A high yield review of

Liver & Gallbladder

Pathology

Tiffany M. Graham, M.D.

(Surgical Pathology/GI Fellow)

(Click on a topic below to learn more)

 

START HERE!! Check out this Liver Biopsy Crash Course courtesy of

Western University on MedEd Portal...  Click to open in new tab then download the 

program and open via any web browser with the most updated version of Flash. 

The Basics

 

Benign Conditions 

 

  • Hepatitis

    • Viral- Hep A, B, C, D, E + Other (CMV, HIV, etc)

    • Other infectious- Parasitic, Bacterial, Fungal

    • Granulomatous

    • Acetaminophen-induced

    • Alcohol-Induced

    • Autoimmune

    • Wilson's Disease

    • Hemochromatosis

    • Alpha 1 Anti-Trypsin Disease

  • Liver Cysts

  • Steatosis & Steatohepatitis

  • Fibrosis & Cirrhosis

  • Vascular Problems

    • Budd Chiari Syndrome

    • Heart failure

    • Portal Hypertension

  • Cholestasis & Jaundice​

  • Biliary Disease

    • Primary Biliary Cholangitis (PBC)​

    • Primary Sclerosing Cholangitis (PSC)

 

 

Neoplastic/Masses in the Liver

  • Hepatic

    • Focal Nodular Hyperplasia (Regenerative Nodule)

    • Hepatocellular/Hepatic Adenoma

    • Hepatocellular Carcinoma (HCC)

    • Fibrolamellar HCC

    • Hepatoblastoma

  • Vascular

    • Hemangioma & Angiosarcoma

  • Biliary

    • Von Meyenberg Complex

    • Bile Duct Adenoma

    • Biliary Adenofibroma

    • Cholangiocarcinoma

  • Neuroendocrine tumors

  • Metastatic Tumors

 

These posts contain high yield information collected from various educational resources including textbooks, journal articles, educational websites and more. They are intended for educational use only. I strongly believe the spreading of knowledge and depth of learned information should be encouraged in today's society rather than coveted. However, membership is required to view these posts  and should be used solely for educational purposes only. It is FREE to sign up. I strongly try to credit any and all sources of information by providing links directly to the source, in a caption, and/or via a list of references. If you feel that I have not credited a source properly or want a complete list of references, please feel free to reach out and I can address your concerns. Thank you kindly.

Liver Pathology Mindmap

Click on Attachment or Image below to download the original PDF document

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Recent Posts.

 

A quick review of Liver Anatomy & Histology

 

 

 

 

Click to view more...

 

The Basics.

Portal tract = Branches of each of the following structures:

  1. Bile duct

  2. Hepatic artery

  3. Portal vein

Central vein = Hepatic vein --> IVC --> Right heart

The histology of the liver is typically described in one of two ways based on the arrangement of triads and central veins:

Liver Lobules

  • Anatomic hexagons based on a central hepatic vein surrounded by portal tracts

Liver Acinar Structures

  • Functional unit of the liver divided into zones based on the distance from a portal tract

    • Zone 1= Nearest portal tract

      • Receives the highest oxygen-rich blood​

      • Most often involved by VIRAL INFECTIONS​ and HEMOCHROMATOSIS

    • Zone 2= intermediate zone between 1 and 3

    • Zone 3= Nearest central (hepatic) vein

      • Receive least oxygenated blood- more susceptible to ISCHEMIC INJURY

      • Most of drug detoxification occurs here- more susceptible to ACETAMINOPHEN/DRUG TOXICITY

 

Tips for [future]

Pathologists.

For a really good overview of how to approach a liver biopsy, be sure to check out these PathCast youtube videos featuring Dr. Emma Furth. Her logical approach and how she brings it back to the "big picture" really helps build the foundation you need when approaching the daunting Medical Liver Biopsy specimen. Kudos, Dr. Furth (if you ever check out this page- I'm a total fan!) 

A Pattern-Based Approach

to the Liver Biopsy

Near-Normal Appearance​

Portal Cellular Infiltrates

Ductular Reaction

Lobular Injury

Steatosis

Fibrosis

Mass or Cystic Lesion

Major patterns of pathology in medical liver:

                         (Click to learn more about each pattern) 

1. Hepatitic pattern

2. Biliary pattern

3. Steatotic pattern

4. Vascular pattern

How to sign out a medical liver explant

How to assess and sign out Hepatitis C

Example format for

Sign Out:

Liver, native, [core/wedge] biopsy:

   - Portal findings:

   - Lobular findings:

   - Fibrosis.

   - See comment.

 
 

Cancer Workup.

From WHO Classification of Tumours of the Digestive System, 4th Ed.- Algorithms for diagnosis of hepatobiliary tumors and cysts

DDx: Mass in a

non-cirrhotic liver

- Focal Nodular Hyperplasia

-Liver cell adenoma

-Hepatocellular carcinoma

Useful IHC Stains

From WHO Classification of Tumours of the Digestive System, 4th Ed.- Algorithms for diagnosis of hepatobiliary tumors and cysts

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DISCLAIMER: THIS WEBSITE DOES NOT PROVIDE MEDICAL ADVICE

These posts contain high yield information collected from various educational resources including textbooks, journal articles, educational websites and more. They are intended for educational use only and should NOT be taken as medical advice. I strongly believe the spreading of knowledge and depth of learned information should be encouraged in today's society rather than coveted. Membership is required to view these posts  and should be used solely for educational purposes only.