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.
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.
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
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).
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
Biliary atresia in 3 y.o. with biliary cirrhosis, esophageal varices and congested spleen. 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).
Multiple infarction of liver--ischemic heart disease. Comment: Multifocal areas of infarction are present--easiest to see are white, sharply demarcated, with irregular borders.
Hepatocellular carcinoma in Laennec's cirrhosis. COMMENT: Although more likely to occur in postnecrotic cirrhosis, can see this in Laennec's cirrhosis (mass in upper right = tumor)
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)
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)
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)
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)
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
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
