hepatopancreaticobiliary pathology jemimah denson
TRANSCRIPT
![Page 1: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/1.jpg)
Hepatopancreaticobiliary pathology
Jemimah Denson
![Page 2: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/2.jpg)
EXOCRINE PANCREAS
![Page 3: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/3.jpg)
Specimen cut-up
• Margins :– Transection:
• Pancreatic• Bile duct (cystic, CHD, CBD) • Gastric and duodenal
– Dissection:• SMV• SMA• Posterior• CRM around CBD stump
![Page 4: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/4.jpg)
Specimen cut-up
From RCPath dataset copyright Paul Brown St James’s University Hospital, Leeds
![Page 5: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/5.jpg)
2906/11
![Page 6: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/6.jpg)
Chronic pancreatitis
• Causes:– ETOH + smoking (act synergistically)– Obstruction– hereditary
• Macro– Diffuse or focal – mimic tumour on imaging– Shrunken and very hard– Dilated ducts with concretions.
![Page 7: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/7.jpg)
Chronic pancreatitis
• Micro:– Acinar atrophy– Fibrosis– Pancreatic duct changes– Inflammation often mild– Islets remain– Enlarged peripheral nerves– Perineural invasion!!
• Complicatons – DM, pseudocyst, vascular
![Page 8: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/8.jpg)
21269/13
![Page 9: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/9.jpg)
Autoimmune pancreatitis
• Two types:
• Type 1 – part of IgG4 disease spectrum
• Type 2 – don’t have raised IgG4 & rarely develop extrapancreatic IgG4 disease. Requires tissue for diagnosis.
![Page 10: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/10.jpg)
Autoimmune pancreatitis
• Macro– Usually diffuse but can be focal & mass
forming– Main PD is diffusely or segmentally narrowed
(cf other forms of pancreatitis)– 60% pancreatic head involved with narrowing
of CBD – May involved peripancreatic fat & enlarge LNs
– mimics Ca
![Page 11: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/11.jpg)
Autoimmune pancreatitis
• Micro– Common to both types:
• Periductal lymphoplasmacytic inflammation• Inflammation of acinar parenchyma• Patchy distribution
– Type I• Storiform fibrosis• Obliterative phlebitis• Involvement of peripancreatic fat
– Type II• Granulocytic epithelial lesion (GEL)
![Page 12: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/12.jpg)
AIP
Show 7728/12
![Page 13: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/13.jpg)
IgG4
• What is positivity??• Depends on tissue and criteria• HISORt
– >10 positive cells per hpf– Better for biopsy material
• Boston– >50 positive cells per hpf AND IgG4:IgG >40%– Better for resection specimens
• Interpret with caution
![Page 14: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/14.jpg)
Groove pancreatitis
• I have yet to see an example• Aka paraduodenal pancreatitis• Clinical history• Underlying cause is ectopic pancreatic tissue
within wall of duodenum – usually between ampulla of Vater and minor ampulla.
• Impaired drainage of pancreatic secretions leads to duct dilatation, cyst formation, rupture and inflammation.
• Worsened by ETOH
![Page 15: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/15.jpg)
Groove pancreatitis
• Cysts in duodenal wall and pancratoduodenal groove
• Cystic spaces lined by flattened ductal epithelium or granulation tissue
• Acute and chronic inflammation
• Thickened duodenal MP with other foci of ectopic pancreas
• Brunner’s gland hyperplasia
![Page 16: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/16.jpg)
![Page 17: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/17.jpg)
Case history
• 25 year old female
• Abdominal and back pain, N&V, early satiety
• Imaging – large solid and cystic neoplasm in head of pancreas
![Page 18: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/18.jpg)
Microscopy
![Page 19: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/19.jpg)
Microscopy
![Page 20: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/20.jpg)
Solid pseudopapillary neoplasm
• Characteristically young females
• Low grade malignant but usually excellent prognosis
• Usually solitary
• Anywhere in pancreas
• Solid or cystic and anything in between, cyst is degenerative
• Usually encapsulated
![Page 21: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/21.jpg)
Solid pseudopapillary neoplasm
• Poorly cohesive monomorphic cells
• Pseudopapillae
• Degnerative changes
• Cells:– Eosinophilic, foamy or vacuolated– Nucleus often indented or grooved– Eosinophilic globules
![Page 22: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/22.jpg)
SPN immunohistochemistry
• Positive• Vimentin, CD10, β-catenin (nuclear and
cytoplasmic), PR, ORA beta, CD56, NSE• A1AT/A1ACT highlight eos. globules
• +/-• Synaptophysin, epithelial markers
• Negative• CK 7 & 19, chromogranin A, ORA alpha
![Page 23: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/23.jpg)
1163/13
![Page 24: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/24.jpg)
Pancreatic cystsNeoplastic epithelial:Serous cystic neoplasm
Mucinous cystic neoplasm
IPMN
SPN
Acinar cell cystadenoma
Cystic teratoma
Cystic ductal adenocarcinoma
Cystic pancreatoblastoma
Cystic mets
Nonneoplastic epithelial:Congenital cyst
Duplication
Choledochal cyst
Cystic hamartoma
Lymphoepithelial cyst
Retention cyst
Groove pancreatitis
Endometrial cyst
Neoplastic non-epithlieal:Lymphangioma
Haemangioma
Cystic schwannoma
Cystic degeneration in LMS
Cystic degeneration in GIST
Cystic degeneration in MPNST
Cystic degeneration in paraganglioma
Nonneoplastic non-epithelial:Pseudocysts
Parasitic cysts
![Page 25: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/25.jpg)
Serous cystic neoplasms
• Serous cystadenoma or cystadenocarcinoma (very rare)
• Microcystic (more♀) or macrocystic (more ♂) • Solid serous adenoma• Often asymptomatic – incidentally detected• Characteristic imaging for microcystic with
‘starburst’ pattern• Associations – minority vHL & NETs
![Page 26: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/26.jpg)
Serous cystadenoma• Macro
– Microcystic mostly body/tail. Sponge like with stellate scar
– Macrocystic mostly head. Few thin walled cysts with watery fluid
– Don’t usually communicate with duct system.
