Histo Path - Liver Flashcards
Which hepatocytes are most metabolically active?
Zone 3 - Perivenular (aka centrolobular) cells located near the terminal hepatic vein are more metabolically active.
Zone 1 - Periportal cells hepatocytes located near the portal tract (i.e. Zone 1) receive blood rich in
nutrients and O2
What do hepatic perivenular/portal cells do?
Break things up (perivenular zone 3)
Glycolysis (breaking down glucose)
Glycogenolysis? (probs)
Alcohol metabolism
Fat metabolism
Build things up (periportal zone 1)
Gluconeogenesis
B oxidation
Cholesterol synthesis
What are the histopathological markers of cirrhosis?
regenerating nodules and fibrosis
Change in liver vascular architecture: shunting of blood to bypass liver (gastro-oesophageal)
Extra-hepatic shunting: Porto-systemic anastomoses e.g. oesophageal varices
Intra-hepatic shunting: Blood entering the liver immediately enters the central vein and bypasses hepatocytes. This is due to fibrotic bridges between portal tract and central vein.
How is cirrhosis classified?
By nodule or cause (aetiology) - fatty (micro) or viral (macro)
MICRONODULAR (nodules < 3mm). Uniform liver involvement.
● Caused by: alcoholic hepatitis, biliary tract disease
MACRONODULAR (nodules > 3mm). Variable nodule size.
● Caused by: viral hepatitis, Wilson’s disease, alpha1 antitrypsin deficiency
Mallory-denk body
Alcoholic hepatitis
Pink infiltrates
Should also have ballooning hepatocytes - from cytoskeletal sctructure loss
Spotty Necrosis
ground glass hepatocytes with central ballooning degeneration
Acute hepatitis
Inflammation and apoptosis spread everywhere
Neutrophil infiltration
Alcoholic hepatitis
Lymphocyte = viral hep
Lymphocyte infiltration
Viral hepatitis
Inflammation confined to the portal tract, marked by the Limiting plate
Portal inflammation
A mononuclear inflammatory cell infiltrate extends from portal areas and disrupts the limiting plate of hepatocytes which are undergoing apoptosis
Interface hepatitis
‘piecemeal necrosis’ - not necrosis
Inflammation in the lobules
Lobular Inflammation
Granulomas infiltrating the bile duct
PBC
Will also have anti-mitochondrial antibodies
Early stage: Granulomas infiltrate bile duct Late stage: Cirrhotic changes with complete loss of BDs.
Periductal fibrosis or portal firbrosis
Normal hepatocytes
Mitochondria stain bright green
PSC
In PBC - bile duct loss only happens in late stage.
In PSC, you get BD loss but no Abs or hepatocyte damage
ERCP beaded appearance, has UC
PSC
Dark brown liver
Haemochromatosis
Hemochromatosis leads to bronze pigmentation of skin, diabetes mellitus (from pancreatic involvement), and cardiac arrhythmias (from myocardial involvement).
‘Chocolate brown’
Stain for haemochromatosis
Prussian blue
haemosiderin deposition - dark blue
Granular brown deposits
Haemosiderosis or Haemochromatosis
Same thing but haemochromatosis is when symptoms show up
Yellowish-Green accumulations
Bile - cholestasis
liver collapse with abundant lipofuscin (yellow-brown deposits) due to degraded membrane fragments; remaining liver shows low-grade disease with fibrosis
Fulminant hepititis
Reddish brown deposits with rhodanine stain
Wilson’s
On gross dark red congestions, nutmeg
Right sided heart failure
Round to oval cytoplasmic eosinophilic globular inclusions in periportal hepatocytes
Also hepatocellular degeneration, giant cell formation, cholestasis and cholangitis, portal fibrosis and cirrhosis
A1aT deficiency
Intra-cytoplasmic inclusions
α1 antitrypsin remains stocked in hepatocytes and causes damage
Portal plasma cell rich inflammation
diffuse whitish-gray plaque without nodularity or cirrhosis
portal inflammatory cells eroding through the limiting plate between the portal tract and liver parenchyma
Autoimmune hepatitis
Interface hepatitis with plasma cells
Interface means not confined to the portal tract, extending beyond the limiting plate
Plasma cells make loads of antibodies
Anti-smooth muscle actin (anti-SMA) antibodies
Caseating granuloma
TB
Cancer
Aspergillus, Cirrhosis, Hep B, Hep C
Hepatocellular Carcinoma
USS and AFP
Cancer
Soft, red/purple
Variably-sized vascular spaces
Well circumscribed
Haemangioma
Most common primary tumour in liver. Usually incidental.
Cancer
Multiple tumour
Adenocarcinoma
Mets from GI, lung or breast
Can also be primary cholangiocarcinoma - very hard to tell on histo alone (hx important)
Cancer
Smooth, well circumscribed
Hepatic Adenoma
