GI Path for exam 3 part 1
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What is this stain? What is it testing (what's the pink)? What is significant about there being more pink around the central vein that portal area?
- 1. PAS-stain to show presence of glycogen
- 2. Here it shows the distributionof glycogen contents: glycogen is more densely concentrated around central vein
- 3. Sinusoidal blood travels from periphery to central vein, glycogen is first stored (fed state) and used (fasting state) from hepatocytes around portal area
- 4. Also note: cells in the periphery near the portal area (zone 1) are more vulnerable to toxins while cells near the central vein (zone 3) are more vulnerable to hypoxia
What is this? What causes it?
- Fatty Liver: most common cause due to alocholism (obesity and DM also contribute)
- 1. Notice the uniform color change due to excessive lipid accumulation in the hepatocytes
- 2. Histo view showing lipid accumulation in hepatocytic vacuoles. These vascuoles stain red with Oil Red
What is this? What are the four arrows indicating?
- Cirrhosis: Ongoing liver damage with liver cell necrosis followed by fibrosis and hepatocyte regeneration, producing a hardened liver with nodular appearance (nodules > 3mm represent macronodular cirrhosis)
- 1. Regenerative nodules consisting of hepatocytes
- 2. Fibrous connective tissue surrounding the regenerative nodules
- 3. Portal tracts are bridged by connective tissue
- 4. Neutrophils are found in collagenous tissue
What diesase is this? What do the arrows indicate?
- Cirrhosis: Specifically, this is an example of micronodular cirrhosis (nodules < 3mm); comic finding resulting from chronic alcohol abuse
- 1. Moderate lipid accumlation within hepatocytes (clear zones)
- The remaining arrows point to Mallory's hyaline, a deposition in the hepatocyte cytoplasm that occurs along with necrosis and fatty change it is also called alcoholic hyaline)
- 2. Enlarged, necrotic hepatocyte containing Mallory's hyaline
- 3. nucleus displaced due to presence of lipid droplet in cytoplasm
- 4. Mallory's hyaline is red due to eosinophilic stain
- 5. Enlarged, necrotic hepatocyte containing Mallory's hyaline
- 6. Filamentous Mallory's hyaline
What do these images indicate? What are the arrows?
- These are signs of portal hypertension
- Cirrhosis causes restricted blood flow in the liver, increasing pressure transmitted to collateral venous channels. These channels can become highly dilated.
- Top photo: Spider veins or telangiectasia on the abdomen
- Bottom picture: Esophageal varices, a more serious problem that forms when the submucosal veins of the esophagus become dilated
- 1. Varices (blue dilated veings) are seen in the lower esophagus
- 2. A hemorrhage is evident. Varices are easily eroded and can lead to massive GI hemorrhage
What is this?
- Hemochromatosis: Liver is dark brown because of extensive iron deposits due to hereditary hemochromatosis (HHC)
- HHC results from mutation in the hemochromatosis gene (HFE) that leads to increased iron absorption from the gut
- Bottom picture: Prussian blue stain for iron revealing extensive deposits of hemosiderin in hepatocytes; note that you can also see evidence of cirrhosis. Excessive iron deposition most severely affects heart (CGF), pancreas (DM), liver (cirrhosis and failure), and joints (arthritis)
What disease is this?
Hemochromatosis: Prussian stain blue shows hepatocytes are filled with blue iron granules; this is an early stage before parenchymal damage and fibrosis develop
What is this? What causes it?
- Cholestasis: Yellowish-green accumulations of bile pigments are seen here. This results in hepatocyte damage.
- Cholestasis is blockage of bile flow from the liver to the duodenum and is most often due to a biliary tract obstruction (i.e. gallstones or primary biliary cirrhosis).
- In some cases, bile may also accumulate because of other types of hepatocyte injury like liver cirrhosis
What is this? What disease often results in it? In the US, what is the most common cause? Worldwide, what is the most common cause? What are the arrows?
- Hepatocellular Carcinoma
- Often arise as a result of cirrhosis
- US: most common cause is chronic alcoholism
- Worldwide: Most common cuase is viral hepatitis
- 1. Neoplasm is large, bulky, and has greenish color because it contains bile
- 2. You can also see smaller, light colored satellite tumors
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