Submassive hepatic necrosis with early postnecrotic cirrhosis. Comment: Nodular lesions represent attempt at regeneration. COMMENT ON SPECIMENS (#25-29): These illustrate the range of changes seen in autopsy livers from patients dying from viral hepatitis (liver disease or complications therefrom): #25=a liver that is bile stained and shows dark areas of necrosis but is not as massively necrotic as #26 and #27 (these two livers probably less than 800-900 gms) and although these two do not now show the usual maroon appearance, there has been a marked loss of hepatocytes. #28 and #29 show pale nodular areas interspersed in liver parenchyma which histologically demonstrates, besides necrosis, scarring or cirrhosis (#28 less, #29 more scarring). The nodular areas actually represent attempts at regeneration of hepatocytes.
Nodular hyperplasia of liver. COMMENT: #46 and #48 have well developed scars in the presence of nodular liver tissue, these being the gross characteristics of this lesion (review microscopic characteristics).
Malignant melanoma metastatic to liver and spleen (no number). COMMENT (#60-64): Metastatic tumors in liver characteristically have central necrosis (umbilicated appearance through the capsule) due to outgrowth of blood/nutrient supply--other than this, variations in appearance may reflect origin of tumor i.e., the melanoma is represented by both pigmented and non-pigmented (amelanotic) metastases; choriocarcinoma typically is hemorrhagic. The cholelithiasis in #64 is unrelated to metastatic tumor)
Metastatic choriocarcinoma to liver from testis. COMMENT (#60-64): Metastatic tumors in liver characteristically have central necrosis (umbilicated appearance through the capsule) due to outgrowth of blood/nutrient supply--other than this, variations in appearance may reflect origin of tumor i.e., the melanoma is represented by both pigmented and non-pigmented (amelanotic) metastases; choriocarcinoma typically is hemorrhagic. The cholelithiasis in #64 is unrelated to metastatic tumor)
Oat cell carcinoma of lung metastatic to liver. COMMENT (#60-64): Metastatic tumors in liver characteristically have central necrosis (umbilicated appearance through the capsule) due to outgrowth of blood/nutrient supply--other than this, variations in appearance may reflect origin of tumor i.e., the melanoma is represented by both pigmented and non-pigmented (amelanotic) metastases; choriocarcinoma typically is hemorrhagic. The cholelithiasis in #64 is unrelated to metastatic tumor)
Chronic myelogenous leukemia with myelofibrosis (of bone marrow)--chronic lymphocytic leukemia usually results in more striking hepatomegaly than CML but this liver is most remarkably enlarged, although no nodular leukemic infiltrates can be seen. Myelofibrosis (fibrosis of bone marrow) may have contributed to the hepatosplenomegaly if hematopoiesis was present in the liver
Hepatoblastoma (mixed type) . COMMENT: Rare malignant tumor of liver in infancy and childhood with histologic picture consisting of cells resembling fetal liver cells, undifferentiated cells or occasionally admixed with other connective tissue elements. Prognosis usually better than hepatocellular carcinoma
Severe fatty metamorphosis of liver (No number). Comment on L-10 through L-12: Livers are pale, enlarged with ""rolled"" edges--one specimen (L-12) has been stained with Oil Red O to demonstrate the fat present in the tissue.
Metastatic choriocarcinoma; multifaceted pigment stones in gallbladder. COMMENT (#60-64): Metastatic tumors in liver characteristically have central necrosis (umbilicated appearance through the capsule) due to outgrowth of blood/nutrient supply--other than this, variations in appearance may reflect origin of tumor i.e., the melanoma is represented by both pigmented and non-pigmented (amelanotic) metastases; choriocarcinoma typically is hemorrhagic. The cholelithiasis in #64 is unrelated to metastatic tumor)
Multiple infarction of liver--ischemic heart disease. Comment: Multifocal areas of infarction are present--easiest to see are white, sharply demarcated, with irregular borders.
Finely and coarsely nodular cirrhosis of liver (mucoviscidosis sequelae). COMMENT (#40-#41): Although a finely nodular biliary cirrhosis is described, one can also see a coarsely nodular (macronodular) pattern in the livers of longstanding cystic fibrosis
Cholangiocarcinoma and metastatic oat cell carcinoma in liver. COMMENT: Central carved-out area represents focus of cholangiocarcinoma; nodular areas=metastatic oat cell (lung) tumor (A81-512)
Multiple liver cell adenomas. COMMENT(#49 & #50): Good examples of multiple adenomas; areas of infarction/hemorrhage often found (remember microscopic characteristics).
Portal cirrhosis; fatty degeneration. COMMENT: Specimens 13-22 are all examples of cirrhosis associated with alcoholism (Laennec's, portal, nutritional, alcoholic)--note that the specimens have a micronodular pattern in general with a generally uniform appearance to the nodules; however, note that some of the livers have nodules of up to about 1 cm. (see note below) and that there may be some variability in nodule size within one specimen. Intervening parenchyma is composed of fibrous septae. Also note that the remaining nodular liver parenchyma is quite pale or yellow = fatty change associated with continued alcohol abuse. Picture corresponding microscopic picture in your mind's eye of fatty change and cirrhosis (remember the definition of cirrhosis). Specimen #22 indicates that microscopically there is necrosis of hepatocytes with an inflammatory response = this is not evident grossly in this specimen. In this series, the small firm livers are good examples of end stage nutritional or alcoholic cirrhosis. NOTE: Although Robbins says that micronodular cirrhosis has nodules of up to 1 cm. in diameter, Dr. Hennigar's measurement of 3mm. and below is more characteristic.
