HEPATOBILLIARY SYSTEM AND

PANCREAS
Department of Anatomic Pathology
Faculty of Medicine
Brawijaya University

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 HEPATOBILLIARY SYSTEM AND PANCREAS
CARCINOMA

A. CARCINOMA of The LIVER

1. PRIMARY
* Liver cell ca ( Hepatocellular ca,
Hepatocarcinoma, Hepatoma)  90%
* Bile duct ca ( Cholangio Ca )  10%

2. SECONDARY

B. CARCINOMA of GALL BLADDER

C. CARCINOMA of EXTRAHEPATIC BILE DUCTS
D. PANCREATIC CARCINOMA
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Carcinoma of the Liver
(Hepatocelluler Ca)

- Incidence : USA < ; South Africa, Southeast Asia >>

- Age : most cases > 50 years old
- Sex : male > female

Predisposing factors :
1. HBV and HCV
Viral hepatits : the leading cause of hepatoma
2. Cirrhosis ( post necrotic, alcoholic, biliary,
Hemochromatosis ( kelebihan Fe ), α1 antitrypsin
defisite, tyrosinemia )
3. Food contaminants HBS&P/PA/2015 4
 Hepatocelluler Cholangio Gallbladder
carcinoma carcinoma carcinoma
Sex M>F 3:1 F>M 2:1 F>M 4:1
Geographic Asia, Africa East Asia Indian & South
distribution America
Age 30 – 50 yrs 60 + 50 +
HBV, HCV, alchoholic, Chlonorsis Gallstone, Chronic
Medical hemocromatosis, Sinensis, Cholecystitis
history chirrhosis Thorotrast ( bahan
radioaktif )
Weight loss, Weight loss, Weight loss,
anoreksia, pain, fever, anoreksia, pain, anorexia,
Symptom
abdominal distended fever, abdominal gallbladder
distended dilatated, icterus
AFP increased normal normal
Increase eritropoietin, - -
Others
hypoglikema
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• Female, Fourty, Fertile, Fat  4F untuk batu
buli-buli
• Parameter untuk melihat hepatoma  cek
Alfa Feto Protein ( AFP )

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Macros :
* liver >, firm, nodular
* unifocal (solitary)/ multifocal (multinodular)
/ diffuse infiltrative
* well circumscribe (uni / multifocal)
* paller than the surrounding liver substance /
green

Micros :
* Well differentiated - moderately -
undifferentiated
* Well diff. and moderately diff :
trabecular,solid, tubular (acinar,pseudoglandular)
* Poorly differentiated :
* pleomorphic  anaplastic giant cell (+)
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* spindle cells, resemble sarcoma 7
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Cholangio Ca :

- Most cases : > 60 years old

Risk condition :
* Primary sclerosing cholangitis
* Congenital fibropolycystic disease of the
biliary system
* Thorotrast
* Invasion of liver fluke Clonorchis sinensis

Macros :
* Tree like tumorous mass / massive tumor /nodule
* Firm and gritty
Micros :
* Well – moderately diff sclerosing adeno ca
* Desmoplastic (dense collagenous stroma)
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Kalo berdungkul curiga sekunder
Primer biasanya cuma satu HBS&P/PA/2015 12
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Billiary System

1. Gallstone
( Cholelithiasis )
2. Inflammation
* Acute cholesistitis
* Chronic cholesistitis
3. Tumors
* Gallbladder carcinoma
* Cholangio carcinoma

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• Karsinoma buli  Columnar  AdenoCa
• Ca endometrium & mammae ~ penggunaan
ERT ( Estrogen Replacement Tx )

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• Undifferentiated ~ lebih sensitif thd terapi
• Silindris  Ca primernya pasti adeno
• sQ  Ca primernya adalah sq cell ca

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Clinical symptom :
* Obstructive ileus ( 85 – 100% cases )
* Weight < , nausea/vomiting, pain
* pruritus ~ pd gx fx ginjal
* dark brown urine
* Acholis faeces
* fever  ascending cholangitis
* hepatomegali ( +/- 50% kasus )
* gallbladder > ( +/- 25% kasus )
 Courvoisier Law
Diagnosis :
* Clinical symptom
* Radiology : Cholangiography, USG, CT Scan
* Duodenal cytology, histopatology
Prognosis :
* poor, death in 6 month – 1 year
* periampullaris region : prognosis > better 27
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AdenoCa

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Pankreas
1. Inflammation
* Acute pancreatitis
* Chronic pankreatitis
2. Tumor
* pancreatic carcinoma

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Pancreas ~ berat bgt sama ky osteogenic sarcoma

D. Choledochus

D. pancreaticus

Papilla Vateri

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Terima kasih
Selamat Belajar

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