liver and pancreas syllabus: rbp(robbins basic pathology) chapters: the liver and the biliary tract...
TRANSCRIPT
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Liver and pancreas
SYLLABUS:
RBP(Robbins Basic Pathology) Chapters:The Liver and the Biliary TractThe Pancreas
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Liver and pancreas
182a Chronic cholecystitis228 Gall bladder carcinoma249 Metastatic carcinoma of the liver (small cell
carcinoma)230 Metastatic carcinoma of the liver (mucinous
carcinoma)254 Chronic hepatitis253 Liver cirrhosis (H&A, Masson)252 Miliary tuberculosis (liver)250 Hepatocarcinoma250a Cholangiocarcinoma246 Acute pancreatitis
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Liver and pancreas
3 Acute hepatic congestion5 Chronic passive congestion of the liver17 Liver steatosis (H&E)18 Liver steatosis (Sudan III)43 Balser necrosis (enzymatic fat necrosis)186 Insuloma
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Acute hepatic congestion
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Chronic passive congestion of the liver
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Liver steatosis (H&E)
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Liver steatosis (Sudan III)
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Chronic hepatitis
Chronic persistent hepatitis (CPH) pattern:
- lymphocyte-predominant inflammation without:
- loss of hepatocytes immediately surrounding the portal region ("piecemeal necrosis")- more than slight fibrosis
Chronic active hepatitis (CAH) pattern:
- portal lymphocyte-predominant inflammation - piecemeal necrosis - inflammation extending outward beyond limiting plate of portal triad to involve periportal hepatocytes- some hepatocytes are simply entrapped by inflammation while others drop out (liquefaction necrosis)- acidophil cells (apoptotic) possible- eventually: bridging fibrosis and/or cirrhosis
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Chronic hepatitis
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Chronic hepatitis
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Chronic hepatitis
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Liver cirrhosis
- bridging fibrous septae in the form of delicate bands or broad scars linking portal tracts with one another and portal tracts with terminal hepatic veins
- parenchymal nodules containing proliferating hepatocytes encircled by fibrosis, with diameters varying from very small (<3 mm, micronodules) to large (several centimeters, macronodules)
- disruption of the architecture of the entire liver
Active cirrhosis:- piecemeal necrosis- extra-portal inflammation
Specific cause can sometimes be determined, (eg for viral infection, hemochromatosis, Wilson's disease, alpha-1-antitrypsin deficiency, and alcohol, if alcoholic hepatitis present)
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Liver cirrhosis
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Liver cirrhosis (Masson stain)
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Liver cirrhosis
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Hepatocarcinoma
- range of appearances from hepatocytes with little atypia forming sinusoidal, trabecular, or possibly tubular structures (well-differentiated)...
- ... to highly atypical hepatocytes in sheets (poorly differentiated)
- complete loss of bile ducts and Kupffer cells
- little sclerosis
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Hepatocarcinoma
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Hepatocarcinoma
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Cholangiocarcinoma
- glands with cuboidal to columnar atypical and pleomorphic cells
- typical perineural and periductal growth pattern
- often desmoplastic stroma
- may contain signet cells
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Cholangiocarcinoma
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Cholangiocarcinoma
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Metastatic carcinoma of the liver
microscopic features depend on the type of the primary tumor:
eg:
- small cell carinoma (lung)
- mucinous carcinoma (GI)
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Metastatic carcinoma of the liver (small cell carcinoma)
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Metastatic carcinoma of the liver (small cell carcinoma)
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Metastatic carcinoma of the liver (mucinous carcinoma)
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Metastatic carcinoma of the liver (mucinous carcinoma)
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Miliary tuberculosis (liver)
numerous small TB granulomas
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Miliary tuberculosis (liver)
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Miliary tuberculosis (liver)
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Chronic cholecystitis
(some use this diagnosis whenever gallstones are identified, whether chronic inflammation is seen or not, others require chronic inflammation)
- chronic inflammatory infiltration features
- Rokitansky's-Aschoff sinuses (diverticula with increased smooth muscle, related to chronic increase in lumenal pressure) usually present and may have associated bile granulomas
- possibly endarteritis obliterans
- „follicular cholecystitis”: same lesion with germinal centers in wall of gallbladder
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Chronic cholecystitis
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Chronic cholecystitis
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Gall bladder carcinoma
- neoplastic glands lined by highly atypical cuboidal cells
- desmoplastic stroma often forms concentric surrounding fibrosis
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Gall bladder carcinoma
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Gall bladder carcinoma
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Acute pancreatitis
Depending on the phase and severity:
- acute inflammation
- edema
- fat necrosis
- small vessel thrombosis
- necrosis of acini
- hemorrhages
- extensive necrosis of both fat and parenchyma
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Acute pancreatitis
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Acute pancreatitis
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Balser necrosis (enzymatic fat necrosis)
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Insuloma
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