Liver Pathology Flashcards
What are the 2 scenarios when a biopsy is useful in liver pathology?
Establish primary diagnosis when not clear from other diagnostic modalities i.e. different modalities are suggesting different diagnoses
Provide additional information in cases where primary diagnosis already been made
I.e. grading inflammation or staging fibrosis
What are the 3 different methods of taking a liver biopsy?
Percutaneous (most common)
Transjugular
-helpful in cases of portal hypertension
Open
-occurs opportunistically during open surgery
What are the 3 components of portal tracts?
How can you differentiate between them histologically
Portal =vein
- thin walled
- larger than others
- might contain RBC
Bile duct
- lined with biliary epithelium i.e. tube surrounded by lining of single layer of cells
- doesn’t contain any RBC
Hepatic artery
- thick wall
- might contained RBC
Surrounded by tissue= quiescent fibroblast
What is a hepatic sinusoid and what is its primary function?
What is a key characteristic of the endothelium lining the sinusoids?
Microvascular structure between portal vein and terminal hepatic vein which seperate hepatocytes
Site of exchange between the blood and perisinusoidal space (space of Disse)
Lined with fenestrated endothelium (sinusoidal epithelium
What is the space of Disse?
Perisinusoidal space containing stellate cells (lipocytes) which contain lipids and act to moderate fibrosis in disease
What are Kupffer cells?
Liver-resident macrophages
What are the 3 different zones in the liver parenchyma and what are the features/difference of each zone?
Zone 1= Periportal
- best oxygenated-> most resistant to ischaemia
- 1st effected by viral hepatitis or toxic substance i.e. will recieve then 1st preferentially to the other zones
Zone 2= Intermediate zone
-affected in yellow fever
Zone 3= pericentral/centrilobular zone
- least oxygenated-> most susceptible to ischaemia
- most sensitive to metabolic toxins due to being the furthers away from blood supply to remove the toxins
- highest amount of CYP450
I.e. zone 1 receives oxygen 1st and zone 3 receives oxygen last
What are the different histological manifestations of liver disease?
Reversible liver injury
- ballooning
- steatosis
- cholestasis
Inflammation
Cell death
Healing and repair
Neoplasia
Why does ballooning occur in liver pathology?
Occurs due to dysfunction of hepatocytes membrane due to damage leading to entry of sodium and water into the cell leading to accumulation of intracellular fluid and swelling of organelles
What are Mallory-Denk bodies and when do they occur?
Cytoplasmic inclusions within ballooned heptaocytes due to collapse of the cytoskeletal frame work leading to accumulation of keratins and ubiquitin
-pinky staining of ballooned hepatocytes
Can occur in NAFLD and ALD
What is steatosis and how does it appear histologically?
Accumulation of fat droplets within hepatocytes
White round circles which distend hepatocytes and displace nucleus to the edge
How does cholestasis present histologically?
Accumulation of bile in liver= bilirubinostasis
-appears as “bile plugs” in bilary tracts in liver parenchyma i.e. not normally present due to bile being excreted
Accumulation of copper
-due to copper normally being excreted in bile
Hepatocyte ballooning
-appears feathery due to cellular damamge from accumulated bile salts
Ductular reaction
- proliferation of bilary tracts in portal tracts to try and regeneration bile structures and remove static bile
- will see clusters of multiple biliary ducts when would only expect to see individual
What special stain is used to highlight copper deposition in hepatocytes?
Orcein stain
-makes copper deposists appear like dark granules within hepatocytes
What special stain can be used to better highlight ductular reaction?
Immunoperoxidase for CK7
I.e. CK7 is a marker for biliary epithelium
What are the 3 native antigen presenting cells in the liver?
Dendritic
Sinusoidal endothelial cells
Kupffer cells
