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.Pathology 3 > Liver > Flashcards

Liver Flashcards

1
Q

describe macrovesicular steatosis and causes of it

A
  • large droplet: single fat vacuole displaces the nucleus to periphery
  • small droplet: multiple fat vacuoles (not as fine as microvesicular)
  • causes:
    • alcohol
    • NASH/NAFLD (metabolic)
    • malnutrition
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2
Q

describe microvesicular steatosis and causes of it

A
  • multiple fine vacuoles, nucleus is central
    • acute fatty liver of pregnancy
    • Reye syndrome
    • drugs
      • NSAIDs, acetaminophen
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3
Q

list the 3 characteristics of cirrhosis

A
  • bridging fibrous septa
  • parenchymal nodules created by regeneration
  • diffuse involvement of liver
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4
Q

cirrhosis leads to an increased risk of ___

A

cirrhosis leads to an increased risk of hepatocellular cancer (HCC)

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5
Q

describe the consequences of portal HTN

A
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6
Q

describe autoimmune hepatitis

A
  • common in females
  • elevated serum IgG
  • anti-nuclear and anti-smooth muscle antibodies
  • anti-LKM (liver kidney microsomal type) antibodies
    • type 2, children/teens
  • prominent interface and lobular activity, plasma cell infiltrate common
  • respond to immunosuppressive therapy
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7
Q

describe primary biliary cholangitis

A
  • formerly called primary biliary cirrhosis
  • disease of middle-aged women
  • antimitochondrial antibodies
  • non-suppurative, granulomatous destruction of small and medium-sized bile ducts
  • ductopenia and cirrhosis
  • secondary biliary cirrhosis
    • due to partial or total bile duct obstruction
    • tumors, strictures, gallstones implicated
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8
Q

____ antibodies are found in PBC

A

antimitochondrial antibodies are found in PBC

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9
Q

describe the histology in primary biliary cholangitis (PBC)

A
  • histology:
    • non-suppurative
    • granulomatous destruction of small and medium-sized bile ducts
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10
Q

what condition is seen in the image?

A

primary biliary cholangitis (primary biliary cirrhosis)

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11
Q

describe primary sclerosing cholangitis

A
  • extrahepatic and large intrahepatic ducts
  • periductal inflammation and fibrosis → “onion skin” lesions
  • ERCP or MRCP: dilatation and beading of the biliary tree
  • p-ANCA often positive
  • associated with UC
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12
Q

PSC affects the ___ and ____

A

PSC affects the extrahepatic and large intrahepatic ducts

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13
Q

PSC leads to ____ inflammation and fibrosis with lesions that look like ____

A

PSC leads to periductal inflammation and fibrosis with lesions that look like onion skins

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14
Q

what is seen on ERCP/MRCP in PSC?

A

dilatation and beading of the biliary tree

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15
Q

PSC is often ____ positive and is associated with ____

A

PSC is often p-ANCA positive and is associated with UC

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16
Q

describe what is seen in the image

A
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17
Q

the HFE gene is located on chr. ____

A

the HFE gene is located on chr . 6

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18
Q

list causes of secondary iron overload

A
  • parenteral iron overload
    • repeated blood transfusions
    • iron dextran injections
  • ineffective erythropoiesis
    • B-thalassemia
    • other chronic hemolytic anemias
  • increased oral intake
    • Bantu disease
  • chronic liver disease
    • alcohol, hepatitis C
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19
Q

describe how hemochromatosis affects the pancreas

A
  • pancreas
    • intensely pigmented
    • diffuse interstitial fibrosis
    • hemosiderin in both acinar and islet cells
    • diabetes mellitus
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20
Q

describe how hemochromatosis affects the heart

A
  • heart:
    • hemosiderin in myocardial fibers (cardiomyopathy)
    • delicate interstitial fibrosis
21
Q

describe how hemochromatosis affects the skin

A
  • skin
    • slate gray coloration
    • iron in dermal melanophages
    • increased melanin production
22
Q

describe Wilson disease

A
  • AR disorder located on chr. 13
  • toxic levels of Cu in liver, brain and eyes
    • brain = deposited in basal ganglia
    • eyes = deposits of copper in descemet membrane of corneal limbus = KF rings
      • sunflower cataracts
    • blood = hemolysis
23
Q

describe investigations in Wilson disease

A
  • investigations:
    • low serum ceruloplasmin
    • increased urinary Cu excretion
    • increased hepatic Cu
24
Q

