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GI > Liver Pathology > Flashcards

Liver Pathology Flashcards

1
Q

Zone for ischemic injury?

Bile duct gets blood from?

ITO cell hyperplasia from?

A

Zone 3 near central vein (blood goes from zone 1 to zone 3)

Hepatic artery

Hypervitaminosis A; leads to fibrosis and cirrhosis

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2
Q

Acetaminophen toxicy causes?

H and E?

Tx?

A

Fulmenant liver failure

Necrosis without inflammation in ZONE 3 (most C450 enzyme highest here); NAPQI is the toxic molecule

NAC

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3
Q

Acute inflammaiton happens where in liver?

Chronic hepatitis happens where?

Canallicular cholestatis only; common clinically in what scenario?

Ductual cholestatis (ducts with inspisated bile) think?

A

Lobule (lobular disarray)

Portal tracks/periportal

Estrogen and steroids in young men

Sepsis

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4
Q

EBV hepatitis you see?

Bridging fibrosis think?

Which Hepatitis is DNA?

What Hep casues HCC?

A

Lymphocytes in the Sinusoids

Autoimmune hepatitis

Hep B (other RNA)

B,C, D

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5
Q

Chronic hepatisis H and E?

Hep C genotype associated with steatosis?

Other causes?

A

“Blue portal tracts” and some steatosis

3

Hep B, C, D; Chronic autoimmune, emds, Wilson, Alpha-1 antitrypsin, Lymphoma

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6
Q

Ground glass hepatocyts, think?

Most common Autoimmune hepatitis?

Tx?

H and E?

A

Hepatitis B from proliferating endoplasic responding to HbsAg

Type 1 adults (P-ANCA); type 2 in kids (anti-LKM1)

Tx: Steroids

Portal inflammation, Zone 3 with inflammation (vs tylenol which has no inflammation)

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7
Q

A1-antitrypsin, gene?

See what clinical issues?

H and E?

PiM means?

A

Chr14; SERPINA1 gene; folding abnormality and doesn’t go into blood

Emphysema (can’t inhibit elsastase) and chronic liver disease

H and E: Periportal PAS-D globules adn hepatitic changes

PiM normal

PiS and PiZ common deficency alleals (Z lowest production)

PiZZ most severe

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8
Q

Hereditary Hemochromatosis gene, presentation?

H and E?

Special stain?

A

Auto recessive; HFE gene (C282Y–highest Fe Overload and H63D), Diabetes, skin pigmentation, cirrhosis

Hepatocytes around zone 1; vs blood transfusions show hemosidering in Kupfer cells

Prussian blue

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9
Q

Gene in Wilsons?

Copper is where in eyes?

Liver H and E?

Lab test?

Know EM has seperations and increased matrix and crystaline inclusions

A

ATP7B; copper transporter in Golgi

Descement membrame

Steatosis, hepatitis, glycongenated nuclei, Mallory hyaline, Copper by Rhodanine

Common low ceruloplasmin and increased urine copper

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10
Q

Bland cholestasis caused by what drugs?

Is periportal copper always Wilson’s?

A

Estrogen and anabolic steroids (intrahepatic only)

NO! Can be from biliary damage

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11
Q

What is primamry billiary cholangitis?

Antibody?

Elevated Ig?

H and E?

A

Autoimmune; loss of intrahepatic bile ducts; Mid age females; Puritis

Antimitochondrial antibody; some AMA negative

IgM vs IgG in autoimmune

Chronic cholestatis, florid bile duct lesion–lymphocytes, non-caseating granulomas, increased copper

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12
Q

Primary Schlerosis Choleangitis disease, population, Key association?

H and E?

ERCP picture?

A

Fibroinflammatory disease; intra and extrahepatic biliary tree; Males, UC 65%; risk cholangiosarcoma

Fibrous obliteration of bile ducts: Periductal fibrosis (onion skin) and Ductopenia (with proliferation and damage)

Beads on a string

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13
Q

Macrovesicular steatosis causes?

A

Obesity, diabetes, metabolic syndrome

Malnutrition, TPN

Alcohol

WIlson’s

Hep C

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14
Q

Micro vesicular steatosis causes?

A

Nuclei indented with fat vacuoles

Pregnancy (AFLD)

Reye’s

Drugs

Valproic acid

Mushrooms

Tetracycline

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15
Q

Where does steatohepatis start?

Stain Mallory-Denk bodies?

Drugs that make Mallory hyaline?

A

Zone 3:

Mallory-Denk bodies: p62+, ubiquitin; intermediate filaments metabolized by cytokeratin from injury

Amiodarone (granular hepatocytes with lysozome inclusions on EM); Methotrexate, Tamoxifen

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16
Q

Fibrin ring granuloma think?

Hydadid cyst, contact with?

