What is special about the fibrolamellar variant of hepatic carcinoma?- Although it has a lot of pleomorphisms, it still has a better prognosis than hepatic carcinoma
- It is a solitary massCCl4 and halothane are associated with? It is not associated with?hepatic necrosis, not with neoplasmvinyl chloride is associated with?angiosarcomaHistology of hemangioma? Will it rupture and bleed on its own?Blood filled vascular neoplasm, will not rupture or bleed on its own.4 characteristics of nodular regenerative hyperplasia (NRH)?- nodules all over the liver
- bile ducts present
- leads to portal HTN
- NO FIBROSISWhat is cholangiocarcinoma and where in the body does it happen?adenocarcinoma that takes place at the hilum of the liver where the left and right hepatic duct join to form the common hepatic duct.What 3 pathologies increase the risk of cholangiocarcinoma?- liver flukes
- PSC
- fibropolycystic disease (cysts in liver and kidney with proliferation of epithelium in bile duct)Mutations associated with cholangiocarcinoma?p53, BRAF, KRASHow do benign glands form in the gall bladder?pseudodiverticulum of the GB mucosa that protrudes through the GB wall and forms glands.What type of CA is GB CA?adenocarcinoma which involves atypical infiltrative intramural glandsWhat are the two pathologies GB CA is associated with?- gallstones (95%)
- PSCLocation of periampullary CA?In the duodenum at the level of the ampulla of VaterPeriampullary CA is associated with?Familial Polyposis ColiSymptoms of periampullary CA?- the ampulla is blocked so fat soluble enzymes cannot go out. This will result in fat malabsorption thus steatorrhea.
- bile will back up to the GB so GB will be bigger and palpable
- bile will get into blood and cause jaundicePancreatic neoplasm:
- describe serous cystadenoma:
- describe the cytoplasm of serous cystadenoma.
- Associated with which mutation?- mass that looks like a sponge with very small cystic spaces with no mucin in them.
- cytoplasm is clear and glycogen rich
- VHLPancreatic neoplasm:
- describe mucinous cystadenoma
- What mutation is this associated with?
- Key feature?
- Who gets it?- cysts are bigger and has mucin in them. The mucin is positive for CEA.
- Mutation: KRAS
- key: ovarian like stroma
- mostly womenPancreatic neoplasm:
- describe intraductal papillary mucinous neoplasm.
- Mutation associated?
- who gets it?- tumor that has papillary fingers and vacuoles containing mucin that are located in the large ducts of the pancreatic head.
- GNAS
- Mostly menPancreatic neoplasm:
- describe solid pseudopapillary tumor.
- mutation involved
- metastasis potential?
- who gets it?- tumor is more solid than cystic but BV degeneration makes it look cystic.
- beta catenin/APC
- metastasis possible to liver
- womenThe most common carcinoma of pancreas?
- Features?ductal adenocarcinoma
- features: poorly formed glands and desmoplastic stromaKey Clinical finding in pancreatitis/pancreatic carcinoma?abdominal pain that radiates to the backParaneoplastic syndrome associated with pancreatic carcinoma?Thrombophlebitis/DVT in the legs that might progress to pulmonary embolism.Compare symptoms if tumor is at the head vs body or tail.Head: the ampulla is blocked so fat soluble enzymes cannot go out. This will result in fat malabsorption thus steatorrhea.
- bile will back up to the GB so GB will be bigger and palpable
- bile will get into blood and cause jaundice
Body or tail: DM due to islet cell destruction.Mutations involved with precursor pancreatic intraepithelial neoplasia (PANIN)?
- PANIN 1 involves?
- PANIN 2 involves
- PANIN 3 involves? What is after it?- KRAS, p53, BRCA2
- Panin 1A is telomere shortening, KRAS activation. PANIN 1B is cell getting bigger
- PANIN 2 is inactivation of CDKNA2
- PANIN 3 is inactivation of p53 and BRCA2 and carcinoma in situ after that it is invasive CA.
