Acute fulminant hepatitis . 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).
Acute infectious hepatitis-massive necrosis. 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.
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.
Marked fatty change of liver (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.
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).
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.
Halothane hepatitis. Comment: (Both this and above specimen have bile stained fluid in the preservative) Dark areas probably represent the areas of necrosis; some of these areas interconnect; remaining cells may contain some fat.
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).
Laennec's cirrhosis and fatty liver. 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.
Laennec's cirrhosis (severe). 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.
Laennec's cirrhosis. 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.
Laennec's cirrhosis. 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.