Worry if contents spills?

Hydatid sand is?

A

Q-Fever, Coxiella burnetiil; fat globule, fibrin and granuloma

Sheep and dogs; Echinoccous Granulosis, Lamanated membrane GMS+

Anaplylaxis

Capsules, free scolices and loose hooklets

17
Q

Non-zonal (geographic) necrosis think about?

A

Herpes (hemmorhage common) and Adenovirus (smudgy nuclei) are common

18
Q

Zone prone to ischemia?

Gross?

A

Zone 3 coagulative necrosis without inflammation; some intralobulal bile duct damage possible

Nutmeg liver

19
Q

Budd-Chiari is?

H and E?

Common clinical?

A

Suprahepatic vein outflow issues; Polycythemia vera, infections, malignancy

Sinusoidal dilation, congestion (RBCs), hemorrhage, hepatocyte atrophy

2-3 weeks post stem cell transplant from chemo

20
Q

What is hepatoportal sclerosis?

DDx?

A

Central vein abnormally close to portal areas; Portal fibrosis with portal vein narrowing or obliteraiton

Portal vein thrombosis

21
Q

What is nodular regenerative hyperplasia?

Disease associations?

Does it cause portal hypertension?

A

Nodules in parenchyma; Trichrome negative; reticulin highlights nodules

Rheumatologic, PV, lymphoma, azathioprine

Yes! Reticulin shows compressed portal between nodules, variable hepatocyte sizes

22
Q

What is a hepatic adenoma?

Associated with?

Reticulin and CD34 staining?

Tx?

A

Solitary, well circumscribed, non cirrhotic, Benign hepatocytes (1-2 layers thick); clear cell glycogen chagnes; NO PROTAL TRIADS just naked arteries

Oral contraceptives

Intact reticulin, CD34 increased

Tx: Surgery, malignant rare

23
Q

What type of hepetic adenoma has HCC risk?

IHC?

A

B-Catenin; 10% of adenomas, cytologic atypia present

IHC: Beta-catenin and diffuse glutamine synthetase (Staining pattern similar to HCC; not useful)

24
Q

Two liver lesions with scar?

FNH, population?

H and E?

IHC?

A

Fibrolamellar carcinoma and focal nodular hyperplasia

Women 3rd-4th decade and kids txed for malignancy; Not associated with OCP

Non-cirrhotic, Hepatocytes divided into nodules but hick walled arteries (at edges) in fibrous septate, ductular reaction at junction

Map like glutamine synthetase (spared around scar and septae)

25
Q

HCC associated with in China, organism?

HCC H and E?

A

Alpha toxin B1 from aspergillus ; Also Cirrhosis common

Mimics liver; trabelcular growth or pseudoglandular gwoth (single layer of tumor cells and dilated canaliculi), can have bile mallory/hyaline/A1-AT bodies, or thick trabeculae lacking protal areas

26
Q

HCC IHC?

A

CD34+ (can be in adenomas)

Glypican III + (- in benign; can be - in 50% of HCC)

Reticulin disrupted

HepPar1+ (also gastric and some adeno)

Arginase +, pCEA + (canallicular)

27
Q

Fibrolamellar carcinoma?
Gross finding?

H and E?

IHC?

Gene?

A

10-35 yr oldCentral Scar: No cirrhosis

Malignant with large eosinophilic granular cytoplasm, with vesicular nuclei and nucleoli think; Parallel fibrosis

CK7+ (most HCC -), CD68+, AFP -,

DNAJB1-PRKACA

28
Q

Cholangiocarcinoma?
H and E?
IHC?

Risk factors?

A

Older patient; No histor of cirrhosos in most;

Desmoplastic fibrous strome, LVI common, glands

CK7+, HepPar1-, Arginase-, CK20-, CDX2-, CK19+, MOC31+

Fluke infection (Clonorchis sinensis or Opisthorchis), PSC, hepatolithiasis, bile duct abnormalities

29
Q

Bost common benign tumor of liver?

H and E?

EHE H and E?

Gene?

A

Hemangioma, 2nd is FNH

Rarely biopsied; Cavernous vasculiture with no atypia

EHE: Abundant myxoid matrix. Dendritic/epithelioid tumors, intracytoplasmic RBCs

t(1;3) WWTR1-CAMTA1

CD34+, ERG+. CD31+, FLI1+, FVIII +, D2-40+

30
Q

Black liver with elevated direct bilirubinemia?

Pattern of inheritance

Gene?

Other cause of hyperbilirubinemia?

A

Dubin Johnson; Benign; Urine shows normal porphorins

Auto Reccesive

cMOAT/MRP2 gene with impaired biliary transport of conjugated bilirubin (direct)

Rotor syndrome (non black liver)

31
Q
A

GI (4 decks)

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