A 36-year-old man from sub-Saharan Africa presents to the clinic with jaundice and right upper quadrant pain. On examination, the liver is palpably enlarged. Laboratory studies demonstrate an increase in liver enzymes. Computed tomography demonstrates a single large mass in the right lobe of the liver, and serum a-fetoprotein is markedly elevated. Which of the following is likely to have contributed to the patient's condition?
High-Yield Explanation
Aflatoxin B1 Fungal metabolite found on moldy nuts and grain Co-carcinogen with hepatitis B, Increase the incidence of hepatocellular carcinoma -C. sinensis is a parasite associated with cholangiocarcinoma. -Hepatitis A has no association with malignancy. -Polyvinyl chloride is associated with Angiosarcoma of the liver. -Tetracyclines can cause microvesicular fatty change in the liver. Pattern of injury Morphological features Examples Cholestatic Cholestasis without inflammation OCP, steroids, antibiotics, HAA Cholestatic hepatitis Cholestasis with necrosis & inflammation Antibiotics, phenothiazines, statins Hepatocellular necrosis Massive necrosis Chronic hepatitis Acetaminophen, halothane Isoniazid Fatty liver disease Microvesicular steatosis Steatohepatitis with Mallory Denk bodies Valproate, tetracyclin Ethanol, amiodarone Fibrosis & cirrhosis Peripoal & pericellular fibrosis Alcohol, methotrexate Granulomas Fibrin ring granulomas Allopurinol Vascular lesions Budd Chiari syndrome OCP