Liver Flashcards
Compare bile duct adenoma and bile duct hamartoma (von Meyenburg complex)
BDA - well formed mostly small ducts in a fibrotic stroma, often subcapsular with CI at edge
VMC - more often multiple, ducts tend to be more dilated and focally contain bile (part of biliary plate malformation - can be associated with PCKD, or PCLD)
Give the key histologic features of EBV hepatitis and CMV hepatitis
EBV-“beads on a string” sinusoidal lymphocytic infiltrate with occasional atypical lymphocytes within sinusoids
CMV – immuno compromised – hepatocytes with inclusions surrounded by neutrophilic microabscesses;
immunocompetent - either identical to EBV hepatitis or microgranulomas
For an inflammatory pseudotumor in the liver, what do you need to consider as etiologies? What extra tests would you get to rule in/ out these
IMT (check for ALK)
Infection
IgG4 - related sclerosing disease
inflammatory pseudotumor variant of follicular dendritic cell sarcoma (FDCS) - will be EBER +
Describe the key histologic, genetic mutational, and immunohistochemical features of the types of hepatocellular adenomas (HCAs) - and include their relative proportions - and FNH
Inflammatory (AKA telangiectatic) (40-50%) - mutation in IL6T, GNAS, STAT3 - see inflammation in some pseudo-portal tracts, sinusoidal ectasia, and there may be steatosis and ductular reaction (can look like FNH, but GS is not map-like) – IHC + for SAA or CRP
Steatototic (30-40%) - HNF1alpa inactivating mutation - see abundant macrovesicular steatosis – IHC shows LOSS of LFABP (normal liver adjacent will be positive)
Beta-catenin activated type (10-15%) – activating b-catenin mutation – see acini formation and some nuclear atypia – IHC shows nuclear and cytoplasmic positivity, AND Glutamine synthetase is diffuse and strong —- this is the most likely to progress to HCC
Unclassified (10%)
FNH - cirrhosis like nodular parenchyma with fibrous septa with thick and thin walled vessels, and ductular reaction along edges – GS shows map-like or geographic distribution
