged tumor like alteration in the head
region of the pancreas, multiple foci in theregion of the pancreas, multiple foci in the
liverliver
Liver biopsy (frozen saLiver biopsy (frozen sammple)ple)
45. Attention!Attention!
It might mimic CCC or metastatic tumorIt might mimic CCC or metastatic tumor
(especially on frozen section)(especially on frozen section)
