Liver: Hepatocellular carcinoma

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A 70-yr-old man who had been losing much weight lately was found to have an 8 cm diameter space-occupying lesion in the right lobe of his liver.

1.    Name some causes of space-occupying lesions in the liver.

Cavernous hemangiomas

Actinomycosis

Liver abscess

Primary carcinoma (hepatocellular, cholangiocarcinoma)

Metastatic carcinoma

2.    What is your diagnosis in this case?

Primary hepatocellular carcinoma

3.    What associated liver conditions are likely to be present?

Cirrhosis.

4.    What pre-operative blood tests would have been done for the following purposes and why?

      a)       Diagnosis

Alpha fetoprotein level (commonly in xs of 400ng/ml in patients with hepatocellular carcinoma)

      b)       Assessment of fitness for major surgery

ALT, AST, GGT levels

Coagulation time e.g. PT, PTT

5.    List the diagnostic histological features.

Trabeculated (thickness > 1 cell thick)

Presence of sinusoids (lined by normal endothelial cells)

Eosinophilic cytoplasm, hyperchromatic nuclei with prominent nucleoli

Large number of mitoses

Increased nuclear to cytoplasmic ratio

Bile production

6.    What pathological (gross and microscopic) parameters have prognostic implications?

Staging

       - T (size of primary tumour)

       - N (nodal involvement)

       - M (metastases)

Cirrhosis

Number of tumours

7.    True / False MCQs:

The following are characteristic of this condition:

      Bile production                                            T

      Alpha-fetoprotein production                  T        

      Tumour embolisation to the lung           T                 

      Intraperitoneal haemorrhage                   T                 

      Mucin production                                        F  

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Copyright � Joseph Ong 2003