7. Pathology Of The Liver, Gallbladder, And Pancreas - BP Flashcards
With what viral hepatitis do we see cholestatic hepatitis as an outcome?
Hep A
What is the microscopic morphology of acute viral hepatitis?
- Ballooning degeneration, hepatocyte necrosis (acidophil bodies), and lobular disarray (loss of architecture).
- Portal tract inflammation - mononuclear infiltrate with or without spillover into the surrounding parenchyma.
- Spotty of bridging necrosis.
- Possible cholestasis.
With what morphology is hep B associated?
Ground-glass hepatocytes.
With what morphology is hep C associated?
With mild fatty change (macrovesicular steatosis in sublobular region, lymphoid aggregates, and reactive bile duct epithelium.
What is the microscopic morphology of chronic viral hepatitis?
- Evidence of hepatocyte injury (ballooning degeneration), necrosis, and regeneration.
- Portal tract inflammation with or without spillover.
- Fibrosis –> portal, periportal, or bridging.
What is referred as interface hepatitis?
Portal tract inflammation with spillover.
Mention some drugs that affect the liver.
- Acetaminophen –> centrilobular necrosis
- Vinyl chloride, thorotrast –> angiosarcoma
- Oral contraceptives –> hepatic adenomas
- Chlorpromazine –> cholestasis
- Halothane –> fulminant hepatitis
- Phenytoin, isoniazid –> acute/chronic hepatitis
- Methotrexate, Amiodarone –> fibrosis and cirrhosis
- Sulfonamides –> granulomas
What is the MC neoplasm affecting the liver?
A metastasis
What are in, decreasing order of occurence, the common sources of liver metastases?
- Lung
- Colon
- Pancreas
- Breast
- Stomach
What is the target group of hepatocellular carcinoma?
> 60, but depends upon risk factors.
Mention some major risk factors for development of HCC.
- 85-90% a background of cirrhosis –> HBV, HCV, Wilson, hemochromatosis, chronic alcoholism are risk factors.
- Aspergillus flavus (Produces aflatoxin).
What is special about HCC?
Its propensity for blood vessel invasion.
What is the gross morphology of HCC?
Tumor may be unifocal, multifocal, or diffuse.
What is the microscopic morphology of HCC?
The more well-differentiated forms look like hepatocytes and can produce bile as well as manifest accumulations of fat (steatosis) and Mallory hyaline.
What are the symptoms of HCC?
- Abdominal pain
- Abdominal mass
- Weight loss
- Deterioration of liver function
What are the signs of HCC?
Incr. α-fetoprotein –> over 400ng/mL.
What are the risk factors of cholangiocarcinoma?
- Primary sclerosing cholangitis
- Opisthorchis sinensis infection
- Thorotrast
What are the forms in which cholangiocarcinoma and HCC can occur in combination?
- Two seperate tumors
- A collision tumor
- A mixed tumor
What is the focal nodular hyperplasia?
Benign tumor - has histologic features similar to cirrhosis.
What is the epidemiology of focal nodular hyperplasia?
Young to middle-aged females.
What is the gross morphology of focal nodular hypeplasia?
Nodule with a central scar.
What is the microscopic morphology of focal nodular hyperplasia?
Nodules of hepatocytes, divided by fibrous septae with bile ductular proliferation within the fibrous septae.
What is the epidemiology of hepatic adenoma?
Young women using oral contraceptives.
What are the complications of hepatic adenoma?
Can rupture and can harbor HCC.
What is the microscopic morphology of hepatic adenoma?
- Nodules of hepatocytes with fibrous septae.
2. No bile duct proliferation within fibrous septae.
What is important to remember for hepatic hemangioma?
- It is common.
2. Could rupture, causing hemoperitoneum.
What type of hemangioma is usually the hepatic one?
Cavernous
What is the target group of hepatoblastoma?
Children
What is the genetic abnormality of hepatoblastoma?
Activation of Wnt/β-catenin signaling pathway by mutation of β-catenin gene in 80% of tumors.
What are the two types of hepatoblastoma?
Epithelial and mixed epithelial and mesenchymal types.
What is the microscopic morphology of epithelial hepatoblastoma?
Composed of small cells resembling fetal and embryonal cells.
What is the microscopic morphology of mixed epithelial and mesenchymal hepatoblastoma?
Epithelial cells and mesenchymal stroma (bone, cartilage, muscle).
