1. NORMAL LIVER
Bile duct
Hepatic arteriole
Portal vein

2. BALLOONING DEGENERATION

3. STEATOSIS (FATTY CHANGE) -- microvesicular (alcohol, Reye’s)
Macrovesicular (alcohol, obesity, diabetes)

4. COUNCILMAN OR APOPTOTIC BODY

5. PIECEMEAL NECROSIS -- viral hepatitis

6. HEPATOCYTE DROPOUT

7. Bridging Fibrosis

8. Massive Hepatic Necrosis
Regenerative nodules
Areas of collapse

9. CIRRHOTIC LIVER

10. regenerative nodules usually don’t contain portal tracts
CIRRHOTIC LIVER--
regenerative nodules usually don’t contain portal tracts

11. HEPATITIS B
Ground glass cell

12. lymphoid follicles and randomly scattered fat characteristic of
Hepatitis C. 50% chronic

13. ALCOHOLIC HEPATITIS - MALLORY’S HYALIN

14. ALCOHOLIC HEPATITIS - FATTY CHANGE

15. Mallory's hyaline is seen here, but there are also neutrophils, necrosis of hepatocytes, collagen deposition, and fatty change. These findings are typical for acute alcoholic hepatitis. Such inflammation can occur in a person with a history of alcoholism who goes on a drinking "binge" and consumes large quantities of alcohol over a short time.

16. Photomicrograph of hemochromatosis
showing iron accumulation in hepatocytes. Prussian Blue stain.

17. The hepatocytes and Kupffer cells here are full of granular brown deposits of hemosiderin from accumulation of excess iron in the liver. The term "hemosiderosis" is used to denote a relatively benign accumulation of iron. The term "hemochromatosis" is used when organ dysfunction occurs. The iron accumulation may lead to a micronodular cirrhosis (so called "pigment" cirrhosis).

18. Glycogenated nuclei and sparse lobular inflammation in Wilson’s
Disease.

19. PAS+, diastase resistant globules in A1AT deficiency.

20. Immunostain for alpha-one antitrypsin showing
accumulation in hepatocytes

21. Lymphocytes infiltrate and destroy the bile duct, constituting the
“florid duct lesion” of primary biliary cirrhosis.

22. This is a case of primary biliary cirrhosis, a rare autoimmune disease (mostly of middle-aged women) that is characterized by destruction of bile ductules within the triads of the liver. Antimitochondrial antibody can be detected in serum. Seen here in a portal tract is an intense chronic inflammatory infiltrate with loss of bile ductules. Micronodular cirrhosis ensues.

23. Bile ducts are destroyed and replaced by fibrous nodular scars in primary sclerosing cholangitis. Male predominance

24. Cavernous hemangioma; note large blood-filled channels

25. Focal nodular hyperplasia; note large central stellate scar
and surrounding nodules of liver parenchyma
Scar
Parenchymal
nodules

26. Focal Nodular Hyperplasia; note large central stellate scar

27. CHOLANGIOCARCINOMA -- irregular borders

28. Cholangiocarcinoma. Note small round infiltrating glands.

29. Cholangiocarcinoma -- associated with?
Thorotrast, liver flukes, primary sclerosisng cholangitis

30. HEPATOCELLULAR CARCINOMA

31. HCC invading vascular channels

32. Hepatocellular Carcinoma. Tumor cells resemble hepatocytes.

33. Hepatocellular carcinoma.
Note hyaline globules and eosinophilic cytoplasm.
Hyaline globule

34. Note that this hepatocellular carcinoma is composed of liver cords that are much wider than the normal liver plate that is two cells thick. There is no discernable normal lobular architecture, though vascular structures are present.

35. Fibrolamellar hepatocellular carcinoma. Note central scar
Fibrolamellar hepatocellular carcinoma. Note central scar. -- better prognosis

36. Fibrolamellar hepatocellular carcinoma.
Note broad fibrous bands separating islands of eosinophilic cells.

37. NORMAL GALLBLADDER

38. Low power view of chronic cholecystitis; note thickened, congested
wall and mucosal chronic inflammation.

39. High power view of chronic cholecystitis; note mucosal
chronic inflammation

40. Rokitansky-Aschoff
sinus in chronic
cholecystitis.

41. Impacted stone at ampulla within marked dilated common
bile duct (CBD).
CBD
duodenum

42. Papillary adenocarcinoma of the gallbladder in a patient with gallstones.

43. Papillary adenocarcinoma of gallbladder.

44. CBD
duodenum
Tumor at ampulla

45. Invasive adenocarcinoma at ampulla.

46. Perineural invasion in a cholangiocarcinoma
nerve

47. Normal Pancreas
Acinar tissue
Islet
Duct

48. Acute hemorrhagic pancreatitis.
pancreas

49. Acute pancreatitis with fat necrosis.

50. Chronic pancreatitis with calcifications apparent on an xray.

51. Chronic pancreatitis: small, fibrotic pancreas with numerous
stones impacted in pancreatic duct.

52. Chronic pancreatitis: dense fibrosis and destruction of acinar
tissue; only scattered islets remain.

53. Pancreatic Pseudocyst

54. Adenocarcinoma replacing tail and body of pancreas.

55. Malignant glands in pancreatic adenocarcinoma.

56. Acinar tissue
Islet cell
tumor
Islet

57. High power view of islet cell tumor (left). Note how cells resemble
normal islet at right.

58. The islet cell adenoma at the left contrasts with the normal pancreas with islets at the right. Some of these adenomas function. Those that produce insulin may lead to hypoglycemia. Those that produce gastrin may lead to multiple gastric and duodenal ulcerations (Zollinger-Ellison syndrome).