The Liver, Gallbladder and Biliary Tract Flashcards
Marked cell enlargement with irregularly clumped cytoplasm showing large, clear spaces.
Ballooning degeneration (TOPNOTCH) Robbins Basic Pathology, 8th ed, p633
Appear typically with an abundant fibrous stroma (desmoplasia) explaining their firm, gritty consistency Most exhibit clearly defined glandular and tubular structures lined by somewhat anaplastic cuboidal to low columnar epithelial cells. Bile pigment and hyaline inclusions are not found within the cells.
Cholangiocarcinomas (TOPNOTCH) Robbins Basic Pathology, 8th ed, p672
This pattern of GB carcinoma grows into the lumen as an irregular, cauliflower mass, but at the same time it invades the underlying wall.
Exophytic pattern of gallbladder carcinoma (TOPNOTCH) Robbins Basic Pathology, 8th ed, p671
Appears as a poorly defined area of diffuse thickening and induration of the gallbladder wall that may cover several square centimeters or involve the entire gallbladder, scirrhous and very firm in consistency.
Infiltrating pattern of gallbladder carcinoma (TOPNOTCH) Robbins Basic Pathology, 8th ed, p671
Defined as a complete obstruction of bile flow caused by destruction or absence of all or part of the extrahepatic bile ducts.
Biliary atresia (TOPNOTCH) Robbins Basic Pathology, 8th ed, p670
The gallbladder may be contracted, of normal size, or enlarged. Presence of stones in the absence of inflammation is diagnostic.
Chronic cholecystitis (TOPNOTCH) Robbins Basic Pathology, 8th ed, p669
Severe cholecystitis wherein the GB is transformed into a green-black necrotic organ.
Gangrenous cholecystitis (TOPNOTCH) Robbins Basic Pathology, 8th ed, p669
Condition wherein the exudate contained in the gallbladder is composed virtually of pure pus.
Empyema of the gallbladder (TOPNOTCH) Robbins Basic Pathology, 8th ed, p669
Gallbladder is usually enlarged (twofold to threefold) and tense, and it assumes a bright red or blotchy, violaceous to green-black discoloration, imparted by subserosal hemorrhages. The gallbladder lumen is filled with a cloudy or turbid bile that may contain fibrin, blood, and frank pus.
Acute cholecystitis (TOPNOTCH) Robbins Basic Pathology, 8th ed, p669
A type of pigment stone found in infected intrahepatic or extrahepatic ducts. Tends to be single or few in number and are soft with a greasy, soaplike consistency that results from the presence of retained fatty acid salts released by the action of bacterial phospholipases on biliary lecithins. Contains calcium soaps, and are radiolucent.
Brown pigment stones (TOPNOTCH) Robbins Basic Pathology, 8th ed, p668
A type of pigment stone found in sterile gallbladder bile, usually small and present in large quantities and crumble easily. 50% to 75% are radiopaque.
Black pigment stones (TOPNOTCH) Robbins Basic Pathology, 8th ed, p668
May arise anywhere in the biliary tree and are trivially classified as black and as brown. Contain calcium salts of unconjugated bilirubin and lesser amounts of other calcium salts, mucin glycoproteins, and cholesterol.
Pigment stones (TOPNOTCH) Robbins Basic Pathology, 8th ed, p668
Gallbladder stones that are mostly radiolucent, ovoid and firm; can occur singly but most often there are several, with faceted surfaces resulting from apposition to one another. They are pale yellow but w/ increasing proportions of CaCO3, phosphates and bilirubin, they turn gray-white to black and radiopaque.
Cholesterol stones (TOPNOTCH) Robbins Basic Pathology, 8th ed, p668
A distinctive variant of HCC, which occurs in young male and female adults (20-40 years of age) of equal incidence, no association with cirrhosis or other risk factors. usually consists of a single large, hard “scirrhous” tumor with fibrous bands coursing through it. Composed of well-differentiated polygonal cells growing in nests or cords and separated by parallel lamellae of dense collagen bundles.
