The document presents an algorithmic approach for evaluating liver masses and cysts. It provides guidance on distinguishing between various benign and malignant solid liver lesions, including focal nodular hyperplasia (FNH), hepatocellular adenoma (HCA), hepatocellular carcinoma (HCC), dysplastic nodules, and others. Imaging features and immunohistochemical staining patterns are summarized to aid in differential diagnosis. The algorithm focuses on diagnostic criteria such as presence of fibrosis, immunohistochemical markers, architectural atypia, and small or large cell changes.
Hematuria for undergraduates
this is a presentation i prepared for medical students about hematuria, hope u like it
for more urology resources visit:
www.uronotes2012.blogspot.com
This slides gives you the Facts & Salient features of Liver Cysts / Interesting Case Reports covering Main Departments of Clinical side with Recent Advances made in the treatment of Liver cyst & Key points.
Evaluation of the patient with hematuria , with recent update in Diagnosis, Evaluation, and Follow-up of asymptomatic microscopic hematuria (AMH) in Adult | american association of urology AUA guideline
This is a lecture from the Ghana Emergency Medicine Collaborative (GEMC). To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc.
Sentience Everywhere: Complexity and the Role of Sentience in a Self-Organizi...Neil Theise
How viewing the world as a hierarchy of complex adaptive systems maps to quantum physics, insights about the structure of the universe from spiritual/contemplative traditions, and the relationships of these concepts to understanding the nature of consciousness.
Hematuria for undergraduates
this is a presentation i prepared for medical students about hematuria, hope u like it
for more urology resources visit:
www.uronotes2012.blogspot.com
This slides gives you the Facts & Salient features of Liver Cysts / Interesting Case Reports covering Main Departments of Clinical side with Recent Advances made in the treatment of Liver cyst & Key points.
Evaluation of the patient with hematuria , with recent update in Diagnosis, Evaluation, and Follow-up of asymptomatic microscopic hematuria (AMH) in Adult | american association of urology AUA guideline
This is a lecture from the Ghana Emergency Medicine Collaborative (GEMC). To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc.
Sentience Everywhere: Complexity and the Role of Sentience in a Self-Organizi...Neil Theise
How viewing the world as a hierarchy of complex adaptive systems maps to quantum physics, insights about the structure of the universe from spiritual/contemplative traditions, and the relationships of these concepts to understanding the nature of consciousness.
Alternative models of the body: Opening science to cross-cultural dialogueNeil Theise
Complexity theory approaches to biology and universal structure. This construct may provide a linguistic and perhaps mathematical way to cross cultural boundaries when discussing biology, medicine, and healing.
A presentation by Dr Dave Collins of SASH Vets Sydney
on Canine Biliary Disease - Gallbladder mucocoeles, Cholangitis and Extrahepatic bile duct obstruction.
Discovering a "new organ": Tales of the InterstitiumNeil Theise
In vivo microscopy in humans reveals interstitial spaces with novel anatomy never before recognized, in every tissue and organ of the body. The fluid filled spaces comprise 20% of the volume of the body and they and the collagen bundles and lining cells that define the spaces is therefore the largest "organ" of the body.
Stem Cells, Complexity, and the Science of BeingNeil Theise
Implications of the universe as a self-organizing system. Bodies are comprised of cells, Cells are comprised of molecules. Molecules are comprised of atoms. Atoms are comprised of subatomic particles. Subatomic particles arise from the smallest possible entities (e.g. strings?), and these arise from the energy rich vacuum in a quantum foam. "Everything only looks like a thing"
Non material beings in a non-material worldNeil Theise
Our daily experience tells us that the world and our bodies are material things, made of “stuff.” Our Buddhist traditions however tell us otherwise, that the appearance of materiality is an illusion.
In past talks Dr. Neil Soten Theise has described his views that the universe is not material, but arises from the self-organization of quantum level entities that themselves arise out of pure Fundamental Awareness. Thus, contemporary science and philosophy can also view the world and ourselves as non-material.
But what of the non-material beings that fill Zen study texts and liturgy? Are they merely myths, metaphors, or Jungian archetypes? Or is it possible that gods, demons, angels, spirits are also as “real” as each of us? Can the Fundamental Awareness framework shed light on what is “real” and what is “not real” for us – living, sentient beings – in a non-material world?
