Fatty liver of alcoholism . 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.
Adenocarcinoma of bile duct. COMMENT: Tumor involves central portion of specimen--obviously in this and above five specimens, the histologic appearance is crucial to the diagnosis
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.
Acute hepatic necrosis secondary to occlusion of hepatic veins by renal cell carcinoma and thrombus ). COMMENT: Note thrombosed veins (arrows) and adjacent necrosis (dark areas). Remember tendency of renal cell carcinoma to invade vascular structures (i.e., renal veins to IVC and out hepatic veins).
Multiple liver cell adenomas. COMMENT(#49 & #50): Good examples of multiple adenomas; areas of infarction/hemorrhage often found (remember microscopic characteristics).
INH hepatitis with massive necrosis. COMMENT: Looks just like the massive necrosis of fulminant viral hepatitis (decrease in liver size, shrunken capsule, vascular structures close together, purple red, soft, flabby).
Biliary cirrhosis secondary to common bile duct atresia. COMMENT: (#36-#37): Biliary cirrhosis--two examples--of the secondary type, i.e., secondary to atresia (or obstruction) of extrahepatic or intrahepatic bile ducts. Both are examples of micronodular cirrhosis. In the first, ectasia of intrahepatic bile ducts can be appreciated. In the second, appreciate the blood-filled submucosal esophageal varices and the enormous spleen with focal subcapsular infarcts (at top) (compare size of spleen with esophagus to appreciate the splenomegaly).
Alpha-1-antitrypsin deficiency. COMMENT: Bile stasis and a micronodular cirrhosis are seen in this example of enzyme deficiency disease. Can also result in a macronodular cirrhosis
Polyarteritis nodosa with liver and kidney infarcts. Comment: Almost entire left lobe is infarcted--arrow points to thrombosed hepatic artery branch; many arteries (arrows) near the corticomedullary junctions of kidney (probably arcuate arteries) have abnormally thick walls and are thrombosed--infarcts can be seen (arrows).
Cardiac cirrhosis. COMMENT: You would expect a centrilobular necrosis and fibrosis in cirrhosis resulting from right-sided heart failure. A resulting fine cirrhosis is present usually as in most of this specimen; however, there are a few areas of broader scars in the center of the specimen.
Cirrhosis of liver in cystic fibrosis. 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.
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).
Focal 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).
