The document discusses different types of liver tumors, including primary and secondary tumors. Primary tumors originating in the liver include benign tumors such as adenomas and hemangiomas, as well as malignant tumors like hepatocellular carcinoma and cholangiocarcinoma. Secondary tumors refer to metastases from other parts of the body that spread to the liver. Hepatocellular carcinoma is the most common primary liver cancer, and results from chronic liver conditions like viral hepatitis or cirrhosis. Symptoms, causes, gross and microscopic appearance are described for different tumor types.

1. Liver TumorsLiver Tumors
1. Primary tumour1. Primary tumour – originating in Liver (uncommon)– originating in Liver (uncommon)
a.Benigna.Benign
 Adenoma – Liver cell adenoma , Bile duct adenomaAdenoma – Liver cell adenoma , Bile duct adenoma
 HaemangiomaHaemangioma
b. Malignantb. Malignant
 Hepatocellular carcinomaHepatocellular carcinoma
 CholangiocarcinomaCholangiocarcinoma
 AngiosarcomaAngiosarcoma
 HepatoblastomaHepatoblastoma
2. Secondary (metastatic) Tumour2. Secondary (metastatic) Tumour

2. Liver TumorsLiver Tumors
 The liver is the most common site of metastatic cancersThe liver is the most common site of metastatic cancers
from many sites of the body. (colon, lung, GB and breast)from many sites of the body. (colon, lung, GB and breast)
 HCC & Cholangiocarcinoma – 2 basic types of primary Ca.HCC & Cholangiocarcinoma – 2 basic types of primary Ca.
 Hepatocellular carcinomas are by far the most common.Hepatocellular carcinomas are by far the most common.
 HCC (also known as liver cell carcinoma or, erroneouslyHCC (also known as liver cell carcinoma or, erroneously
Hepatoma)Hepatoma)

3. Liver Cell AdenomaLiver Cell Adenoma
 Solitary mass composed of cytological benign hepatocytes with highSolitary mass composed of cytological benign hepatocytes with high
predilection for women on contraceptives.predilection for women on contraceptives.
Gross PathologyGross Pathology
 Approximately 70% are solitaryApproximately 70% are solitary
 Occasionally may be as many as ten or more (liver cell adenomatosis)Occasionally may be as many as ten or more (liver cell adenomatosis)
 Anywhere in the liver, including the caudate lobeAnywhere in the liver, including the caudate lobe
 Well-defined capsuleWell-defined capsule

4. HistopathologyHistopathology
 Well-differentiated hepatocytes with abundant eosinophilic granularWell-differentiated hepatocytes with abundant eosinophilic granular
cytoplasmcytoplasm
Edge of a hepatic adenoma, showing encapsulation and a well-differentiated cytologic
appearance, with some large vacuolated elements.

5. Hepatocellular CarcinomaHepatocellular Carcinoma
 Carcinoma with hepatocyte differentiation. (originates fromCarcinoma with hepatocyte differentiation. (originates from
hepatocytes)hepatocytes)
EtiopathogenesisEtiopathogenesis
Most common etiology for liver cancer areMost common etiology for liver cancer are
 Chronic viral hepatitis (B, C)Chronic viral hepatitis (B, C)
 Aflatoxins from aspergillus flavusAflatoxins from aspergillus flavus
 Cirrhosis of liverCirrhosis of liver
Other conditions includeOther conditions include
 Hemochromatosis and tyrosinemia.Hemochromatosis and tyrosinemia.
 Many variables, including age, gender, chemicals, viruses, hormones,Many variables, including age, gender, chemicals, viruses, hormones,
alcohol, and nutrition - interact in the development of HCC.alcohol, and nutrition - interact in the development of HCC.