1. Icahn School of Medicine at
MMoouunntt SSiinnaaii
Algorithmic Approach to Liver Masses and Cysts
Neil Theise, MD
Departments of Pathology and Medicine (Digestive Diseases)
Mount Sinai Beth Israel Medical Center
New York City
2. Icahn School of Medicine at
MMoouunntt SSiinnaaii
Algorithmic Approach to Liver Masses and Cysts
Download at: NeilTheise on SlideShare.net
Neil Theise, MD
Departments of Pathology and Medicine (Digestive Diseases)
Mount Sinai Beth Israel Medical Center
New York City
3. Icahn School of Medicine at
MMoouunntt SSiinnaaii
Algorithmic Approach led by Romil Saxena Liver Masses Neil Theise, MD
Departments of Pathology and Medicine (Digestive Diseases)
Mount Sinai Beth Israel Medical Center
New York City
4. SOLID MASS
Fibrotic
Background No Fibrotic
Background
+ + + Benign
Hepatoblastoma,
except Fetal Type
Large
Renerative
Nodule
Dysplastic
Nodule
HCC
FNH
HCA
HCC
Fibrolamellar HCC
Hepatoblastoma,
Fetal Type
von Meyenburg
complex
Bile duct
adenoma
Biliary
Adenofibroma
HSA, AFP,
Arg1
Any of: Bile, HSA, Arg1,
CD10, pCEA
Any of: Bile, HSA, Arg1,
CD10, pCEA
Hepatocytes with any of:
Bile, Arg1, HSA, CD10,
pCEA
AND
Ducts/glands/mucin/K19
CholangioCa
Metastasis
Combined
HCC-CholangioCa
Malignant
Immature
appearing cells
Hepatocytes or other large
eosinophilic cells
Ducts/glands/mucin Hepatocytes and
ducts/glands/mucin
Metastasis Metastasis
Metastasis
5. SOLID MASS
Fibrotic
Background No Fibrotic
Background
+ + + Benign
Hepatoblastoma,
except Fetal Type
Large
Renerative
Nodule
Dysplastic
Nodule
HCC
FNH
HCA
HCC
Fibrolamellar HCC
Hepatoblastoma,
Fetal Type
Bile Duct
Adenoma
Peribiliary Gland
Hamartoma
Biliary
Adenofibroma
HSA, AFP
Arg1
Any of: Bile, HSA, Arg1,
CD10, pCEA
Any of: Bile, HSA, Arg1
CD10, pCEA
Hepatocytes with any of:
Bile, HSA, CD10, pCEA
AND
Ducts/glands/mucin/K19
CholangioCa
Metastasis
Combined
HCC-CholangioCa
Malignant
Immature
appearing cells
Hepatocytes or other large
eosinophilic cells
Ducts/glands/mucin Hepatocytes and
ducts/glands/mucin
Metastasis Metastasis
Metastasis
von Meyenburg
complex
Bile duct
adenoma
AFP,
Arg1
Arg1,
Arg1, HSA, CD10,
pCEA
AND
Ducts/glands/mucin/K19
6. WHO Tumours of the DDiiggeessttiivvee TTrraacctt,, 44tthh EEdd..
7. SOLID MASS
Fibrotic
Background No Fibrotic
Background
+ + + Benign
Hepatoblastoma,
except Fetal Type
Large
Renerative
Nodule
Dysplastic
Nodule
HCC
FNH
HCA
HCC
Fibrolamellar HCC
Hepatoblastoma,
Fetal Type
Bile Duct
Adenoma
Peribiliary Gland
Hamartoma
Biliary
Adenofibroma
AFP
Hepatocytes with any of:
Bile, HSA, CD10, pCEA
AND
Ducts/glands/mucin/K19
CholangioCa
Metastasis
Combined
HCC-CholangioCa
Malignant
Immature
appearing cells
Hepatocytes or other large
eosinophilic cells
Ducts/glands/mucin Hepatocytes and
ducts/glands/mucin
Metastasis Metastasis
Metastasis
von Meyenburg
complex
Bile duct
adenoma
HSA, AFP,
Arg1
Any of: Bile, HSA, Arg1,
CD10, pCEA
Any of: Bile, HSA, Arg1,
CD10, pCEA
Arg1, HSA, CD10,
pCEA
AND
Ducts/glands/mucin/K19
8. Dysplastic Nodules
Distinctive nodules which differ from
the surrounding parenchyma in terms of:
size,
color,
texture,
or
degree of bulging from the cut surface…
9.
10.
11.
12.
13. Dysplastic Nodules
Distinctive nodules which differ from
the surrounding parenchyma in terms of:
size,
color,
texture,
or
degree of bulging from the cut surface…
…AND contain portal tracts.
20. Features of High Grade DNs:
Cytologic atypia
e.g. small cell change
Architectural atypia
e.g. pseudogland formation
Clone-like domains
e.g. Mallory body clustering, fatty or
clear cell change, iron resistance, etc.
21.
22.
23.
24.
