PATHOLOGY OF THE LIVER VII practical training 3

Congestion of the liver (hepar moschatum) 2 1 1 Portobilial spaces 2 Ways of

Congestion of the liver (hepar moschatum), detail 3 1 5 4 2 1 Portobilium-

Viral hepatitis HAV RNA hepatovirus HBV DNA hepadnavirus HDV RNA defect virus HCV RNA

Acute viral hepatitis – morphology Macro: játra zduřelá, červená, pouzdro napjaté Micro: 1. klasická

Necrosis A) Type lytic koagulative (apoptosa) piecemeal B) Intensity C) Localisation monocelular centrolobular focal

Liver – chronic viral hepatis 1 2 1 Portobiliar space with chronic inflammatory infiltrate

Liver – chronic viral hepatis 2 1 1 Chronic inflammatory infiltrate in portobiliar space

Chronic viral hepatis, active 3 2 2 1 1 Necrosis of hepatocytes with accumulation

Massive necrosis (hepatodystrophy, yellow atrophy) 4 2 3 1 1 Biliary duct 2 Artery

Massive necrosis (hepatodystrophy, yellow atrophy) 2 4 1 3 1 Hepatocyt with eosinophilic cytoplasm

Liver cirrhosis etiology morphology alkohol po CAH kryptogenní 60 -70% 10 -15% biliární primární

Tumoriformní léze Fokální nodulární hyperplazie Parciální nodulární hyperplazie Nodulární regeneratorní hyperplazie Cysty; hamartom; zánětlivý

Cavernous haemangioma 1 Liver capsule 2 Liver parenchyma 3 Fibrous septum 4 Big vascular

Cavernous haemangioma 1 1 2 1 1 1 Big vascular spaces 2 Fibrous septum

Cavernous haemangioma 2 1 4 3 4 1 1 Vascular spaces 2 Flat endothelial

Cavernous haemangioma 1 2 1 3 2 1 Vascular spaces 2 Flat endothelial cells

Cavernous haemangioma Angiosarcoma copy Mitosis

Hepatocellular carcinoma 1 2 3 1 1 Hepatocellular carcinoma, „pseudoglandular pattern“ 2 Residues of

Hepatocellular carcinoma 1 Hepatocellular carcinoma 2 Cells of nontumorous parenchyma 1 2

Hepatocellular carcinoma Absence of liver architecture, anisonucleosis, hyperchromic nuclei, high N/C ratio

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PATHOLOGY OF THE LIVER VII. practical training 3 rd year General Medicine

Haemochromatosis

Congestion of the liver

Congestion of the liver (hepar moschatum) 2 1 1 Portobilial spaces 2 Ways of congestion (congestion with necrosis of hepatocytes) Pseudolobulus from residues of 3 lobuli, in centre is portobilium

Congestion of the liver (hepar moschatum), detail 3 1 5 4 2 1 Portobilium- dilatated branch of v. portae 2 Pseudolobulus from residues of 3 lobuli, in centre is portobilium 3 Ways of congestion (congestion with necrosis of hepatocytes) 4 Biliary duct 5 Branch of a. hepatica 3

Viral hepatitis HAV RNA hepatovirus HBV DNA hepadnavirus HDV RNA defect virus HCV RNA flavi a pestivirus-like HEV RNA kalicivirus HFV RNA togavirus HGV RNA flavivirus non A non B (NANB) herpesvirus, cytomegalovirus, paramyxovirus, . . .

Acute viral hepatitis – morphology Macro: játra zduřelá, červená, pouzdro napjaté Micro: 1. klasická AH s fokální nekrózou 2. AH s bridging nekrózou 3. AH s panacinární nebo multiacinární nekrózou 4. AH s periportální nekrózou Poškození hepatocytů – nekrózy monocelulární, fokální disarray – rozvolnění z trámců, polymorfie Zánětlivá reakce – mononukleární – lobulární, méně portální zduření Kupfferových buněk Regenerace } Méně často: lymfoidní agregáty VHC poškození žlučovodů cholestáza fulminantní, cholestatická neutrofily VH }

Necrosis A) Type lytic koagulative (apoptosa) piecemeal B) Intensity C) Localisation monocelular centrolobular focal periportal submasive midzonal masive bridging (C – C; C – P) activation, healing ad integrum course fibrosis + activation; cirrhosis acute liver failure, death

Acute stage of viral hepatitis

Viral hepatitis subacute fatal

Chronic viral hepatis

Liver – chronic viral hepatis 1 2 1 Portobiliar space with chronic inflammatory infiltrate 2 „piece-meal necroses“ 3 Central part of lobulus with mixed steatosis 3

Liver – chronic viral hepatis 2 1 1 Chronic inflammatory infiltrate in portobiliar space 2 Biliary duct

Chronic viral hepatis, active 3 2 2 1 1 Necrosis of hepatocytes with accumulation of lymphocytes 2 Steatosis 3 Swelling of hepatocytes

Massive necrosis (hepatodystrophy, yellow atrophy) 4 2 3 1 1 Biliary duct 2 Artery 3 Vena 4 Parenchyma

Massive necrosis (hepatodystrophy, yellow atrophy) 2 4 1 3 1 Hepatocyt with eosinophilic cytoplasm and partly defunct nucleus 2 Hepatocyt with degradated nucleus and eosinophilic cytoplasm 3 Lipofuscin 4 Completely defunct hepatocytes

Acute hepatodystrophy

Liver cirrhosis etiology morphology alkohol po CAH kryptogenní 60 -70% 10 -15% biliární primární sekundární pigmentové hemochromatóza mikronodulární makronodulární smíšená primární sekundární z vrozených poruch metabolismu (tyrosinemie, galaktosemie. . . )

Cirrhosis hepatis

Biliary cirrhosis

Biliary cirrhosis (Fouchet)

Alcohol liver steatosis

Alcohol liver cirrhosis

Tumoriformní léze Fokální nodulární hyperplazie Parciální nodulární hyperplazie Nodulární regeneratorní hyperplazie Cysty; hamartom; zánětlivý pseudotumor Benigní tumory adenom hepatocelulární cholangiogenní hemangiom Maligní Hepatocelulární karcinom; fibrolamelární karcinom Cholangiogenní karcinom (periferní, hilový-Klatskin, extrahepatální) Hepatoblastom (embryonální, teratoidní. . . ) Angiosarkom; maligní hemangioendoteliom sekundární nádory = metastázy

Cavernous haemangioma 1 Liver capsule 2 Liver parenchyma 3 Fibrous septum 4 Big vascular spaces 5 Biliary duct 1 5 2 4 3 3 3

Cavernous haemangioma 1 1 2 1 1 1 Big vascular spaces 2 Fibrous septum

Cavernous haemangioma 2 1 4 3 4 1 1 Vascular spaces 2 Flat endothelial cells 3 Fibrous septum 4 Biliary ducts

Cavernous haemangioma 1 2 1 3 2 1 Vascular spaces 2 Flat endothelial cells 3 Fibrous septum

Cavernous haemangioma Angiosarcoma copy Mitosis

Primary liver carcinoma

Hepatocellular carcinoma

Hepatocellular carcinoma 1 2 3 1 1 Hepatocellular carcinoma, „pseudoglandular pattern“ 2 Residues of nontumorous liver parenchyma 3 Periportal space

Hepatocellular carcinoma 1 Hepatocellular carcinoma 2 Cells of nontumorous parenchyma 1 2

Hepatocellular carcinoma Absence of liver architecture, anisonucleosis, hyperchromic nuclei, high N/C ratio

Cholangiocarcinoma of the liver