Difference between revisions of "Medical liver disease"

[[File:1 etoh 3 680x512px.tif| Alcoholic hepatitis with Metavir stage IV fibrosis (advanced fibrosis/cirrhosis).]]

[[File:2 etoh 3 680x512px.tif| Alcoholic hepatitis with Metavir stage IV fibrosis (advanced fibrosis/cirrhosis).]]

[[File:3 etoh 3 680x512px.tif| Alcoholic hepatitis with Metavir stage IV fibrosis (advanced fibrosis/cirrhosis).]]

[[File:4 etoh 3 680x512px.tif| Alcoholic hepatitis with Metavir stage IV fibrosis (advanced fibrosis/cirrhosis).]]

Trichrome shows relatively non-inflamed fibrous bands, as well as [between green dots] nodules. The lack of regeneration throughout might have precluded a diagnosis of cirrhosis, but stage IV fibrosis under the Metavir system is justified (Row 1 Left 20X). Reticulin shows regenerative nodules [left] with mostly two or more nuclei between black lines juxtaposed to non-regenerative hepatocytes on the right, without piecemeal necrosis. (Row 1 Right 100X). Regenerative nodules show occasional neutrophils [red arrow] and cytoplasmic tufts of ballooned cells, sometimes possibly Mallory hyalin [green arrows] (Row 2 Left 200X). Triads (note vein [green arrow], artery [yellow arrow], and interlobular bile duct [blue arrow]) generally showed little or no interface hepatitis, even when expanded by fibrosis and inflamed (Row 2 Right 200X). Occasional foci of spotty necrosis were seen (Row 3 Left 200X).   This edge of an inflamed triads shows neutrophils about proliferated bile ducts [red arrows], as well as Mallory-Denk bodies [blue arrows] (Row 4 Left 400X).

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[[File:1 etoh 4 680x512px.tif| Cirrhosis in an alcoholic.]]

[[File:2 etoh 4 680x512px.tif| Cirrhosis in an alcoholic.]]

[[File:3 etoh 4 680x512px.tif| Cirrhosis in an alcoholic.]]

[[File:4 etoh 4 680x512px.tif| Cirrhosis in an alcoholic.]]

[[File:5 etoh 4 680x512px.tif| Cirrhosis in an alcoholic.]]

[[File:6 etoh 4 680x512px.tif| Cirrhosis in an alcoholic.]]

Definite cirrhosis in an alcoholic. Hepatocyte free bands parse tissue, with occasional definite islands [arrows] (Row 1 Left 40X). Trichrome establishes blue fibrosis about isles [arrows] (Row 1 Right 40X). Reticulin stain shows nodules with regeneration, wherein a large proportion of them are at least two nuclei thick [arrows] (Row 2 Left 200X). Bile duct proliferation can be difficult, sometimes mimicking cholangiocarcinoma. Follow the double headed arrows to see how the ductules can be seen to proliferate from a single sources, with all ducts being complete, without necrotic epithelial cells. (Row 2 Right 400X). PAS with distase can help, as cholangiocarcinoma generally lacks the red rim of proliferating bile ductules [arrows]; again note the connections that can be made between the ductule openings by the blue double headed arrows. The cyan double headed arrows show general parallelism, consistent with uniform directionality induced by extrinsic force, not a neoplastic spread (Row 3 Left 400X). Trichrome shows the most difficult focus. Double headed arrows display the connectivity seen before of the proliferated bile ductules. Note that numerous pairs of adjacent perpendicular glands without a head to foot appearance are not seen that would indicate the disorderly spread of cholangiocarcinoma  (Row 3 Right 400X).

 

[[File:2 ALC 2 680x512px.tif|Trichrome stain shows periportal fibrosis [red arrowheads] (200X).]]

Alcoholic hepatitis without cirrhosis. No history of viral disease. AMA negative. Expanded, inflamed triads with increased bile duct/vascular openings. Mild steatosis (UL 40X). Trichrome stain shows periportal fibrosis [red arrowheads] (UR 200X). PAS with diastase stain shows proliferated bile ductules [blue arrowheads] in stroma with mixed inflammatory infiltrate (LL 400X) Neutrophils about ballooned hepatocyte (satellitosis) [yellow arrowheads]. Councilman bodies [green arrowheads] (LR 400X).