Fibrolamellar carcinoma (TOPNOTCH) Robbins Basic Pathology, 8th ed, p665
May appear grossly as (1) a unifocal, usually massive tumor, (2) a multifocal tumor made of nodules of variable size or (3) a diffusely infiltrative cancer, permeating widely and sometimes involving the entire liver, blending imperceptibly into the cirrhotic liver background.
Primary Hepatocellular Carcinoma (TOPNOTCH) Robbins Basic Pathology, 8th ed, p665
These are lesions larger than 1 mm in diameter that appear in cirrhotic livers. Considered to be precursors of hepatocelluar cancers, are often monoclonal, and may contain chromosome aberrations similar to those present in liver cancers.
Dysplastic nodules (TOPNOTCH) Robbins Basic Pathology, 8th ed, p664
These appear in cirrhotic livers, are larger than surrounding cirrhotic nodules but do not display atypical features. Contains more than one portal tract, have an intact reticulin framework, and do not seem to be precursors of malignant lesions.
Macroregenerative nodules (TOPNOTCH) Robbins Basic Pathology, 8th ed, p664
Well-demarcated but poorly encapsulated lesion, consisting of hyperplastic hepatocyte nodules with a central fibrous scar. Appears in noncirrhotic livers and may reach up to many centimeters in diameter. It occurs in response to local vascular injury.
Focal nodular hyperplasia (TOPNOTCH) Robbins Basic Pathology, 8th ed, p664
Caused by toxic injury to sinusoidal endothelium. Damaged endothelial cells slough off and create emboli that block blood flow. Accompanied by passage of red blood cell into the space of Disse, proliferation of stellate cells, and fibrosis of terminal branches of the hepatic vein.
Sinusoidal Obstruction Syndrome (TOPNOTCH) Robbins Basic Pathology, 8th ed, p662
Results from the thrombosis of two or more major hepatic veins and is characterized by hepatomegaly, weight gain, ascites, and abdominal pain. The liver is swollen, is red-purple, and has a tense capsule. The affected hepatic parenchyma reveals severe centrilobular congestion and necrosis.
Budd-Chiari syndrome (TOPNOTCH) Robbins Basic Pathology, 8th ed, p662
A rare condition wherein there is primary dilation of sinusoids, impeding hepatic blood efflux. Associated with exposure to anabolic steroids, OCP’s and danazol.
Peliosis hepatis (TOPNOTCH) Robbins Basic Pathology, 8th ed, p661
Hepatocytes in the central region of the lobule undergo ischemic necrosis. The liver takes on a variegated mottled appearance, reflecting hemorrhage and necrosis in the centrilobular regions, alternating with pale midzonal areas, known traditionally as the “nutmeg” liver.
Passive congestion of the liver secondary to left-sided heart failure. (TOPNOTCH) Robbins Basic Pathology, 8th ed, p661
Liver is slightly enlarged, tense, and cyanotic, with rounded edges. Microscopically, there is congestion of centrilobular sinusoids. With time, centrilobular hepatocytes become atrophic, resulting in markedly attenuated liver cell cords. Liver fibrosis mostly “centrilobular”.
Passive congestion of the liver secondary to right-sided heart failure. (TOPNOTCH) Robbins Basic Pathology, 8th ed, p660
A chronic cholestatic disorder, characterized by progressive fibrosis and destruction of extrahepatic and large intrahepatic bile ducts. Affected portal tracts show concentric periductal “onion-skin” fibrosis and a modest lymphocytic infiltrate. Progressive atrophy of the bile duct epithelium leads to obliteration of the lumen, leaving behind a solid, cordlike fibrous scar.
Primary sclerosing cholangitis (TOPNOTCH) Robbins Basic Pathology, 8th ed, p660
A chronic, progressive, and often fatal cholestatic liver disease, characterized by a nonsuppurative destruction of small and medium-sized intrahepatic bile ducts (“florid duct lesion”). On cut surface, the liver is hard, with a finely granular appearance, with extraordinary yellow-green pigmentation.
