Pathology - Liver Flashcards
What three structures are found in a portal triad?
Hepatic artery, portal vein, bile duct
What is a Kuppfer cell?
A liver macrophage
What cell type is responsible for the generation of fibrosis in cirrhosis?
Stellate cells
Within what microstructure in the liver are stellate cells found?
In the space of Disse.
Hepatocytes in zone ____ (1, 2, 3) have the highest concentration of CYP450 enzymes.
zone 3
Hepatocytes in zone ____ are most susceptible to ischemic insult.
zone 3
Name one major histopathologic feature of hepatocytes infected with hepatitis B.
Ground glass hepatocytes.
Which infection is more likely to lead to chronic hepatitis, hepatitis B or C?
Hep C is more likely to cause chronic infection, but Hep B is more prevalent.
Describe the histopathologic features you would expect to find in a liver section from a patient with chronic hepatitis C.
- Blue balls in the portal triad areas, which are lymphoid aggregates
- Steatosis
What three histopathologic features are typical of alcoholic hepatitis?
- Mallory bodies (clumped intermediate cytoskeletal filaments)
- Fat
- Inflammatory aggregates
What is your Dx?
Cirrhosis
Metabolic syndrome and other insulin-resistant states are associated with what type of liver disease (in the absence of alcohol intake)?
Non-alcoholic steatohepatitis (NASH)
Name two primary chronic biliary tract disorders.
- Primary biliary cirrhosis
- Primary sclerosing cirrhosis
Describe the pathogenesis of primary biliary cirrhosis.
Name two labs that are associated with the disease.
Name one histopathologic finding that is often seen.
Pathogenesis: autoimmune destruction of interlobular bile ducts.
Associated with anti-mitochondrial antibodies and elevated ALKPhos.
Florid duct lesions are seen - granulomatous inflammation surrounding bile ducts w/ inflammatory infiltrate.
In what particular population is primary biliary cirrhosis most commonly seen in?
Middle-aged females
Describe the pathogenesis of primary sclerosing cholangitis.
What population is it most often seen in?
Name one finding that is often seen during diagnostic testing.
Idiopathic obliterative fibrosis of bile ducts.
Seen in young males, often seen in patients with inflammatory bowel disease.
Strictures of bile ducts on ERCP look like beads on a string.
Your 22 y.o male patient w/ a history of ulcerative colitis presents with pale and fatty stools. Biopsy shows this. What is your Dx?
Concentric periductal (onion-skin) fibrosis is suggestive of primary sclerosing cholangitis. It is often seen in young males with IBD.
Your patient has cirrhosis, diabetes, and is really tan. It is February in Seattle and he has not been on vacation anywhere. What is the likely mutated gene and inheritance pattern?
What would likely be seen on liver biopsy?
Hereditary hemochromatosis - HFE gene mutation, autosomal recessive.
You’d see iron pigments on liver biopsy.
What is this finding called? What is your Dx? What gene is likely mutated and what is the pathogenesis of the disease?
Kayser-Fleisher ring
Wilson’s disease
Mutated ATP7B, a transmembrane copper-transporting ATP pump
Can’t get copper into bile, copper accumulates in organs, including brain, eye, liver
What is the treatment for Wilson’s disease?
D-penicillamine (copper chelating agent)
Alpha-1-antitrypsin deficiency is characterized by an inability to inactivate ________ in the lungs and liver, leading to hepatitis, cholestasis, and cirrhosis.
inability to inactivate elastase from neutrophils
Describe the basic histopathologic pattern seen in biopsy of a cirrhotic liver.
Nodules of regenerating hepatocytes between bands of fibrosis.
What is wrong with these livers?
They are cirrhotic.
Describe the two different morphologies of cirrhosis and the diseases that they are associated with.
Micronodular (<3mm): alcohol abuse
Macronodular (>3mm): viral hepatitis
In reality, shit be mixed
What is your Dx?
Cirrhosis
Is metastasis to the liver more common than primary liver cancer?
Yeah
What is a cholangiocarcinoma?
Primary liver cancer derived from bile duct epithelial cells
Grossly, how can you tell the difference between a metastatic cancer to the liver vs. a primary cancer like HCC?
In metastasis to the liver, there should be a background of normal liver tissue. In HCC, the background liver would be cirrhotic.
Name three risk factors for developing cholangiocarcinoma.
- Exposure to thorotrast (radiocontrast dye no longer used)
- Liver flukes: Opithorchis and Clonorchis sinensis
- Primary sclerosing cholangitis
What benign liver neoplasm is associated with oral contraceptive use? What is the treatment for it?
Hepatocellular adenoma. Regresses after discontinuation of OCP. They may be excised due to risk of rupture.
