Pathology of the Liver

Question 1

What are the histological features and causes of acute hepatitis?

Answer 1

• Diffues hepatocyte injury seen as swelling
• A few have died, described as ‘spotty necrosis’
• There is an inflammatory cell infiltrate in all areas (portal tracts, interface and parenchyma)
• Causes include autoimmune, viral and drugs

Question 2

What are the histological features and causes of acute cholestasis/cholestasis hepatitis?

Answer 2

• Brown bile (bilirubin) pigment
• Diffuse hepatocyte injury seen as swelling
• A few have died, described as ‘spotty necrosis’
• There is an inflammatory cell infiltrate in all areas (portal tracts, interface and parenchyma)
• Causes include extraepatic biliary obstruction or drug injury

Question 3

What are the histological features and causes of chronic hepatitis?

Answer 3

• May look acute plus fibrosis
• Mild portal tract fibrosis (Masson stain)
• Formation of fibrous septum (band)
• Specific feature of hepatitis B is a ground glass cytoplasm in hepatocytes

Question 4

What are the histological features and causes of chronic biliary disease?

Answer 4

• Focal, portal, predominant inflammation and fibrosis with bile duct injury; granulomas in PBC
• Causes inc;ide primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC)

Question 5

What are the benign and malignant variants of space occupying lesions in the liver?

Answer 5

Question 6

What is a haemangioma?

Answer 6

• Benign blood vessel tumour
• Biopsy avoided because of risk of bleeding

Question 7

Who gets hepatic adenomas and how are they treated?

Answer 7

• Mainly young women, often associated with hormonal therapy
• Risk of bleeding and rupture so excision if large

Question 8

Hepatocellular carcinoma

Answer 8

• Most common primary liver tumour
• Risk factors include hepatitis B/C, alcohol, NAFLD and other chronic liver disease
• Presentation:
  
  • Weight loss
  • Abdominal pain
  • Anorexia
  • Nausea and vomiting
  • Jaundice
  • Pruritis
• Investigation
  
  • Alpha-fetoprotein (AFP)
  • Liver US
  • CT/MRI for staging
• Management
  
  • Poor prognosis
  • Kinase inhibitors (i.e. sorafenib) - inhibit proliferation of cancer cells