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Liver and pancreas

Liver and pancreas. SYLLABUS: RBP( Robbins Basic Pathology ) Chapter s : The Liver and the Biliary Tract The Pancreas. Liver and pancreas. 182a Chronic cholecystitis 228 Gall bladder carcinoma 249 Metastatic carcinoma of the liver (small cell carcinoma)

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Liver and pancreas

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  1. Liver and pancreas SYLLABUS: RBP(Robbins Basic Pathology) Chapters: TheLiver and theBiliaryTract ThePancreas

  2. Liver and pancreas 182aChronic cholecystitis 228Gall bladder carcinoma 249Metastatic carcinoma of the liver (small cellcarcinoma) 230Metastatic carcinoma of the liver (mucinouscarcinoma) 254Chronic hepatitis 253Liver cirrhosis (H&A, Masson) 252Miliary tuberculosis (liver) 250Hepatocarcinoma 250aCholangiocarcinoma246Acute pancreatitis

  3. flashback Liver and pancreas 3 Acute hepatic congestion 5Chronic passive congestion of the liver 17 Liver steatosis (H&E) 18 Liver steatosis (Sudan III) 43Balser necrosis (enzymatic fat necrosis) 186Insuloma

  4. Acute hepatic congestion flashback

  5. Chronic passive congestion of the liver flashback

  6. Liver steatosis (H&E) flashback

  7. Liver steatosis (Sudan III) flashback

  8. 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

  9. Chronic hepatitis

  10. Chronic hepatitis

  11. Chronic hepatitis

  12. 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)

  13. Liver cirrhosis

  14. Liver cirrhosis (Masson stain)

  15. Liver cirrhosis

  16. 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

  17. Hepatocarcinoma

  18. Hepatocarcinoma

  19. Cholangiocarcinoma - glands with cuboidal to columnar atypical and pleomorphic cells - typical perineural and periductal growth pattern - often desmoplastic stroma - may contain signet cells

  20. Cholangiocarcinoma

  21. Cholangiocarcinoma

  22. Metastatic carcinoma of the liver microscopic features depend on the type of the primary tumor: eg: - small cell carinoma (lung) - mucinous carcinoma (GI)

  23. Metastatic carcinoma of the liver (small cellcarcinoma)

  24. Metastatic carcinoma of the liver (small cellcarcinoma)

  25. Metastatic carcinoma of the liver (mucinouscarcinoma)

  26. Metastatic carcinoma of the liver (mucinouscarcinoma)

  27. Miliary tuberculosis (liver) numerous small TB granulomas

  28. Miliary tuberculosis (liver)

  29. Miliary tuberculosis (liver)

  30. 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

  31. Chronic cholecystitis

  32. Chronic cholecystitis

  33. Gall bladder carcinoma - neoplastic glands lined by highly atypical cuboidal cells - desmoplastic stroma often forms concentric surrounding fibrosis

  34. Gall bladder carcinoma

  35. Gall bladder carcinoma

  36. 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

  37. Acute pancreatitis

  38. Acute pancreatitis

  39. Balser necrosis (enzymatic fat necrosis) flashback

  40. Insuloma flashback

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