6. MORPHOLOGY.MORPHOLOGY.
Hepatocellular carcinoma, cholangiocarcinoma, or the mixed pattern mayHepatocellular carcinoma, cholangiocarcinoma, or the mixed pattern may
appear grossly asappear grossly as
1.1. Unifocal (usually large) massUnifocal (usually large) mass
2.2. Multifocal, widely distributed nodules of variable size; orMultifocal, widely distributed nodules of variable size; or
3.3. Diffusely infiltrative- permeating widely and sometimes involving theDiffusely infiltrative- permeating widely and sometimes involving the
entire liver.entire liver.
All 3 may cause liver enlargement, particularly unifocal and multifocalAll 3 may cause liver enlargement, particularly unifocal and multifocal
 HCC- usually paler than the surrounding liver & sometimes take on aHCC- usually paler than the surrounding liver & sometimes take on a
green hue (when composed hepatocytes capable of secreting bile)green hue (when composed hepatocytes capable of secreting bile)

7. Gross appearance of liver cell carcinoma The tumor is well circumscribed and
shows numerous small hemorrhagic foci.

8. • Here is an hepatocellular carcinoma. The neoplasm is large and bulkyHere is an hepatocellular carcinoma. The neoplasm is large and bulky
and has a greenish cast because it contains bile. To the right of the mainand has a greenish cast because it contains bile. To the right of the main
mass are smaller satellite nodules.mass are smaller satellite nodules.

9. Here is another hepatocellular carcinoma with aHere is another hepatocellular carcinoma with a
greenish yellow hue. (Diffuse variant)greenish yellow hue. (Diffuse variant)

10. Liver cell carcinoma. The tumor is multicentric and has arisen against a
background of cirrhosis.

11. Multiple hepatic metastases from a primary colon adenocarcinoma

12. HistologicallyHistologically
 Hepatocellular carcinomas range from well-differentiated to highlyHepatocellular carcinomas range from well-differentiated to highly
anaplastic undifferentiated lesions.anaplastic undifferentiated lesions.
In well and moderately well differentiated tumorsIn well and moderately well differentiated tumors ,,
 Trabecular pattern – composed of several layers of tumour cellsTrabecular pattern – composed of several layers of tumour cells
 Acinar pseudoglandular pattern – tumour cells are disposed aboutAcinar pseudoglandular pattern – tumour cells are disposed about
lumen creating peudoglandular patternlumen creating peudoglandular pattern

13. In well and moderately well differentiated tumorsIn well and moderately well differentiated tumors ,,
 Fibrolamellar pattern – composed of well differentiated polygonal cellsFibrolamellar pattern – composed of well differentiated polygonal cells
arranged in nests or cords separated by wide fibrous bands.arranged in nests or cords separated by wide fibrous bands.
 Occurs in young men & women with no association with HBV orOccurs in young men & women with no association with HBV or
cirrhosiscirrhosis
 Better prognosisBetter prognosis

14.  In the better differentiated variants, globules of bile may be foundIn the better differentiated variants, globules of bile may be found
within the cytoplasm of cells and in pseudocanaliculi between cells.within the cytoplasm of cells and in pseudocanaliculi between cells.
 Acidophilic hyaline inclusions within the cytoplasm may be present,Acidophilic hyaline inclusions within the cytoplasm may be present,
resembling Mallory bodies.resembling Mallory bodies.

15. In poorly differentiated forms, tumor cells disposed in following patternIn poorly differentiated forms, tumor cells disposed in following pattern
 Giant cell type / patternGiant cell type / pattern
 spindle cell type/ pattern resembling spindle cell sarcoma.spindle cell type/ pattern resembling spindle cell sarcoma.

16. CholangiocarcinomaCholangiocarcinoma
 Carcinoma of bile ducts.Carcinoma of bile ducts.
 Associated with liver flukes in uncooked fish & muttonAssociated with liver flukes in uncooked fish & mutton
 Resemble adenocarcinomas may exhibit the full range of morphologicResemble adenocarcinomas may exhibit the full range of morphologic
variation.variation.
 However, most are moderately differentiatedHowever, most are moderately differentiated
 With clearly defined glandular and tubular structures lined byWith clearly defined glandular and tubular structures lined by
somewhat anaplastic cuboidal to low columnar epithelial cells.somewhat anaplastic cuboidal to low columnar epithelial cells.