Gupta only pics Flashcards
Parotid gland
Most common cause?
Sialandenitis
S. aureus
What can this cause if recurrent or persistent?
Sialolith
causes: Chronic Sialadenitis
Cannot be scraped off
Cause?
Hairy Leukoplakia
caused by: EBV
bottom: hyperkeratosis, acanthosis, BALLOON cells in upper spinous layer
Association?
Erythroplakia
association: tobacco use
oral
Leukoplakia
severe dysplasia
nuclear and cellular pleomorphism; mitoses, loss of maturation
- Normal
- Hyperplasia/Hyperkeratosis
- Mild/moderate dysplasia
- severe dysplasia/carcinoma in situ
- squamous cell carcinoma
originates around crown of an unerupted tooth
association?
Dentigerous cyst
lined by thin layer of stratified squamous epithelium with dense chronic inflammatory cell infiltrate
association: impacted thrid molar (wisdom) teeth, ameloblastoma
oral
Key to Dx?
association?
odontogenic keratocyst
thin layer of keratinized stratified squamous epithelium with prominent basal cell layer and a CORRUGATED EPITHELIAL SURFACE (key to Dx)
association: nevoid basal cell CA syndrome
middle or internal ear
associated with?
Cholesteatoma
cystic lesions (1-4 cm) lined by keratinizing stratified squamous epithelium or metaplastic mucus secreting epithelium and filled with amorphous debris
associated with: chronic otitis media
Arise from?
Branchial Cyst (Cervical Lymphoepithelial Cyst)
LATERAL: upper lateral aspect of the neck along the sternocleidomastoid muscle
left: microfibrous wall lined by stratifeid squamous or psuedostratified columnar epithelium; LYMPHOID tissue with GERMINAL CENTERS
arise from: remnants of second branchial arch
Arises from?
Tx?
Thyroglossal duct cyst
MIDLINE
lined by stratified squamous epithelium or pseudostratified cloumnar epithelium
connective tissue may have lymphoid aggregates or thyroid tissue
arise from: remnants of thyroid tract from foramen cecum at base of tongue to anterior neck
Tx: excision
esophageal diverticulum
Association?
Mallory-Weiss tears
lacerations: longitudinal mucosal tears near GE junction
association: severe retching (bulimia, alcoholic)
tend to heal without intervention
Tx?
produces?
can present as?
DDx?
Boerhaave syndrome
transmural tearing and RUPTURE of distal esophagus
pic: contrast extravasion from distal esophagus
produces: severe mediastinitis
Tx: surgical intervention
can present as: chest pain, tachypnea and shock
DDx: MI
Diaphragmatic Hernia
Diaphragmatic Hernia
left: omphalocele
right: gastrochesis
Omphalocele
Gastrochisis
Ileum
Meckel diverticulum
Esophageal mucosal web
Esophageal (Schatzki) rings
Viral esophagitis
A: herpetic ulcers in distal esophagus
B: multinucleate squamous cells containing herpesvirus NUCLEAR inclusions
C: CMV infected endothelial cells with NUCLEAR and CYTOPLASMIC inclusions
Candida
Esophageal graft-versus-host disease
basal cell apoptosis, mucosal atrophy, submucosal fibrosis
NO significant acute inflammatory infiltrates
Stress ulcers
due to: ISCHEMIA shock, sepsis or trauma
Gastric Antral Vascular Ectasia
WATERMELON stomach
bottom: antrum: reactive gastropathy with dilated capillaries and fibirn thrombi
After hematopoietic stem cell transplantation
What is most commonly involved?
Mechanism?
Graft Vs Host disease
most commonly involved: small bowel and colon
mechanism: donor T cells target antigens on recipient GI epithelial cells (sparse lymphocytes in lamina propria)
epithelial apoptosis (particularly crypt cells)
What causes this?
condyloma acuminatum
HPV
anal canal
associated with?
most significant prognostic factors?
squamous cell carcinoma
HPV 16
prognosis: tumor size (T), node status (N)
What is req. for Dx
Acute appendicitis
cause: progressive increase in intraluminal pressure that compromises venous outflow: fecalith that obstructs lumen
Dx: neutrophilic infiltration of muscularis propria
child with right lower quadrant tenderness
acute appendicitis with Enterobius vermicularis (pinworm)
itchy butthole
Carcinoid tumor
most common tumor of appendix
BENIGN
top: solid bulbous swelling at distal tip of appendix
Appendix
Mucinous neoplasm
Appendix
mucinous neoplasm
A: circumferential growth pattern in appendiceal mucosa with variable papillary architecture
B: tumro cells with abundant mucin and enlarged hyperchromatic nuclei that are basally located with minimal cytologic atypia
C: peritoneal mucin deposits contain scant strips and clusters of mucin-containing epithelial cells
D: epithelial cells that are low grade
Focal Nodular Hyperplasia
left: central gray-white, depressed stellate scar (fibrous septa)
right: broad fibrous scar with hepatic arterial and bile duct elements (arrow); chronic inflammation present within parenchyma that lacks normal architecture due to hepatocyte regeneration
Focal Nodular Hyperplasia
Nodular Regenerative Hyperplasia
left: resembles cirrhosis
right: nodules less well defined, parenchyma softer than in cirrhosis, fibrous septa lacking
Reticulin stain
Nodular regenerative Hyperplasia
nodule at center (wide liver cell plates)
arrow: narrowed liver cell plates
NO fibrosis
Nodular Regenerative Hyperplasia
plump hepatocytes surrounded by rims of atrophic hepatocytes
arrow: sinusoidal dilation
NO inflammatory infiltrate or necrosis
Nodular Regenerative Hyperplasia
reticulin stain
atrophic hepatic cords on left alternate with plump, thickend cords on right
Nodular Regenerative Hyperplasia
trichrome stain: highlights compressed central vein
Cavernous hemangiomas
blood vessel tumor
MOST COMMON BENIGN liver tumor
left: blood-filled vascular channels separated by dense fibrous stroma
right: red-blue soft nodules located BENEATH CAPSULE
NUTMEG LIVER
What can be inactivated?