• Micro– Single layer cuboidal cells with clear cystoplasm
• ICC and ∆∆• Malignancy diagnosed on clinical behaviour
![Page 27: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/27.jpg)
Show 3847/13
![Page 28: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/28.jpg)
Mucinous cystic neoplasms
• Classification– Premalignant
• Low-grade, intermediate & high-grade dysplasia.
– Malignant i.e. invasive carcinoma
• Mostly female• Mean age 45• Most in body or tail• Solitary – uni or multilocular• Don’t communicate with duct system• Lined by tall, columnar, mucin-producing cells
with characteristic ovarian-type stroma
![Page 29: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/29.jpg)
2283/13
![Page 30: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/30.jpg)
Intraduct papillary mucinous neoplasia
• Grossly and radiologically visible papillary mucin forming lesion arising from main PD or its branches
• Classification:– Premalignant
• Low to high grade dysplasia
– Malignant
• Mean 65 yrs, ♂:♀ = 1.5:1• Associations ??P-J & FAP. Synchronous &
metachronous extrapancratic malignancies in 10-40%
![Page 31: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/31.jpg)
IPMN
• Further subtyped into:– Main duct type, branch duct type or mixed– Epithelial subtype:
• Gastric (BD > MD)• Intestinal (MD > BD)• Pancreaticobiliary (BD > MD)• Oncocytic (BD > MD)
• Gastric type most likely to be LG, rest more likely to be HG
![Page 32: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/32.jpg)
PanIN
• Precursor lesion for pancreatic ca• Classification
– PanIN 1A = mucinous (pyloric) metaplasia, flat lesion
– PanIN 1B = papillary architecture– PanIN 2 = atypical hyperplasia (LG dysplasia)– PanIN 3 = HG dysplasia
• Microscopic diagnosis• ∆∆• Show 29021/13
![Page 33: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/33.jpg)
Ductal adenocarcinoma
• Risk factors– Age– Sex– Race– Chronic pancreatitis– Smoking– Familial/inheritied (10%)
• FAMMM• BRCA2• Peutz-Jeghers• HNPCC & FAP
![Page 34: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/34.jpg)
Ductal Adenocarcinoma
• Site– Distal BD, ampulla, pancreas
• Epithelial subtypes– Pancreaticobiliary, intestinal, clear cell, foamy cell
etc..
• Mixed tumours/variants– Adenosquamous (squame at least 30%)– Colloid (mucin pools at least 80%)– Signet ring, Medullary, hepatoid, undifferentiated etc– MANEC (both at least 30%)
![Page 35: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/35.jpg)
Show 29683/13
![Page 36: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/36.jpg)
Acinar cell carcinoma
• Mostly adults, mean 60 yrs, but account for 15% of paediatric exocrine pancreatic neoplasms.
• May get lipase hypersecretion syndrome
• 50% present with mets
• Macro – large, well circumscribed or encapsulated tumours. Pushing border. Occur anywhere in pancreas.
![Page 37: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/37.jpg)
Acinar cell carcinoma
• Lobules of cellular tumour sep’d by fibrous bands.
• Acinar pattern, solid or trabecular• Granular eosinophilic cytoplasm• Prominent nucleoli• Zymogen granules PAS/D positive• ICC:
– Trypsin, chymotrypsin, lipase, (amylase)– Bcl10, A1AT, AE1/AE3
![Page 39: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/39.jpg)
Show 32345/13
![Page 40: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/40.jpg)
Other pancreatic tumours
• Non-epithelial– Very rare <1% of pancreatic neoplasms– More often spread from extrapancreatic
primary
• Paediatric
• Mets– Lung, kidney, breast, colon and MM most
common
![Page 41: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/41.jpg)
LIVER
![Page 42: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/42.jpg)
Classification
• Hepatocellular
• Biliary
• Other
![Page 43: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/43.jpg)
7060/12
![Page 44: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/44.jpg)
7060/12
![Page 45: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/45.jpg)
Focal nodular hyperplasia• Young women• Aetiology ?abnormal blood flow• Can have more than 1 lesion• Characteristic macroscopic appearance
with central scar• Large, thick walled vessels within fibrous
septae• Bile ductules at periphery• Features of cholestasis• Bland, normal appearing hepatocytes
![Page 46: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/46.jpg)
Sounds like FNH??
