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PATHOLOGY OF THE LIVER

PATHOLOGY OF THE LIVER. VII. practical training 3 rd year General Medicine. Haemochromatosis. Congestion of the liver. Congestion of the liver. Congestion of the liver (hepar moschatum). 2. 1. 1. 2. 1. 1 Portobilial spaces

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PATHOLOGY OF THE LIVER

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  1. PATHOLOGY OF THE LIVER VII. practical training 3rd year General Medicine

  2. Haemochromatosis

  3. Congestion of the liver

  4. Congestion of the liver

  5. Congestion of the liver (hepar moschatum) 2 1 1 2 1 1 Portobilial spaces 2 Ways of congestion (congestion with necrosis of hepatocytes) Pseudolobulus from residues of 3 lobuli, in centre is portobilium

  6. Congestion of the liver (hepar moschatum), detail 3 1 5 4 2 1 Portobilium- dilatated branch of v. portae 2 Pseudolobulus from residues of 3 lobuli, in centre is portobilium 3 Ways of congestion (congestion with necrosis of hepatocytes) 4 Biliary duct 5 Branch of a. hepatica 3

  7. Viral hepatitis HAV RNA hepatovirus HBV DNA hepadnavirus HDV RNA defect virus non A non B (NANB) HCV RNA flavi a pestivirus-like HEV RNA kalicivirus HFV RNA togavirus HGV RNA flavivirus herpesvirus, cytomegalovirus, paramyxovirus, ...

  8. Acute viral hepatitis – morphology Macro: játra zduřelá, červená, pouzdro napjaté Micro: 1. klasická AH s fokální nekrózou 2. AH s bridging nekrózou 3. AH s panacinární nebo multiacinární nekrózou 4. AH s periportální nekrózou Poškození hepatocytů – nekrózy monocelulární, fokální disarray – rozvolnění z trámců, polymorfie Zánětlivá reakce – mononukleární – lobulární, méně portální zduření Kupfferových buněk Regenerace Méně často: lymfoidní agregáty poškození žlučovodů cholestáza neutrofily }VHC }fulminantní, cholestatická VH

  9. Necrosis B) Intensity monocelular focal submasive masive bridging (C – C; C – P) C) Localisation centrolobular periportal midzonal A) Type lytic koagulative (apoptosa) piecemeal activation, healing ad integrum course fibrosis + activation; cirrhosis acute liver failure, death

  10. Acute stage of viral hepatitis

  11. Viral hepatitis subacute fatal

  12. Chronic viral hepatis

  13. Liver – chronic viral hepatis 1 2 1 Portobiliar space with chronic inflammatory infiltrate 2 „piece-meal necroses“ 3 Central part of lobulus with mixed steatosis 3

  14. Liver – chronic viral hepatis 2 1 1 Chronic inflammatory infiltrate in portobiliar space 2 Biliary duct

  15. Chronic viral hepatis, active 3 2 2 1 1 Necrosis of hepatocytes with accumulation of lymphocytes 2 Steatosis 3 Swelling of hepatocytes

  16. Massive necrosis (hepatodystrophy, yellow atrophy) 4 2 1 Biliary duct 2 Artery 3 Vena 4 Parenchyma 1 3

  17. Massive necrosis (hepatodystrophy, yellow atrophy) 2 4 3 1 1 Hepatocyt with eosinophilic cytoplasm and partly defunct nucleus 2 Hepatocyt with degradated nucleus and eosinophilic cytoplasm 3 Lipofuscin 4 Completely defunct hepatocytes

  18. Acute hepatodystrophy

  19. Liver cirrhosis etiologymorphology alkohol 60-70% mikronodulární po CAH 10% makronodulární kryptogenní 10-15% smíšená biliární primární sekundární pigmentové hemochromatóza primární sekundární z vrozených poruch metabolismu (tyrosinemie,galaktosemie ...)

  20. Cirrhosis hepatis

  21. Cirrhosis hepatis

  22. Cirrhosis hepatis

  23. Biliary cirrhosis

  24. Biliary cirrhosis

  25. Biliary cirrhosis (Fouchet)

  26. Alcohol liver steatosis

  27. Alcohol liver cirrhosis

  28. Tumoriformní léze Fokální nodulární hyperplazie Parciální nodulární hyperplazie Nodulární regeneratorní hyperplazie Cysty; hamartom; zánětlivý pseudotumor Benigní tumory adenom hepatocelulární cholangiogenní hemangiom Maligní Hepatocelulární karcinom; fibrolamelární karcinom Cholangiogenní karcinom (periferní, hilový-Klatskin, extrahepatální) Hepatoblastom (embryonální, teratoidní ...) Angiosarkom; maligní hemangioendoteliom sekundární nádory = metastázy

  29. Cavernous haemangioma 1 Liver capsule 2 Liver parenchyma 3 Fibrous septum 4 Big vascular spaces 5 Biliary duct 5 1 2 4 3 3 3

  30. Cavernous haemangioma 1 1 2 1 2 1 1 1 Big vascular spaces 2 Fibrous septum

  31. Cavernous haemangioma 2 4 1 3 4 1 Vascular spaces 2 Flat endothelial cells 3 Fibrous septum 4 Biliary ducts 1

  32. Cavernous haemangioma 1 3 2 2 1 1 Vascular spaces 2 Flat endothelial cells 3 Fibrous septum

  33. Cavernous haemangioma Angiosarcoma copy Mitosis

  34. Primary liver carcinoma

  35. Hepatocellular carcinoma

  36. Hepatocellular carcinoma 2 1 3 1 1 Hepatocellular carcinoma, „pseudoglandular pattern“ 2 Residues of nontumorous liver parenchyma 3 Periportal space

  37. Hepatocellular carcinoma 1 Hepatocellular carcinoma 2 Cells of nontumorous parenchyma 1 2

  38. Hepatocellular carcinoma Absence of liver architecture, anisonucleosis, hyperchromic nuclei, high N/C ratio

  39. Cholangiocarcinoma of the liver

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