N3a

A 23 year old female whose only current medication is birth control -  presents  with RUQ pain. Imaging done of the abdomen shows  a solitary mass.

AFP is normal. Why was this tested?

• Marker for HCC

Describe the gross specimen:

solitary circumscribed mass - yellow/light brown

Describe the histology seen below: Is this benign or malignant?

•  Sheets of hepatocytes (no bile ducts, portal areas)
•   Kupffer cells rare – and nonfunctional if present
•   +/- fibrous capsule
•   30-40% hemorrhage
• well differentiated
• uniform cells

     How do you differentiate a benign from a malignant tumor?

Benign

Malignant

·         Slow growing ·         Expansile mass ·         Low mitotic activity ·         Localized ·         Circumscribed (pushing margins) +/- fibrous rim ·         Well differentiated, low grade ·         No metastatic potential ·         Papilloma: exophytic ·         Adenoma: glandular (origin or pattern of growth) ·         Hamartoma: disorganized mature specialized cells indigenous to area ·

·         Rapidly growing (high mitotic rate) ·         Capable of invasion/distant mets ·         Spectrum of differentiation ·         Infiltrative margins ·         Desmoplastic stroma ·         Pleomorphism (variation in size/shape) ·         Hyperchomasia (dark/coarse chromatin) ·         High N:C ratio ·         Large nucleoli ·         Low of organized growth ·         Necrosis (due to ischemia in large tumors) ·         Carcinoma (epithelial tumor derived from any of the three germ layer) ·         Sarcoma (arise in mesenchymal tissue) ·         Melanoma (carcinoma of melanocyte) ·         Lymphoma/leukemia (malignant hematopoietic tumor)