DISEASES OF THE LIVER AND BILIARY

TRACT
Dr. Jan Michael T. Lao, DPCOM
Department of Pathology
MHAM College of Medicine
November 19 (B), 21 (A), 25 (D), & 27 (C), 2019 (Microscopy)
November 26 (BD) & 28 (AC), 2019 (Practical Exams)
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 1. Fatty change, Liver

Case:
5 y.o. boy
• Bronchopneumonia
• Died

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 1. Fatty change, Liver

Gross:
Liver
• Enlarged & yellowish
• Flabby, soft
Cut surface
• Greasy

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 1. Fatty change, Liver

Micro:
Widespread cytoplasmic vacuolization of
hepatocytes
• Nuclei pushed to 1 side
Maintenance of lobular pattern

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Histological features of alcoholic hepatitis.
(B) (Black arrows) Mallory bodies are
irregular eosinophilic cytoplasmic
structures with a rope-like appearance.
(Open arrow) Ballooning degeneration of 13
hepatocytes.
2. Chronic Passive Congestion (CPC), Liver

Case:
58 y.o. male w/ CHF
• Respiratory complications
• Died

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2. Chronic Passive Congestion (CPC), Liver

Gross:
Liver
• Enlarged & heavy
• Deep red, boggy consistency
Cut surface, w/ oozing blood
• Nutmeg appearance
• Intense red-brown centrilobular zones
• Tan or pale peripheral regions
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2. Chronic Passive Congestion (CPC), Liver

Micro:
Markedly dilated central vein & surrounding
sinusoids, filled w/ blood (congestion)
Atrophic nearby hepatocytes
• Fatty change or necrosis

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 3. Liver Cirrhosis

Case:
50 y.o. male
• Heavy drinker
• Recurrent ascites, jaundice, emaciation
• Massive hematemesis & melena
• Died

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 3. Liver Cirrhosis
Gross:
Liver
• Contracted
• Firm to hard
• Finely nodular
• Yellow-brown
Cut surface
• Uniform nodules
• Surrounded by gray-white fibrous tissue

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The characteristic diffuse
nodularity of the surface reflects
the interplay between nodular
regeneration and scarring. The
greenish tint of some nodules is
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due to bile stasis.
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 3. Liver Cirrhosis

Histo:
Distorted architecture
• Regenerative lobules (pseudolobules)
– Swollen hepatocytes undergoing fatty change
• Surrounded by wide bands of portal fibrosis
– Mononuclear cell infiltrates
• Predominant: lymphocytes

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Laennec Cirrhosis

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Laennec Cirrhosis

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 4. Amoebic Abscess, Liver

Case:
40 y.o. male
• High-grade fever
• Vague RUQ pain
• Rigid abdomen
• Jaundice
• Alternating diarrhea and constipation history
• Died

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 4. Amoebic Abscess, Liver

Gross:
Liver
• Pasty reddish brown exudate
• From ruptured liver abscess

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 4. Amoebic Abscess, Liver

Histo:
Abscess
• Mononuclear cell infiltrates
• Fibroblastic reaction at periphery
• Amoebic trophozoites

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 5. Pyogenic Abscess, Liver

Case:
6 y.o. boy
• Malnourished
• Multiple infections
• Septicemia
• Died

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 5. Pyogenic Abscess, Liver

Gross:
Abscess
• w/in parenchyma
• Green-yellow exudate

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 5. Pyogenic Abscess, Liver

Histo:
Abscess
• Well-circumscribed
• Surrounded by fibroblasts & capillaries
• Fibrinopurulent exudate at center

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 6. Typhoid Liver Nodules

Case:
36 y.o. female
• Typhoid fever
• Septic shock
• Died

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 6. Typhoid Liver Nodules

Gross:
Liver
• Necrotic

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 6. Typhoid Liver Nodules

Histo:
• Patchy & random areas of necrosis
• Typhoid nodules
– Aggregates of reticuloendothelial cells &
histiocytes
• Heavy lymphocytic infiltrates at portal areas

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 7. Schistosomiasis, Liver

Case:
43 y.o. female
• Non-alcoholic
• Sensorial changes
• Massive abdominal enlargement
– Massive ascites
– Hepatosplenomegaly
• (-) HBsAg & (+) COPT
• Portal HPN w/ hepatic hematemesis
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 7. Schistosomiasis, Liver

Gross:
Liver
• Enlarged
• Nodular
Cut surface
• Pipe-stem fibrosis

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 7. Schistosomiasis, Liver

Histo:
Schistosoma eggs
• Portal areas
• Periphery of lobules
• Inflammatory infiltrates:
– Lymphocytes, plasma cells, eosinophils, giant cells,
fibroblasts

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 8. Chronic Cholecystitis

Case:
42 y.o. female
• Obese
• Intermittent vague, RUQ pain
• Episodic epigastric distress & vomiting,
unrelieved by antacids
• Multiple gallstones
• Cholecystectomy

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 8. Chronic Cholecystitis
Gross:
Gallbladder
• Enlarged
• w/ 10 multi-faceted black stones
Cut surface
• Smooth & glistening serosa
• Thickened wall
• Velvety mucosa
– Focal areas of scarring

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 8. Chronic Cholecystitis
Histo:
Mucosa
• Focal hyperplasia of glands
Lamina propria
• Pockets of inflammatory infiltrates
– Predominant: lymphocytes
Muscularis
• Hypertrophy
• Focal fibrosis
• Mucosal glands
– Rokitasnky-Aschoff sinuses

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 9. Biliary Cirrhosis

Case:
49 y.o. female
• Cholecystectomy
– Multiple gallstones in gallbladder & CBD

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 9. Biliary Cirrhosis

Gross:
Liver
• Normal size
• Greenish-brown
• Finely nodular
• Pigskin texture

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 9. Biliary Cirrhosis

Histo:
Bridging portal fibrosis
• Forming pseudolobules
Bile duct proliferation
Mononuclear infiltrates
Swollen hepatocytes w/ bile pigments

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 10. Hepatocellular Carcinoma (HCCA)

Case:
45 y.o. male
• Upper abdominal pain • Elevated direct, indirect
• Abdominal enlargement bilirubin
• Jaundice • Low albumin
• Body malaise, anorexia, • Slightly elevated
weight loss transaminases
• Palpable, slightly tender, • (+) HBsAg
nodular liver • Pneumonia
• Palpable spleen • Died
• (+) fluid wave

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10. Hepatocellular Carcinoma (HCCA)

Gross:
Hepato-splenomegaly
Ascitic fluid
Liver
• Enlarged & heavy
• Massive tan mass
• Areas of green cholestasis
• Reddish hemorrhages
• Yellow-brown necrosis
• Portal vein thrombus

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10. Hepatocellular Carcinoma (HCCA)

Micro:
Neoplastic nodules
• Cords & sheets of polygonal cells
– Abundant pink cytoplasm
– Hyperchromatic nuclei
– Mitotic figures
Regenerative pseudolobules
• Surrounded by fibrous tissue
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 Extra:
Cholangiocarcinoma
Gross:

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 Gallbladder Carcinoma
• Gross:

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 Both

Micro:

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Both

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Both

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Both

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Polycystic Liver Disease

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Polycystic Liver