L8: Liver Cytology (Beatty) Flashcards
Cholangiohepatitis localizes periportally in the liver
:)
Collect larger liver biopsy if fibrosis is expected or to increase sensitivity of diagnosis of chronic hepatitis
:)
Sensitivity of wedge biopsies better than core biopsies
:)
General advice on liver biopsy:
- 14 g needle for most dogs (16 g in small dogs)
- collect multiple samples from multiple lobes
- get biggest sample you can get safely
Which liver diseases more accurately dx with a wedge biopsy vs. Trucut core biopsy?
- hepatitis/cirrhosis
- fibrosis
- cholangitis
- portovascular anomaly
When is a FNA preferred over bigger biopsy?
- hepatic lipidosis
- vacuolar hepatopathy
- lymphoma
- neutrophilic hepatitis
Cytology has POOR correlation w/ histo when lesions are:
Focal or multifocal
When is FNA not preferred?
- lymphocytic inflamm.
- fibrosis
- cirrhosis
- portovascular anomalies
- focal mass
- early metastasis
US-guided mass FNA useful to distinguish:
- inflammatory lesions
- hyperplastic lesions
- neoplastic lesions
8 diagnostic categories of hepatic cytology
- nondiagnostic
- normal
- degenerative/metabolic
- pigment abnormalities
- extramedullary hematopoiesis
- inflammation
- hyperplasia
- neoplasia
Normal liver appearance on cytology
- epithelial
- polyhedral cells w/ round to oval nucleus and coarse chromatin
- single nucleolus
- rare mast cells
- dk. Blue pigment can be accumulation of bile pigment or lipofuscein (wear and tear pigment)
Nuclear crystals can be sign of hepatic hyperplasia
:)
Vacuolar degeneration
- common change in liver of dogs and cats
- mild, moderate, or severe
- distinct or indistinct
- indistinct due to water or glycogen accum.; looks foamy
- distinct due to lipid accum. (More common in cats); mild normal but if severe, can indicate hepatic lipidosis
- unregulated diabetes in dogs common cause
- other causes: cushings, steroid hepatopathy, toxic insult, neoplasia
Hepatic pigments
1) Lipofuscein (blue/purple; older animals)
2) Bile (dk blue; cholestasis)
3) copper (refractile)
4) Hemosiderin (iron storage dz, etc.)
Bile cast
Due to accumulation of bile in a blocked bile duct
- will see these BEFORE liver enzymes increase!
- looks dk blue/black
Cholangitis
Inflamm. Of the biliary tree
Hepatitis
Inflamm. Of hepatocytes
*cannot tell difference b/w hepatitis and cholangitis on cyto
failure to detect lymphocytic inflammation in a FNA can’t be used to definitively exclude underlying inflamm. Dz
:)
Lymphocytic portal cholangitis most common in what age cats?
> 10 yr
Cats most often get small cell lymphoma
:)
Lymphoma most common in cats of what age?
> 10 yr
Chronic cholangitis is most common in cats of what age?
Middle age (9yr)
Lymphocytic cholangitis most common in cats of what age?
Young to mid
False positives for hepatic inflammation
- leukocytosis
- EMH
- leukemia
- abd. Effusion
TRUE inflamm. Will be neutrophilic, lymphocytic, or pyogranulomatous
Hard to differentiate hyperplasia vs. well-differentiated neoplasia in the liver
:)
Chars. Of nodular hyperplasia
- idiopathic
- common in older dogs
- no CS
- increased ALP
- nodules vary in size and #
- may be mistaken for regenerative nodules
Most commonly diagnosed liver neoplasm**
Lymphoma (met. Dz more common than 1ary liver neoplasia)
Primary Neoplasia of the liver
- hepatocellular (dogs)
- bile duct (cats)
- anaplastic carcinoma
- neuroendocrine
- sarcoma
- myeloproliferative
- round cell
Hepatocellular carcinoma usually on the left side of the animal
:)
May need histo to differentiate b/w normal, hyperplasia, adenoma, or well differentiated carcinoma in the liver
:)
If lymphoma involves the liver, what stage is it?
4
Indications for liver biopsy
- icterus in plasma
- colorless/gray feces
- clinical icterus (>2.0 bilirubin)
- ammonium biurate crystals in urine
- hepatomegaly on rads/US
- evidence of liver masses
