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Learning Liver


Learning Liver

  • 13 Pins

Bile duct adenoma is SINGULAR, vs. hamartomas. Not really dilated, often slit like and NO BILE

Hepatic adenoma, very well circ (similar to FNH but those are cirrhotic)

Hepatic adenoma. Normal liver tissue with a portal tract is seen on the left. The hepatic adenoma is on the right and is composed of cells that closely resemble normal hepatocytes, but the neoplastic liver tissue is disorganized hepatocyte cords and does not contain a normal lobular architecture.

Hepatic Pathology

library.med.utah.edu

A 2-week-old, ex-38-week-gestation male infant is brought to his pediatrician for a routine check-up. On examination, he appears healthy and energetic but mildly jaundiced. He has a mildly triangular face with a broad forehead and deeply recessed eyes. Laboratory testing reveals a conjugated hyperbilirubinemia. Skeletal X-rays show several butterfly-shaped vertebrae. A needle core biopsy of the liver demonstrates bile ductular proliferation and cholestasis. These are the classic features of Alagille syndrome, which can be confirmed by mutational testing of the JAG1 gene. Liver biopsy findings are highly variable depending on the stage of the disease at the time of assessment, and can appear to have normal numbers of bile ducts (usually in the first year of life) or relative paucity (in older children).

Bile duct hamartomas (von Myenberg complexes) are potential mimickers of metastatic adenocarcinoma. They have the three features seen in this case: 1) there are multiple lesions; 2) they contain bile; and 3) they are lined by a flattened epithelium. Bile duct adenomas are usually solitary and they do not contain bile. Pleomorphism and an invasive growth pattern help distinguish adenocarcinomas from bile duct adenomas and hamartomas.

CK7- cholangiocarcinoma (Pure hepatocellular carcinoma should not show overt gland formations, expression of biliary type cytokeratins such as cytokeratin 7, or intracytoplasmic mucin.Peripheral cholangiocarcinoma would lack the areas of true hepatocellular differentiation, as evidenced by the trabecular morphology and immunostaining for HepPar1)

Cryoglobulins: Type 1 = isolated monoclonal IgG or IgM (5-25%). Type 2 = mixture of polyclonal Ig in a/w a monoclonal Ig (IgM or IgA) (40-60%) and is seen in HEPATITIS C or HIV. Type 3 = solely of a polyclonal mixture of Ig, seen in connective tissue disorders (40-50%). 2 and 3 affect skin, nervous system and kidneys. Type 1 also affects bone marrow. The CG here would stain with PAS.

Schistosomatosis => reactive biliary epithelium

Epithelioid hemangioendothelioma in liver of young female. CD34 and 31 positive. Within the hyalinized stroma are vacuolated cells with hyperchromatic nucleoli which form cords that are distinct from the benign entrapped bile ducts

Focal nodular hyperplasia in 45 year old woman. Has central scar. Also called "focal cirrhosis" ... Hepatic adenoma would not have the fibrous bands and bile duct proliferation associated with this lesion.

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pathology2.jhu.edu

Schistosomasis, calcified eggs

Epithelioid hemangioendothelioma in liver, hyalinized/infarcted, low atypia and no mitoses. stains with vascular markers but also can stain with CKs

Hepatobiliary cystadenoma (mucinous lining with ovarian like stroma, women!)