What can be activated?
Associated with?
Hepatocellular Adenoma
cords of hepatocytes, arterial vascular supply (arrow), NO PORTAL TRACTS
inactivated: HNF1-alpha
activated: B-catenin
association: oral contraceptives, anabolic steroids, MODY-3
Activation of?
Association?
Hepatoblastoma
resembles fetal liver
WNT activation
association: APC/Familial adenomatous polyposis
Hepatoblastoma
Association?
Mutations?
What is increased in 1/2 of patients?
Hepatocellular Carcinoma (HCC)
association: Hep. B and C, chronic liver disease
increased: alpha fetal protein
activation: B-catenin
inactivation: p53
Fibrolamellar Heptacellular carcinoma
under 35 yrs with no identifying pre-disposing conditions or gender predilection
Hepatocellular Carcinoma
arrow: Hep. C related cirrhosis with large nodule
nodule in nodulegrowth: evolving CA
left: top is moderately diffentiated, bottom well differentiated
often produce?
Cholangiocarcinoma (adenocarcinoma)
produce: mucin
desmoplasia (middle: pale purple in background)
perineural invasion (right), lymphovascular invasion common
Intrahepatic Cholangiocarcinoma
right: glandular
Most common sources?
liver metastasis
most common liver cancer
source: colon, breast, lung, pancreas
Kernicterus
Defect?
Dubin-Johnson
impaired excretion due to canalicular membrane carrier defect: MRP2
darkly pigmented cytoplasmic globules in liver
Cholestasis
Acute Large Bile Duct Obstruction
edema of portal stract stroma (white spaces) and ductular rxn with neutrophils at between portal tract and parenchyma
INTERFACE INFLAMMATION
What increases the risk for this?
Common causes?
What can this lead to?
Ascending cholangitis
top: neutrophils within bile duct epithelial lining and lumen
bottom: purulent bile fills and distends bile ducts
risk: large bile duct obstruction due to stasis in the biliary tree
cause: enteric organisms like coliforms, enterococci
can get: liver abscess
Sx?
Tx?
Ascending Bacterial Cholangitis
arrows: bile ductules with luminal acute inflammatory cells and hepatocytes with intracellular cholestasis
Sx: fever, chills, abdominal pain and jaundice
Tx: relief of obstruction, antibiotics
Caused by?
Chronic Biliary Obstruction: secondary or obstructive biliary cirrhosis
periportal fibrosis leading to scarring and nodule formation
arrow: nodularity and bile staining of end-stage biliary cirrhosis
caused by: uncorreceted ascending cholangitis
Biliary Liver Cirrhosis
IRREGULAR nodules: JIGSAW PUZZLE
Chronic Biliary Obstruction
FEATHERY degeneration of periportal hepatocytes
periportal MALLORY-DENK bodies
BILE INFARCTS: can be very subtle
retained bile salts cause: enlarged FOAMY hepatocytes
Cholestasis of Sepsis
due to: microbial products
most common form: canalicular cholestasis with BILE PLUGS within predominantly centrilobular canaliculi
Ductular cholestasis: ominous: SEPTIC SHOCK
dilated canals of Hering and bile ductules with bile plugs
Leads to?
Primary Hepatolithiasis: intrahepatic gallstone
atrophic right hepatic lobe with dilated and distorted bile ducts with large pigment stones and broad areas of collapsed liver parenchyma
leads to: repeated ascending cholangitis, inflammatory destruction of parenchyma, biliary neoplasia
Major cause?
Neonatal Cholestasis: conjugated bilirubin
Major cause: biliary atresia
neonatal hepatitis: lobular disarray, apoptosis and necrosis, multinucleated giant hepatocytes
Biliary Atresia
left: obliterated bile duct
right: normal bile duct
inflammation and fibrosing stricture of hepatic or common bile ducts
Primary Biliary Cirrhosis
nonsuppurative, inflammatory destruction of SMALL and MEDIUM sized intrahepatic bile ducts
Primary Biliary Cirrhosis
arrow: lymphocytic inflammation and damage to a medium size bile duct in portal tract
curved arrow: poorly formed granuloma
inflammatory damage to bile duct: results in cholestasis and damage to hepatocytes
NEUTROPHILS attack bile ducts
Primary Biliary Cirrhosis
portal fibrosis with development of cirrhosis
trichrome stain: collagen
Primary Biliary Cirrhosis
arrow: bile ductular proliferation in portal tracts proximal to obstructed regions
bile ductules: small-caliber ducts with cuboidal to flattened epithelium, often collapsed lumina
multiple bile ducutules in periphery of portal: sign of damage distal in biliary tree
Stain?