Primary biliary cirrhosis (TOPNOTCH) Robbins Basic Pathology, 8th ed, p659
A rare disease characterized by microvesicular fatty change in the liver and encephalopathy. Microscopy of hepatocellular mitochondria reveals pleomorphic enlargement and electron lucency of the matrices, with disruption of cristae and loss of dense bodies.
Reye syndrome / “mitochondrial hepatopathies” (TOPNOTCH) Robbins Basic Pathology, 8th ed, p658
Hepatocytes with round to oval cytoplasmic globular inclusions which are strongly positive in a periodic acid-Schiff stain. By electron microscopy they lie within smooth, and sometimes rough, endoplasmic reticulum.
Alpha-1 antitrypsin Deficiency (TOPNOTCH) Robbins Basic Pathology, 8th ed, p657
Excessive copper deposition in the liver causing hepatic changes ranging from mild fatty change to massive liver necrosis. In the brain, injury affects the basal ganglia, demonstrating atrophy and cavitation. Kayser-Fleischer rings are characteristic.
Wilson disease (TOPNOTCH) Robbins Basic Pathology, 8th ed, p655
Green to brown deposits of copper in Descemet membrane in the limbus of the cornea.
Kayser-Fleischer rings (TOPNOTCH) Robbins Basic Pathology, 8th ed, p656
Golden-yellow granules in the cytoplasm of periportal hepatocytes, which stain blue with the Prussian blue stain.
Hemosiderin (TOPNOTCH) Robbins Basic Pathology, 8th ed, p655
Characterized by deposition of hemosiderin in the following organs: liver, pancreas, myocardium, pituitary, adrenal, thyroid and parathyroid glands, joints, and skin; cirrhosis; and pancreatic fibrosis
Hereditary hemochromatosis (TOPNOTCH) Robbins Basic Pathology, 8th ed, p655
The liver may shrink to 500 to 700 gm and become transformed into a limp, red organ covered by a wrinkled, overly large capsule. Necrotic areas have a muddy red, mushy appearance with blotchy bile staining. Complete destruction of hepatocytes in contiguous lobules leaves only a collapsed reticulin framework and preserved portal tracts.
Massive hepatic necrosis (TOPNOTCH) Robbins Basic Pathology, 8th ed, p653
Pattern of cirrhosis in alcoholic hepatitis.
Micronodular (TOPNOTCH) Robbins Basic Pathology, 8th ed, p650
Pattern of cirrhosis in viral hepatitis.
Macronodular (TOPNOTCH) Robbins Basic Pathology, 8th ed, p650
Liver is yellow-tan, fatty, and enlarged, usually weighing over 2 kg. Over the span of years it is transformed into a brown, shrunken, nonfatty organ, sometimes weighing less than 1 kg.
Alcoholic Cirrhosis (TOPNOTCH) Robbins Basic Pathology, 8th ed, p650
Almost always accompanied by a brisk sinusoidal and perivenular fibrosis; occasionally periportal fibrosis may predominate.
Alcoholic hepatitis (TOPNOTCH) Robbins Basic Pathology, 8th ed, p650
Eosinophilic, cytoplasmic inclusions characteristic of alcoholic hepatitis.
Mallory bodies (TOPNOTCH) Robbins Basic Pathology, 8th ed, p650
Lipid accumulates to the point of creating large clear macrovesicular globules, compressing and displacing the nucleus to the periphery of the hepatocyte.
Hepatic Steatosis (Fatty Liver) (TOPNOTCH) Robbins Basic Pathology, 8th ed, p649
Liver is enlarged (4-6kg), soft, yellow and greasy.
Hepatic Steatosis (Fatty Liver) (TOPNOTCH) Robbins Basic Pathology, 8th ed, p649
May occur as solitary or multiple lesions, ranging from millimeters to massive lesions, many centimeters in diameter. They are generally produced by gram-negative bacteria such as Escherichia coli and Klebsiella sp.
Pyogenic (bacterial) hepatic abscesses (TOPNOTCH) Robbins Basic Pathology, 8th ed, p648