Liver mass pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]

Gross Pathology

	Pathogeneis	Genetics	Associated conditions	Gross Pathology	Microscopic Pathology
Hepatocellular adenoma	Estrogens cause the transformation of hepatocytes via steroid receptors Results in generalized vascular ectasia	Transcription factor 1 gene (TCF1) Interleukin 6 signal transducer gene (IL6ST) β catenin-1 gene (CTNNB1)	Glycogen storage disease types Ia and III Fanconi anemia Thalassemia Familial adenomatous polyposis Familial diabetes mellitus Hurler disease Galactosemia	Well circumscribed Nonlobulated Smooth and soft White to yellow to brown lesions	Cords of hepatocytes that have a high glycogen and fat content Lack of normal hepatic parenchymal architecture Absence of portal tracts and hepatic veins
Focal nodular hyperplasia	Develop around a preexisting arterial malformation Production of growth factors promote growth of small arteries  Increased perfusion of the adjacent tissue results in peritumoral hyperplasia.	β-catenin gene (CTNNB1) TP53 APC or HNF1α	Klippel-Trénaunay-Weber syndrome	Well-circumscribed Non-encapsulated Central fibrous scar	Hepatic parenchyma arranged in incomplete nodules Fibrous tissue with thick-walled vessels Bile ductular proliferation Cells of chronic inflammation
Intrahepatic bileduct cystadenoma
Hemangioma	Congenital disorder Vascular malformations that enlarge by ectasia  Estrogen and progesterone influence over tumor growth More common in females		Von Hippel Lindau disease	Well-circumscribed Appear red-brown Solitary nodules Less than 5cms	Large cystically dilated vessels Thin walls Intravascular thrombosis Calcifications
Hepatic Cyst	Von Meyenburg complexes separate from biliary tree and dilate to form cyst			Single, unilocular cyst Variable amounts of clear amber fluid (may contain blood, bile, mucus, pus)	Lined by flat / cuboidal epithelium Epithelium rests on thin collagenous wall without spindle cell stroma Degenerative changes include epithelial desquamation, multiloculation, calcification
Lymphangioma
Lymphangiomatosis
Angiomyolipoma	Derive from a common progenitor cell that suffered the common second hit mutation. Angiomyolipomas are members of the perivascular epithelioid cells tumor group (PEComas) Composed of variable amounts of three components. Vascular cells Immature smooth muscle cells Fat cells	TSC1 gene TSC2 gene	Von Hippel-Lindau syndrome Tuberous sclerosis
HCC	Arises from precancerous lesions.	p53 PIKCA β-catenin genes ARID1A genes ARID2 genes RB1 genes	HBV infection HCV infection Underlying cirrhotic liver disease Inflammation Necrosis and fibrosis of the liver	Nodular or diffusely infiltrative. Pale in relation to surrounding liver or green.	Large polygonal tumours cells Graunular eosinophilic cytoplasm Layered dense collagen bundles
Cholangiocarcinoma
Hepatic abscess
Parasitic cysts