Primary Biliary Cirrhosis
CK-7 stain
absence of medium sized bile ducts inside portal tract and brisk bile ductular proliferation at portal border
Primary Biliary Cirrhosis
progressive hepatocyte damage and fibrosis, portal-portal bridging fibrosis: frank cirrhosis develops
regenerative hepatic nodule surrounded by bridging fibrosis
Primary Sclerosing Cholangitis
BEADING
inflammation and obliterative fibrosis of intrahepatic and extrahepatic bile ducts with dilation of preserved segments
Results in?
Can lead to?
Primary Sclerosing Cholangitis
LARGE duct inflammation: acute, neutrophilic infiltration of epithelium superimposed on chronic inflammation
smaller ducts: little inflammation and ONION SKIN fibrosis around atrophic duct lumen with eventual obliteration
results in biliary cirrhosis
can lead to intraepithelial neoplasia: Cholangiocarcinoma
Primary Sclerosing Cholangitis
Biliary cirrhosis, cholestasis, ONION SKIN fibrosis
Choledochal cyst
Von Meyenburg Complexes
bile duct hamartoma (always associated with portal tracts)
dilated and irregularly shaped bile ducts in fibrous stroma
What is this called if congenital hepatic fibrosis is also present?
Caroli disease
intra or extrahepatic biliary cysts
plus congential hepatic fibrosis: Caroli syndrome
Mutation?
Complications?
congenital hepatic fibrosis
portal tracts enlarged by irregular, broad bands of collagenous tissue: form septa that divide liver into irregular islands
PKHD1 mutation
complications: portal HTN, bleeding varices
congenital hepatic fibrosis
abnormally shaped bile ducts in fibrous tissue (remain continous with biliary tree)
Due to?
Budd-Chiari Syndrome
thrombosis of portal vein
centrilobular congestion/necrosis
progresses to centrilobular fibrosis
due to: polycythemia vera, myeloproliferative diseases, pregnancy, OCP, abdominal CA
left: normal
right: fatty liver
left: normal liver
middle: fatty
right: cirrhosis
Steatosis
fatty liver
Cholestasis
bilirubin
Hepatocyte apoptosis
arrow: Councilman bodies
Hepatocyte necrosis
arrow: spotty necrosis
Confluent (widespread) liver necrosis
Bridging Necrosis (liver)
link central veins to portal trats or bridge adjacent portal tracts
Liver Cirrhosis
fibrous septa that surround regenerating hepatocytes
Acute Hepatic Necrosis
portal area: inflammation (likely alcholic)
hepatocytes mostly viable
arrow: edge of necrosis
Acute Hepatic Necrosis
V: veins with surrounding necrosis
P: portal systems with viable cells
What drug can cause this?
Acute Massive liver necrosis
arrow: zone 3 with centrilobular necrosis
drug: acetaminophen
Primary defect?
diffuse microvesicular steatosis
defect: mitochondrial lesion, inhibition of mitochondrial beta oxidation of fatty acids
blue: microvesicular steatosis
green: macrovascular steatosis
Possible causes?
Cirrhosis
depressed areas of dense scar separating bulging regenerative nodules over the liver surface
Causes: Chronic Hep B or C, NAFLD, ALD
A to B
Regression of Fibrosis
A: Cirrhosis of alcoholic
B: liver after long term abstinence
What causes this?
Hepatitis B
(not any other Hep virus)
GROUND GLASS hepatocytes
Chronic Hepatitis
will see mononuclear infiltrates around portal tract and briding necrosis
G0: no activity
G1: mild activity
G2: moderate
G3: severe
Don’t memorize
Chronic Hepatitis
F0: no fibrosis
F1: portal fibrosis with no septa
F2: portal fibrosis with few septa
F3: many septa with NO cirrhosis
F4: cirrhosis
Type 1 Ab?
Type 2 Ab?
Autoimmune Hepatitis
plasma cells
type 1: ANA, ASMA
type 2: anti-LKM1
Pregnant
Preeclampsia
periportal sinusoids: fibrin deposits with hemorrhage in space of Disse
leads to periportal hepatocellular coagulative necrosis
Pregnant
Eclampsia
Blood under pressure may coalesce and expand to form a hepatic hematoma
Pregnant
Acute Fatty Liver of Pregnancy
microvesicular steatosis in zone 2 or 3
ballooning of hepatocytes and macrovesicular fat
severe: hepatocyte dropout, reticulin collapse, portal tract inflammation
Pregnancy
Intrahepatic Cholestasis of Pregnancy
mild cholestasis without cirrhosis
Gaucher Disease
Normal liver with reticulin stain
