Difference between revisions of "Medical liver disease"

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Medical liver disease (view source)

Revision as of 17:59, 30 August 2016

364 bytes added ,  17:59, 30 August 2016
→‎Images: Replaced the cirrhotic case with a large picture example
(→‎Images: Replaced the cirrhotic case with a large picture example)
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| Metavir activity index 2 (Piecemeal necrosis 2, Lobular necrosis 1). Hepatitis C genotype 3a.    Steatosis, not pan-acinar and dark, expanded triads(UL) with the inset showing a Councilman body. Reticulin collapse, not portal-central (UR green arrowhead). Reticulin with more than focal piecemeal necrosis in some triads/tracts (LL magenta arrowheads) Trichrome stain of a  tract (the entire structure may be a large bridge) with thinner bridges (LR cyan arrowheads).   
| Metavir activity index 2 (Piecemeal necrosis 2, Lobular necrosis 1). Hepatitis C genotype 3a.    Steatosis, not pan-acinar and dark, expanded triads(UL) with the inset showing a Councilman body. Reticulin collapse, not portal-central (UR green arrowhead). Reticulin with more than focal piecemeal necrosis in some triads/tracts (LL magenta arrowheads) Trichrome stain of a  tract (the entire structure may be a large bridge) with thinner bridges (LR cyan arrowheads).   
Original oculars. UL 4X (inset 40X with higher magnification), UR 20X, LL 40X, LR 10X
Original oculars. UL 4X (inset 40X with higher magnification), UR 20X, LL 40X, LR 10X
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| [[File:HCV c1 2016 06 23.tif|thumb|Metavir stage 4 fibrosis in patient with HCV, for Libre Pathology]]
| Metavir activity index 3 (Piecemeal necrosis 2, Lobular necrosis 2), Metavir fibrosis stage 4.  Hepatitis C genotype 1a. Inflamed bands separate hepatocyte regions distorted by steatosis (UL). Bordering tract and acini (UR) lymphocytes, macrophages, eosinophils, and rare neutrophils (black arrowhead) invest both proliferated bile ducts (yellow arrowheads) and hepatocytes, some showing ballooning degeneration (green arrowhead). Reticulin shows hepatocyte cords often two nuclei thick bounded by directionless sinusoids, consistent with a regenerative nodule (LL). Trichrome shows extensive bridging with a potential flattened nodule; although a debate about the presence or absence of definite fibrosis would have existed, with the Metavir scoring system, this is considered fibrosis stage 4 (LR). 
Original oculars UL 4X, UR 40X, LL 20X, LR 10X
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[[File:1 hcv 6 680x512px.tif|Inflamed bands cross hepatocytes with steatosis (Row 1 Left 40X).]]
[[File:2 hcv 6 680x512px.tif|Trichrome shows extensive bridges  (Row 1 Right 40X).]]
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[[File:3 hcv 6 680x512px.tif|Trichrome also documents early nodule formation (Row 2 Left 40X).]]
[[File:4 hcv 6 680x512px.tif|Reticulin shows regeneration (two nuclei per cord) in a nodule, but not throughout (Row 2 Right 200X).]]
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[[File:5 hcv 6 680x512px.tif|Hematoxylin and eosin shows piecemeal necrosis as inflammatory cells surrounding hepatocytes (Row 3 Left 400X).]]
[[File:6 hcv 6 680x512px.tif|Reticulin shows black lines about hepatocytes, indicating confluent piecemeal necrosis (Row 3 Right 400X).]]
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Hepatitis C with metavir stage IV fibrosis (advanced fibrosis/cirrhosis) and confluent piecemeal necrosis.
Inflamed bands cross hepatocytes with steatosis (Row 1 Left 40X). Trichrome shows extensive bridges  (Row 1 Right 40X). Trichrome also documents early nodule formation (Row 2 Left 40X). Reticulin shows regeneration (two nuclei per cord) in a nodule, but not throughout (Row 2 Right 200X). Hematoxylin and eosin shows piecemeal necrosis as inflammatory cells surrounding hepatocytes (Row 3 Left 400X). Reticulin shows black lines about hepatocytes, indicating confluent piecemeal necrosis (Row 3 Right 400X).


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