Definition : primary malignant neoplastic tumor arising from liver cell
Aetiology : The exact aetiology is unknown but those are predisposing factor
Age : usually above 40
Sex : Male is more common than female
Predisposing factor :
1. Cirrhosis, particularly macronodular
2. Chronic hepatitis B or C
3. Aflatoxins, derived from Aspergillus flavus fungus contaminating moldy grains and peanuts
Pathology
Sites liver
Gross
1. A large solitary tumor
2. Multicentric nodule (multinodular) pattern, multiple nodular tumor
3. Diffuse, the whole liver is almos entirely infiltrated by the tumor
Microscopy
1. Pleomorphism, increase N/C ratio, prominent nucleoli, abnormal mitotic figure, anaplasia
2. Arranged in trabecular or acinar pattern, separated by little vascular stroma
3. Fibrolamellar carcinoma(rare) :large eosinophilic hepatocytes, separated by parallel bundles of collagen
Effect
Spread
i)Direct : liver
ii) Lymphatic : to hilar lymph node
iii) Blood : through hepatic veins to lungs then other organs
through portal veins leading metastasis in liver itself
complication
1. Haemorrhage
2. Secondary infection
3. Liver failure( loss of function)
4. Hepatomegaly
5. Jaundice
6. Portal vein thrombosis
7. Ascites
8. Elevation of serum alpha fetoprotein