Histo Path - Liver

Question 1

Which hepatocytes are most metabolically active?

Answer 1

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

Question 2

What do hepatic perivenular/portal cells do?

Answer 2

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

Question 3

What are the histopathological markers of cirrhosis?

Answer 3

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.

Question 4

How is cirrhosis classified?

Answer 4

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

Question 5

Mallory-denk body

Answer 5

Alcoholic hepatitis

Pink infiltrates
Should also have ballooning hepatocytes - from cytoskeletal sctructure loss

Question 6

Spotty Necrosis

ground glass hepatocytes with central ballooning degeneration

Answer 6

Acute hepatitis

Inflammation and apoptosis spread everywhere

Question 7

Neutrophil infiltration

Answer 7

Alcoholic hepatitis

Lymphocyte = viral hep

Question 8

Lymphocyte infiltration

Answer 8

Viral hepatitis

Question 9

Inflammation confined to the portal tract, marked by the Limiting plate

Answer 9

Portal inflammation

Question 10

A mononuclear inflammatory cell infiltrate extends from portal areas and disrupts the limiting plate of hepatocytes which are undergoing apoptosis

Answer 10

Interface hepatitis

‘piecemeal necrosis’ - not necrosis

Question 11

Inflammation in the lobules

Answer 11

Lobular Inflammation

Question 12

Granulomas infiltrating the bile duct

Answer 12

PBC

Will also have anti-mitochondrial antibodies

Early stage: Granulomas infiltrate bile duct 

Late stage: Cirrhotic changes with complete loss of BDs.

Question 13

Periductal fibrosis or portal firbrosis
Normal hepatocytes
Mitochondria stain bright green

Answer 13

PSC

In PBC - bile duct loss only happens in late stage.

In PSC, you get BD loss but no Abs or hepatocyte damage

Question 14

ERCP beaded appearance, has UC

Answer 14

PSC

Question 15

Dark brown liver

Answer 15

Haemochromatosis

Hemochromatosis leads to bronze pigmentation of skin, diabetes mellitus (from pancreatic involvement), and cardiac arrhythmias (from myocardial involvement).

‘Chocolate brown’

Question 16

Stain for haemochromatosis

Answer 16

Prussian blue

haemosiderin deposition - dark blue

Question 17

Granular brown deposits

Answer 17

Haemosiderosis or Haemochromatosis

Same thing but haemochromatosis is when symptoms show up

Question 18

Yellowish-Green accumulations

Answer 18

Bile - cholestasis

Question 19

liver collapse with abundant lipofuscin (yellow-brown deposits) due to degraded membrane fragments; remaining liver shows low-grade disease with fibrosis

Answer 19

Fulminant hepititis

Question 20

Reddish brown deposits with rhodanine stain

Answer 20

Wilson’s

Question 21

On gross dark red congestions, nutmeg

Answer 21

Right sided heart failure

Question 22

Round to oval cytoplasmic eosinophilic globular inclusions in periportal hepatocytes

Also hepatocellular degeneration, giant cell formation, cholestasis and cholangitis, portal fibrosis and cirrhosis

Answer 22

A1aT deficiency

Intra-cytoplasmic inclusions 

    α1 antitrypsin remains stocked in hepatocytes and causes damage

Question 23

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

Answer 23

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

Question 24

Caseating granuloma

Answer 24

TB

Question 25

Cancer

Aspergillus, Cirrhosis, Hep B, Hep C

Answer 25

Hepatocellular Carcinoma

USS and AFP

Question 26

Cancer

Soft, red/purple
Variably-sized vascular spaces
Well circumscribed

Answer 26

Haemangioma

Most common primary tumour in liver. Usually incidental.

Question 27

Cancer

Multiple tumour
Adenocarcinoma

Answer 27

Mets from GI, lung or breast

Can also be primary cholangiocarcinoma - very hard to tell on histo alone (hx important)

Question 28

Cancer

Smooth, well circumscribed

Answer 28

Hepatic Adenoma