• Nodular regenerative hyperplasia– Hyperplastic hepatocytes form small nodules,
without fibrous tissue. More diffuse, part of a process of disorder blood flow in liver
• Partial nodular transformation– Very rare, nodule at the hilum, similar to NRH
• Macroregenerative nodule– At least 8mm diam. Usually a large nodule of
cirrhosis. May be pre-neoplastic (see later)
![Page 47: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/47.jpg)
3717/13
![Page 48: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/48.jpg)
Hepatocellular adenoma
• Steatotic– HNF1α mutated – usually somatic but can be inherited –
association with hereditary DM, multiple colonic adenomas– Least associated with malignancy
• Inflammatory (telangiectatic)– OCP association and obesity, fatty liver, ETOH excess– Present with inflammatory syndrome
• Β-catenin activated– More often male– More malignancy risk, may be precursor lesion– ??FAP association
• Other
![Page 49: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/49.jpg)
Hepatocellular adenoma
• General features– Occur in non-cirrhotic liver– Often unencapsulated– Bland hepatocytes, 2-3 cell thick plates, retained retic
network.– No bile ducts although ductules may be seen.
• Specific features– Steatotic– Β-cat mutated may show mild atypia & rosettes– Inflammatory – inflamed portal tracts with no
veins/BDs, thick walled vessels, ductular reaction, sinusoidal dilatation & peliosis
![Page 50: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/50.jpg)
Hepatocellular adenoma
• Special stains– No specific marker– Reticulin– Steatotic
• LFABP negative (cf normal liver and other HCA types)
– β-catenin activated• Nuclear β-cat & GS positive
– CD34– Serum amyloid A
![Page 51: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/51.jpg)
Premalignant/early malignant lesions
• Macroscopic lesions– Large regenerative nodule = MRN– Dysplastic nodule – low and high grade– Early HCC <2cm
• Microscopic features– Large cell change - ?if premalignant or not– Small cell change - premalignant– Dysplastic foci = <1mm diameter
• Definition of HCC = stromal invasion
![Page 52: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/52.jpg)
33469/13
![Page 53: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/53.jpg)
![Page 54: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/54.jpg)
HCC
• Liver disease
• Environment
• Geographical
• Unless patient is being screened it often presents late
• Pt may have raised serum AFP
![Page 55: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/55.jpg)
HCC
• Macroscopic– Classic appearance = ……– Usually soft tumour
• Microscopic– Varied but classically:
• pseudoglandular/trabecular growth• cells look like hepatocytes• Bile production• Various inclusions esp eosinophilic globules
![Page 56: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/56.jpg)
Diagnosing HCC
• Hopefully characteristic macro and microscopic appearances
• On biopsy can be very difficult to ∆∆ low-grade HCC from dysplastic nodule or even adenoma.
• Histochemistry– Reticulin, DPAS
• ICC
![Page 57: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/57.jpg)
HCC ICC
• Malignant or not?– CD34, glypican 3, HSP70, glutamine
synthetase all more +ve in HCC– CK7/19 can help differentiate between true or
pseudo invasion (+ve ductular reaction in pseudo)
• HCC vs non-hepatic– HepPar 1, AFP, TTF-1, CD10, pCEA
Show ICC & 21521/13
![Page 58: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/58.jpg)
2478/10
![Page 59: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/59.jpg)
Fibrolamellar HCC
• Younger patients
• Not associated with chronic liver disease/cirrhosis
• Better prognosis
• Polygonal eosinophilic cells within abundant fibrous stroma
![Page 60: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/60.jpg)
22567/13
![Page 61: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/61.jpg)
Benign biliary tumours
• Von Myenburg complex
• Bile duct adenoma
• Bile duct cyst
• Ciliated hepatic foregut cyst
• Intraductal papillary neoplasms & biliary papillomatosis
• Mucinous cystic neoplasm (hepatobiliary cystadenoma)
![Page 62: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/62.jpg)
260/12
![Page 63: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/63.jpg)
Cholangiocarcinoma
• Intrahepatic vs hilar vs extrahepatic• Aetiology less clear than HCC• Increased risk in chronic biliary dx,
cirrhosis, parasitic infections (SE Asia), mucinous cystic neoplasm, biliary papillomatosis
• Diagnostic difficulties:– Intrahepatic CC vs met adenocarcinoma– HCC vs CC or mixed tumour
![Page 64: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/64.jpg)
Mixed HCC-CC
• Peripheral mass forming intrahepatic CC thought likely to have a hepatic progenitor cell origin which may explain mixed tumours (which tend to behave like CC)
![Page 65: Hepatopancreaticobiliary pathology Jemimah Denson](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649e005503460f94ae941e/html5/thumbnails/65.jpg)
Non-epithelial liver lesions
• Vascular– Haemangiomas, epithelioid
haemangioendothelioma
• Other mesenchymal– Inflammatory pseudotumour– angiomyolipoma
• Leukaemias & lymphomas