Pathology - Liver

Question 1

What three structures are found in a portal triad?

Answer 1

Hepatic artery, portal vein, bile duct

Question 2

What is a Kuppfer cell?

Answer 2

A liver macrophage

Question 3

What cell type is responsible for the generation of fibrosis in cirrhosis?

Answer 3

Stellate cells

Question 4

Within what microstructure in the liver are stellate cells found?

Answer 4

In the space of Disse.

Question 5

Hepatocytes in zone ____ (1, 2, 3) have the highest concentration of CYP450 enzymes.

Answer 5

zone 3

Question 6

Hepatocytes in zone ____ are most susceptible to ischemic insult.

Answer 6

zone 3

Question 7

Name one major histopathologic feature of hepatocytes infected with hepatitis B.

Answer 7

Ground glass hepatocytes.

Question 8

Which infection is more likely to lead to chronic hepatitis, hepatitis B or C?

Answer 8

Hep C is more likely to cause chronic infection, but Hep B is more prevalent.

Question 9

Describe the histopathologic features you would expect to find in a liver section from a patient with chronic hepatitis C.

Answer 9

1. Blue balls in the portal triad areas, which are lymphoid aggregates
2. Steatosis

Question 10

What three histopathologic features are typical of alcoholic hepatitis?

Answer 10

1. Mallory bodies (clumped intermediate cytoskeletal filaments)
2. Fat
3. Inflammatory aggregates

Question 11

What is your Dx?

Answer 11

Cirrhosis

Question 12

Metabolic syndrome and other insulin-resistant states are associated with what type of liver disease (in the absence of alcohol intake)?

Answer 12

Non-alcoholic steatohepatitis (NASH)

Question 13

Name two primary chronic biliary tract disorders.

Answer 13

1. Primary biliary cirrhosis
2. Primary sclerosing cirrhosis

Question 14

Describe the pathogenesis of primary biliary cirrhosis.

Name two labs that are associated with the disease.

Name one histopathologic finding that is often seen.

Answer 14

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.

Question 15

In what particular population is primary biliary cirrhosis most commonly seen in?

Answer 15

Middle-aged females

Question 16

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.

Answer 16

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.

Question 17

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?

Answer 17

Concentric periductal (onion-skin) fibrosis is suggestive of primary sclerosing cholangitis. It is often seen in young males with IBD.

Question 18

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?

Answer 18

Hereditary hemochromatosis - HFE gene mutation, autosomal recessive.

You’d see iron pigments on liver biopsy.

Question 19

What is this finding called? What is your Dx? What gene is likely mutated and what is the pathogenesis of the disease?

Answer 19

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

Question 20

What is the treatment for Wilson’s disease?

Answer 20

D-penicillamine (copper chelating agent)

Question 21

Alpha-1-antitrypsin deficiency is characterized by an inability to inactivate ________ in the lungs and liver, leading to hepatitis, cholestasis, and cirrhosis.

Answer 21

inability to inactivate elastase from neutrophils

Question 22

Describe the basic histopathologic pattern seen in biopsy of a cirrhotic liver.

Answer 22

Nodules of regenerating hepatocytes between bands of fibrosis.

Question 23

What is wrong with these livers?

Answer 23

They are cirrhotic.

Question 24

Describe the two different morphologies of cirrhosis and the diseases that they are associated with.

Answer 24

Micronodular (<3mm): alcohol abuse

Macronodular (>3mm): viral hepatitis

In reality, shit be mixed

Question 25

What is your Dx?

Answer 25

Cirrhosis

Question 26

Is metastasis to the liver more common than primary liver cancer?

Answer 26

Yeah

Question 27

What is a cholangiocarcinoma?

Answer 27

Primary liver cancer derived from bile duct epithelial cells

Question 28

Grossly, how can you tell the difference between a metastatic cancer to the liver vs. a primary cancer like HCC?

Answer 28

In metastasis to the liver, there should be a background of normal liver tissue. In HCC, the background liver would be cirrhotic.

Question 29

Name three risk factors for developing cholangiocarcinoma.

Answer 29

1. Exposure to thorotrast (radiocontrast dye no longer used)
2. Liver flukes: Opithorchis and Clonorchis sinensis
3. Primary sclerosing cholangitis

Question 30

What benign liver neoplasm is associated with oral contraceptive use? What is the treatment for it?

Answer 30

Hepatocellular adenoma. Regresses after discontinuation of OCP. They may be excised due to risk of rupture.