Liver pathology Flashcards
The ______ constitutes 70% of the afferent blood volume of the liver and is rich in nutrients but relatively poor in oxygen
portal vein
What is the anatomic unit of the liver?
liver lobule- histologically definable and divided into periportal, mid, and centrilobular areas
What is the functional unit of the liver?
Liver acinus (zones 1 to 3) occupies adjacent sectors of neighbor hexagonal liver lobules
The hepatocytes in zone 3 (the centrilobular area) have the highest levels of _________
CYP450 enzymes
= least oxygen and greatest levels of toxic eletrophilic metabolites generated by P450s
What conditions show ballooning degeneration?
alcohol, drugs, toxins, ACUTE viral hepatitis
In what conditions do triglycerides accumulate in injured but viable hepatocytes?
Alcohol, drug toxicity (aspirin- Reye’s in children), HCV, Wilson’s disease
In the setting of ______, visible bile pigment may occur in canaliculi and hepatocytes and the centrilobular hepatocytes may be ballooned
cholestasis
______ accumulates in hereditary hemochromatosis while _____ accumulates in Wilson’s disease
iron; copper
In _______, the outlines of dead hepatocytes perisist but the nuclei disappear leaving anucleate pink cells
coagulative necrosis
Coagulative necrosis is seen in the setting of _______
ischemia
In ______, individual hepatocytes undergo lytic necrosis due to severe osmotic disturbances and the space previously occupied by hepatocytes is filled by inflammatory cells.
spotty necrosis
Spotty necrosis is seen in _____ and damage due to ______
viral hepatitis; alcohol
In _______, zone 3 of the liver parenchyma is most affected
focal necrosis
What conditions lead to focal necrosis?
ischemic injury
acetaminophen toxicity
venous outflow obstruction, Budd Chiari
What is Budd Chiari syndrome?
Budd–Chiari syndrome is a condition caused by occlusion of the hepatic veins that drain the liver. It presents with the classical triad of abdominal pain, ascites and liver enlargement. Examples of occlusion include thrombosis of hepatic veins.
_________ is severe diffuse liver injury involving most liver lobules and can be seen in acute liver failure, drugs, toxins, poisons, severe viral infection, and severe autoimmune hepatitis
massive necrosis
What etiologies can cause apoptosis in hepatocytes?
viral hepatitis, drugs
List the three leading causes of cirrhosis
alcohol
viral hepatitis
NAFLD
Describe the gross appearance of the liver in alcoholic steatosis
swollen, yellow, greasy
Describe the microscopic appearance of the liver in alcoholic steatosis
pure steatosis with no inflammation, most pronounced in zone 3
Describe the microscopic appearance of alcoholic steatoheptatitis
steatosis with neutrophilic inflammation
Mallory bodies- degenerating cytokeratin intermediate filaments
What sort of inflammatory infiltrate is seen in alcoholic steatohepatitis?
neutrophilic
Alcoholic cirrhosis is initially characterized by uniform _________
micronodular cirrhosis
List the clinical entities included within the category NAFLD
steatosis
NASH
Cirrhosis
Describe the inflammatory infiltrate in viral hepatitis
mixed but predominantly lymphocytes
Describe the histology of acute viral hepatitis
Mixed inflammation throughout the liver in parenchyma and portal tracts
Ballooning of hepatocytes
Apoptotic bodies
Describe the histology of chronic viral hepatits
Portal inflammation with lymphocyte predominance
Interface inflammation extending from periphery of portal tract into parenchyma
Ground glass hepatocytes in HBV
no ballooning
The ________ appearance of hepatocytes is characteristic of chronic HBV infection
ground glass
Describe the pattern of inflammation in chronic viral hepatitis
interface inflammation with lymphocyte predominance
Describe the pattern of inflammation in autoimmune hepatitis
plasma cells
Describe the histologic findings in hereditary hemochromatosis
brown iron pigment diffusely in all hepatocytes
increasing fibrosis or cirrhosis
How does iron damage hepatocytes
Direct hepatotoxin, causes free radical injury to hepatocytes
What other organs are affected by hereditary hemochromatosis?
pancreas
skin
myocardium
endocrine organs
In Wilson’s disease, _______ levels are decreased
ceruloplasmin
How does alpha 1 antitrypsin deficiency cause liver damage?
PiZZ genotype
abnormally folded protein accumulates in hepatocytes leading to cell death, fibrosis, cirrhosis
What characteristic histologic feature is seen in A1AT deficiency
pink protein globules in hepatocytes, stain + for PAS
How does congestive heart failure lead to liver damage?
increased pressure in vena cava–>
increased pressure in hepatic veins–>
dilation of terminal hepatic vein and sinusoids (nutmeg liver)–>
pressure atrophy and necrosis of perivenular hepatocytes–>
perivenular fibrosis leading to cirrhosis
________ is due to infection of the biliary tree with enteric bacteria
ascending cholangitis
List signs and symptoms of biliary disease
cholestasis
pruritis
janudice
increases in ALKP, GGT, conjugated bilirubin
__________ antibodies are often seen in primary biliary cirrhosis
anti mitochondrial
Describe the pattern of inflammation in PBC
inflammation is centered on the bile dugs giving rise to florid bile duct lesions (lymphocytes and granulomas near bile duct)
Lymphocytic infiltration and formation of granulomas near the bile duct is characteristic of ______
primary biliary cirrhosis, PBC
Describe the findings in primary sclerosing cholangitis
segmental acute inflammation and periductal fibrosis
strictures and beading
onion skin lesions with periduductal concentric fibrosis
PSC is associated with an increased risk of:
cholangiocarcinoma
Histologic finding of onion skin lesions with periduductal concentric fibrosis is highly suggestive of:
Primary sclerosing cholangitis
Metastatic tumors of the liver are more common than primary liver tumors. What primary tumors most commonly metastasize to the liver
colon> lung> breast> pancreas> stomach
List the major etiologic agents associated with hepatocellular carcinoma
chronic HBV or HCV chronic alcohol NASH Hereditary hemochromatosis aflatoxin
Describe the histology of hepatocellular carcinoma
- well differentiated: cells arranged in trabeculae or cords or tubular acini
- poorly differentiated: cells arranged in sheets
- nuclei are larger, darker, atypical appearing
List etiologic risk factors for cholangiocarcinoma
PSC
liver fluke opisthorchis sinensis
Describe the microscopic appearance of cholagniocarcinoma
The carcinoma cells are arranged in tubules (acini) or are in solid nests or sheets.
They are associated with an intense fibrous stroma, called a desmoplastic response.
_________ invasion by malignant cells is common in cholangiocarcinoma
perineural
______ is a pediatric malignant neoplasm composed of epithelial cells
hepatoblastoma
_______ is a mesenchymal neoplasm of the liver formed by vascular channels lined by malignant endothelial cells
angiosarcoma
List risk factors for angiosarcoma
polyvinyl chloride
arsenic
thorotrast
_______ is a benign neoplasm of hepatocytes with a bland cytology and is common in young women on oral contraceptives or men using anabolic steroids
hepatic adenoma
CCL4 exposure is a risk for development of:
fatty liver and necrosis
nitrosamines in smoked foods are a risk factor for development of:
esophageal squamous cell carcinoma and some gastric adenocarcinomas
