Faculty of allied medical sciences Histopathology and cytology (MLHC-201)

Liver Pathology Supervision : Prof. Dr. Noha Ragab

Outcomes By the end of this lecture, the student will be able to identify: 1-Steatosis 2-Benign tumours of the liver 3-Malignant tumours of the liver

1. Fatty changes (steatosis) It is a reversible condition Grossly : Liver enlargement, yellow and greasy Microscopically: Centrilobular micro-vesicular steatosis (reversible) Eventual fibrosis around the central vein (irreversible)

Fatty changes (steatosis) This liver is slightly enlarged and has a pale yellow appearance, seen both on the capsule and cut surface.

The lipid accumulates in the hepatocytes as vacuoles. Fatty changes (steatosis) The lipid accumulates in the hepatocytes as vacuoles. These vacuoles have a clear appearance with H&E staining.

LIVER TUMORS

BENIGN LIVER TUMORS

Hemangioma Most common primary tumor of the liver It is a benign vascular tumor Grossly: Subcapsular, red spongy mass It is often asymptomatic and detected incidentally

Hemangioma This is a benign hemangioma of the liver just beneath the capsule.

Hepatic adenoma (Liver cell adenoma) Young women Related to oral contraceptive use Sub-capsular adenoma may rupture, causing intra peritoneal hemorrhage Microscopically: Resembles normal liver except for lack of portal tracts It may regress after oral contraceptive is discontinued

Hepatic adenoma

Hepatic adenoma

The hepatic adenoma is composed of cells that closely resemble normal hepatocytes, but the neoplastic liver tissue is disorganized hepatocyte cords and does not contain a normal lobular architecture

MALIGNANT LIVER TUMORS

Hepatocellular carcinoma (HCC) Definition: Hepatocellular Carcinoma (HCC) is a Malignant Tumor that Derives from Hepatocytes or Their Precursors

Risk factors include the following: 1-HEPATITIS B: There is a strong association between HBV infection and HCC. Most (>80%) cases of HCC associated with HBV infection occur in patients with cirrhosis. The repeated cycles of liver cell regeneration in chronic hepatitis initiate the emergence of a neoplastic clone. The worldwide use of a vaccine for HBV should significantly decrease the prevalence of HCC in the future.

2-HEPATITIS C: 3-Haemochromatosis 4-Alcoholic cirrhosis HCV infection is present in about 50% of cases of HCC. Most patients infected with HCV who develop HCC have underlying cirrhosis. 3-Haemochromatosis 4-Alcoholic cirrhosis

Pathological picture: Grossly: HCCs appear grossly as soft, hemorrhagic tan masses in the liver. In some cases, a large solitary tumor occupies a portion of the liver; in other instances, many smaller tumors are found.

The tumor has a tendency to grow into portal veins and may extend into the vena cava and even the right atrium through the hepatic veins. Metastases occur widely, although the most common sites are the lungs and portal lymph nodes.

Hepatocellular carcinoma

Microscopic patterns of HCC: A number of histologic patterns are recognized: 1- Trabecular pattern: The tumor cells are arranged in trabeculae or plates that resemble the normal liver. The plates are separated by endothelium-lined sinusoids.

Trabecular pattern of Hepatocellular Carcinoma

2- Pseudoglandular pattern (adenoid, acinar) In this variety, malignant hepatocytes are arranged around a lumen and thus resemble glands. The lumina may contain bile.

Pseudoglandular pattern of Hepatocellular Carcinoma

3- Fibrolamellar HCC The tumor is composed of large, eosinophilic, neoplastic hepatocytes arranged in clusters and surrounded by delicate collagen fibers. The prognosis is considered more favorable than in most cases of HCC.

Fibrolamellar HCC

Clinical Features: HCC usually presents as a painful and enlarging mass in the liver. HCC may be associated with a variety of paraneoplastic manifestations (e.g., polycythemia, hypoglycemia, hypercalcemia) as a result of ectopic hormone production by the tumor. Alpha-Fetoprotein levels are often elevated in HCC

Metastatic tumors to the liver: Metastatic Cancer is the Most Common Malignant Tumor of the Liver Metastatic cancers, including the gastrointestinal tract, breast, and lung. Also pancreatic carcinoma and malignant melanoma. The first indication of a metastatic tumor is frequently an unexplained increase in the serum alkaline phosphatase level. Most patients die within a year of the diagnosis of

Metastatic tumors to the liver

Metastatic tumors to the liver

Questions 1- What are the microscopic characters of steatosis ? 2- What are the microscopic characters of hepatic adenoma ? 3- Define Hepatocellular carcinoma. 4- What is the first indication of a metastatic tumour ?

سيتم إجراء امتحان العملى يوم الاحد الموافق 29/12/2013 فى مدرج G516 . Practical Exam سيتم إجراء امتحان العملى يوم الاحد الموافق 29/12/2013 فى مدرج G516 . على ان يتم حضور المجموعة الاولى من 10: 30و المجموعة الثانية من .12: 30

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