03-17 Path of Hepatitis Flashcards
—Describe the morphologic patterns of hepatic injury —Compare and contrast the pathologic differences between acute and chronic hepatitis —Describe the most important/common causes of liver injury and their histological features —Describe the histological features of metabolic liver diseases
OBJECTIVE: Describe the morphologic patterns of hepatic injury
periportal inflammation/necrosis - usually due to exposure to a toxin or what have you b/c it’s closer to the portal input
central venular necrosis - happens be/c farthest away from blood supply, so therefore these hepatocytes are more vulnerable
OBJECTIVE: Compare and contrast the pathologic differences between acute and chronic hepatitis
ACUTE
- dense inflamm infiltrate around the portal tract
- w/ periportal, spotty necrosis
- ballooning cells
CHRONIC
- lesser, lymphocytic infiltrate around portal tract
- bridging necrosis/fibrosis between portal tract and central venule
- ground glass cells
Label these structures
- central venule
- portal tract
- portal tract
Dx here?
- Dime lo que ves
- ballooning (hydropic) cells
- diffuse inflammatory infiltrate
- lymphs, M0s and hyperplastic Kupffer cells
- some necrotic areas
- some regenerating hepatocytes
What structure is this arrow pointing to?
an acidophilic body, which is a necrotic hepatocyte
- seen in both acute (more) and chornic (fewer seen)
OBJECTIVE: most important/common causes of liver injury
- i.e. what things cause acute hepatitis histo picture?
- what things cause chronic histo picture?
Acute Hepatits DDx
- Hepatotropic viruses: A, B, C, D, E
- Non-hepatotropic viruses: EBV, CMV, Herpes simplex, Herpes Zoster, Adenovirus, etc
- punched out pattern of necrosis
- often see viral inclusion bodies
- Drug-induced: Two Patterns
Chronic Hepatitis DDx
- Autoimmune hepatitis
- B virus
- C virus
- Drug-induced
- Ethanol
- Others: Hereditary hemochromatosis, Wilson’s disease,
Grading vs. Staging of hepatitis?
- Cartoon below is for which one?
Grading [seen here] is looking at the degree of:
- interface hepatitis
- lobular activity
- (inflam, foci of parenchymal necrosis & apoptotic bodies)
Staging [seen on reverse] is looking at the degree of fibrosis
Histologic features of acute hepatotropic viral hepatitis?
Same as general acute hepatitis
- spotty necrosis
- ballooning hepatocytes → necrotic acidophilic body
- etc.
Histo features of acute hepatitis due to non-hepatropic viruses
Usually only a problem in the immunosuppressed
- punched out pattern of necrosis
- often see viral inclusion bodies
- HSV hepatitis seen here
Histo features of acute hepatitis due to drugs
Submassive or massive necrosis (See here)
Two Clinical Patterns:
- Predictable/Direct Hepatoxicity
- degree of damage dose-related
- Idiosyncrasy/Immunological Rxn
- Seemingly unrelated to dose
- insidious onset (therefore often not caught in trials
Can cause pretty much any liver damage pattern you can imagine (bolded ones where mentioned on own slides)
- Acute or chronic hepatitis
- Granulomas
- Steatohepatitis
- Cholestasis
- Zone 3 necrosis
- Zone 1 necrosis
- Fibrosis
- Mitochondrial cytopathies
- Vascular
- Sclerosing cholangitis / primary biliary cirrhosis - like
- Benign & malignant tumors
- Steroids can cause HCC, others
Histo features of chronic AIH
Expect to see:
- extensive hepatocellular damage
- Piecemeal necrosis (interface hepatitis)
- Predominantly lympho-plasma-cellular infiltrate with eosinophils
- plasma cells [seen here]
- eccentrically-located nuclei and basophilic cytosol
- hepatocytes in rosette formation
Histo features of chronic Hep B
Similar to other cause of chronic hepatitis but:
- “Ground glass” hepatocytes [seen here]
- No steatosis
- Marked variation of hepatocytes
Histo features of chronic Hep C
Three main findings
- Portal lymphocytic infiltrate [seen here]
- Bile duct damage [seen here]
- Steatosis
Histo features of chronic drug-induced injury
highly varied depending on drugs as w/ acute
example here of cholestatic drug-induced liver injury
Histo features of chronic EtOH abuse
DDx is NASH
- Steatosis
- Mallory hyaline deposits (more than NASH) [shown here]
- Central hyaline fibrosis
- unique to more severe EtOH hepatitis, not NASH
How do you make histopath dx of HDV?
You can actually just stain for HDV (also HBV)
Histo of chronic hep 2° to A1AT Def
Intracellular globules in periportal hepatocytes, which are D(iastase)-PAS reactive (see here)
Histo of chronic hep 2° to Wilson’s
Pathology: Chronic Hepatitis but many forms
- Steatosis
- Ballooning degen. of hepatocytes
- Mallory-Denk hyalins
- Glycogenated nuclei
- Increased Cu in the hepatocytes (Rhodanin stain) [seen here]
- Fibrosis and cirrhosis [seen here] or massive hepatic necrosis
In acute presentations mimics fatty liver dz…tricky, need to keep on DDx
Histo of chronic Hep 2° to Hereditary Hemochromatosis
- iron deposition
- peri-portal inflammation [seen here] becoming more diffuse if not tx’ed