25. Incidence of DNs in Cirrhotic Livers
Location Source # Cirrhotic
Livers
# w/ DNs (%)
Tokushima Autopsy 315 46 (14%)
New York Explant 44 11 (25%)
San Francisco Explant 110 17 (15%)
Kanazawa Autopsy 209 45 (21%)
New York Explant 155 32 (22%)
Bordeaux Explant 41 10 (24%)
26. Chronic Hepatitis
Hepatitis B and C
Autoimmune hepatitis
Chronic Biliary Tract Disease
PBC, PSC
Metabolic Disease
Genetic hemochromatosis
A-1-AT Deficiency
Toxic Injury
Chronic alcoholic liver injury
32. Features found in dysplastic nodules
LGDN HGDN eHCC
Diffuse hemosiderosis X
Diffuse (or zonal) fatty change X
Angiogenesis (“unpaired arteries”) X
Scirrhous change X
Large cell change X
33. Features found in dysplastic nodules
LGDN HGDN eHCC
Diffuse hemosiderosis X rare rare
Diffuse (or zonal) fatty change X X X
Angiogenesis (“unpaired arteries”)
X XX XXX
Scirrhous change X X X
Large cell change X X X
34. LGDN HGDN eHCC
Diffuse hemosiderosis X rare rare
Diffuse (or zonal) fatty change X
Angiogenesis (“unpaired arteries”) X XX XXX
Scirrhous change X X X
Large cell change X X X
Small cell change X X
Pseudoacinar growth X XX
Iron resistence in otherwise siderotic nodule X X
Mallory body clustering X X
Nodule-in-nodule expansile growth
X X
(with steatosis or other changes above)
Features found in dysplastic nodules
35. Features found in dysplastic nodules
LGDN HGDN eHCC
Diffuse hemosiderosis X rare rare
Diffuse (or zonal) fatty change X
Angiogenesis (“unpaired arteries”) X XX XXX
Scirrhous change X X X
Large cell change X X X
Small cell change X X
Pseudoacinar growth X XX
Iron resistence in otherwise siderotic nodule X X
Mallory body clustering X X
Nodule-in-nodule expansile growth
X X
(with steatosis or other changes above)
Stromal invasion X
75. Chapter 10-4,
N. D. Theise, O. Nakashima, Y. N. Park, Y. Nakanuma
1. Combined HCC-ChC
2. Combined HCC-ChC with stem cell features
A. typical subtype
B. intermediate cell subtype
C. cholangiolocellular subtype
76. Solitary bile
duct cyst
Fibropolycys
tic disease
+/-
associated
renal disease
Obstructive
dilatation of
bile duct
Ciliated
foregut
cyst
Epithelial-lined Without
Epithelial Lining
Cuboidal to
low columnar
Ciliated Biliary / mucinous / oncocytic
+/- papillary architecture
Neoplastic
Benign
Malignant
Mesench.
hamartoma
Undif’d
embryonal
sarcoma
Cavernous
heman-gioma
Cystic
degener-ation
in any
tumor
Cystic
degener-ation
in any
tumor
Hydatid
cyst
Non-neoplastic
Hydatid
cyst
Pyogenic
abscess
Amoebic
abscess
Hemo-rrhagic
cyst
Necrotizing
eosinophilic
granuloma
Laminated
wall
Inflammation,
necrosis
CYST
Ovarian-like stroma w/o Ovarian-like stroma
Cystadenomas and cystadenocarcinomas
77. Cystadenomas Solitary bile and cystadenocarcinomas
duct cyst
Fibropolycys
tic disease
+/-
associated
renal disease
Obstructive
dilatation of
bile duct
Ciliated
foregut
cyst
Epithelial-lined Without
Epithelial Lining
Cuboidal to
low columnar
Ciliated Biliary / mucinous / oncocytic
+/- papillary architecture
Neoplastic
Benign
Malignant
Mesench.
hamartoma
Undif’d
embryonal
sarcoma
Cavernous
heman-gioma
Cystic
degener-ation
in any
tumor
Cystic
degener-ation
in any
tumor
Hydatid
cyst
Non-neoplastic
Hydatid
cyst
Pyogenic
abscess
Amoebic
abscess
Hemo-rrhagic
cyst
Necrotizing
eosinophilic
granuloma
Laminated
wall
Inflammation,
necrosis
CYST
Ovarian-like stroma w/o Ovarian-like stroma
78. Solitary bile
duct cyst
Fibropolycys
tic disease
+/-
associated
renal disease
Obstructive
dilatation of
bile duct
Ciliated
foregut
cyst
Epithelial-lined Without
Mucinous
cystic
neoplasm
Mucinous
cystic
neoplasm
with
associated
invasive
carcinoma
Biliary
intraductal
papillary
neoplasm
Malignant
biliary
intraductal
papillary
neoplasm
Intrahepatic
cholangio-carcinoma
with cystic
change
Epithelial Lining
Cuboidal to
low columnar
Ciliated Biliary / mucinous / oncocytic
+/- papillary architecture
No
epithelial
invasion
into wall
Neoplastic
Benign
Malignant
Mesench.
hamartoma
Undif’d
embryonal
sarcoma
Cavernous
heman-gioma
Cystic
degener-ation
in any
tumor
Cystic
degener-ation
in any
tumor
Hydatid
cyst
Non-neoplastic
Hydatid
cyst
Pyogenic
abscess
Amoebic
abscess
Hemo-rrhagic
cyst
Necrotizing
eosinophilic
granuloma
Laminated
wall
Inflammation,
necrosis
CYST
Ovarian-like stroma w/o Ovarian-like stroma
Epithelial
invasion
into wall
No
epithelial
invasion
into wall
Epithelial
invasion
into wall