describe the images

A
25
Q

describe hemangioma of the liver

A

vast majority require no treatment

  • remainder:
    • pain
    • bleeding
    • platelet consumption
26
Q

describe the image

A

hepatic hemangioma

27
Q

hepatic adenoma is associated with ___ and ___

A

hepatic adenoma is associated with oral contraceptives and anabolic steroids

28
Q

describe a hepatic adenoma

A
  • associated with oral contraceptives, anabolic steroids
  • spontaneously hemorrhage, malignant transformation
  • may be fatal during pregnancy
  • clinical pres.:
    • acute:
      • pain in abdomen
      • shock and hemorrhage
        • hemorrhage into tumor or peritoneal cavity
      • episodic pain or discomfort
    • incidental
  • normal serum AFP
29
Q

describe the 3 mutations associated with hepatic adenomas

A
30
Q

describe focal nodular hyperplasia (FNH)

A
  • associated with OCs
  • most often small, may be large
  • central scar on CT, MRI
  • resect if symptomatic or uncertain diagnosis
31
Q

describe the image

A
32
Q

describe hepatoblastoma

A
  • most common liver tumor in neonates and young children
  • clinical presentation:
    • hepatomegaly or abdominal mass, jaundice care
  • associated with Beckwith-Wiedermann syndrome, Down syndrome, familial polyposis coli, hemihypertrophy, renal malformation and various cytogenic abnormalities
  • AFP elevated
  • rapid growth, poor prognosis, spreads to lungs, LN and peritoneum
33
Q

hepatoblastoma is the most common liver tumor in ____ and is associated with…. (6 conditions)

A

hepatoblastoma is the most common liver tumor in neonates and young children and is associated with:

  1. Beckwith-Wiedermann syndrome
  2. Down syndrome
  3. familial polyposis coli
  4. hemihypertrophy
  5. renal malformation
  6. various cytogenic abnormalities
34
Q

the fetal epithelial morphology in hepatoblastoma resembles ____

A

the fetal epithelial morphology in hepatoblastoma resembles fetal liver

35
Q

describe the embryonal epithelial morphology in hepatoblastoma

A

smaller, round, fusiform cells arranged in rosettes, cords and ribbons

36
Q

describe a hepatoblastoma with combined epithelial-mesenchymal components

A
  • epithelial with mesenchymal elements
    • fibrous tissue
    • osteoid or cartilaginous differentiation
37
Q

describe the histology of hepatocellular carcinoma

A
  • histology:
    • well differentiated to poorly differentiated
    • trabecular, sinusoidal, or pseudoacinar pattern
    • bile production by tumor cells, cytoplasmic inclusions
    • usually cirrhosis in adjacent liver parenchyma
38
Q

describe the image

A
39
Q
A
40
Q

describe clinical features of HCC

A
  • not uniform
  • usually masked by underly0-ing liver disease
  • ill-defined upper abdominal pain, fatigue, cachexia
  • raised AFP levels in 60-75%
  • diagnosis = FNA, biopsy
41
Q

describe fibrolamellar variant of HCC

A
  • younger age
  • no association with HBV or cirrhosis
  • AFP normal
  • outcome similar to HCC in non-cirrhotic liver
  • usually single hard tumor with fibrous bands traversing through it
  • well-differentiated polygonal cells in cords or nests, separated by fibrous septa
42
Q

in the fibrolamellar variant of HCC, there is no association with ___ or ___, and ____ is normal

A

in the fibrolamellar variant of HCC, there is no association with HBV or cirrhosis, and AFP is normal

43
Q

in the fibrolamellar variant of HCC, there are well-differentiated ____ in cords or nests, separated by ____

A

in the fibrolamellar variant of HCC, there are well-differentiated polygonal cells in cords or nests, separated by fibrous septa

44
Q
A
45
Q

describe the image

A

cholangiocarcinoma

multifocal cholangiocarcinoma in a liver from a patient with infestation by the liver fluke Clonorchis sinensis

46
Q

describe the image

A

cholangiocarcinoma

invasive malignant glands in a reactive, sclerotic stroma

47
Q

describe the Charcot triad and what it is associated with

A

Charcot triad is associated with cholangiocarcinoma

  • Charcot triad = jaundice, fever, chills
48
Q

describe the Raynaud pentad and what it is associated with

A

Raynaud pentad is associated with cholangiocarcinoma

  • Raynaud pentad = Charcot triad + hypotension and mental status changes
    • poor prognostic sign
49
Q

describe metastasis to the liver

A

.Pathology 3 (8 decks)

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