liver pathology 4 - columbia university...“diseases of the liver & biliary system” peter j....
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••Biliary diseasesBiliary diseases••Vascular diseasesVascular diseasesP itP it
Liver Pathology 4:Liver Pathology 4:
••ParasitesParasites••TumorsTumors••Liver transplantationLiver transplantation
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Causes of Large Bile Duct Obstruction
Extrahepatic Biliary Atresia (EHBA)
•Reovirus 3•Rotavirus•Immune targeting?
K i
Loop of smallintestine
KasaiHepaticPortoenterostomy
EHBARx Liver Transplantation
Primary Sclerosing Cholangitis (PSC)
ERCP: endoscopic retrogradecholangiopancreatography
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, fewer Crohn’s
Primary Biliary Cirrhosis(PBC)
Guys’ Hospital ReportLondon, 1851
Mrs. Elizabeth Peacock
Addison & Gull
PBC: Primary biliary cirrhosis----Chronic nonsuppurative destructive cholangitis
•middle-aged women+ AMA (anti-mitochondrial
antibodies); M2 subtype• Alkaline Phosphatase• IgM•AMA directed against inner
PDC-E2MolecularMimicry?
Gram –bacteria
mitochondrial membranePDC-E2 (pyruvate dehydrogenasecomplex-E2)
florid bileduct lesion
bile duct
HLAII
AMAT TT
•Assoc. with other autoimmunedis: e.g. RA, sicca, celiac, scleroderma
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Vascular Disease &the Liver
•Veins•Sinusoids•Arteries
•Liver is often involved in heart disease or other outflow problems(“hepatic venousoutflow obstruction”)
Budd-Chiari Syndrome(Hepatic venous outflowobstruction)
•oral contraceptives•coagulopathy (prot. S, C,
f t V L id d f
ascites
factor V Leiden def.,anti-cardiolipin Ab’s
•tumor invasion of hep. V’sor IVC: renal cell CA + HCC
•small vein disease: VOD
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Peliosis hepatis: blood lakes of the liver-HIV, C17-alkylated steroids (OC’s,
anabolic steroids; systemic inflamm.
Infarct: Arterial disease (PAN, ligation,chemoRx installation)Portal vein: Zahn infarct
P.V.P.V.
Pylephlebitis:-perforated ulcer, -ruptured appendix, etc.
Pylephlebitis:-perforated ulcer, -ruptured appendix, etc.
Schistosomiasis: Pre-sinusoidal,intrahepaticportal hypertension
(Symmers’ “clay pipestem fibrosis”)
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pancreas
LIVER-CELL ADENOMA-oral contraceptives-hepatocyte nuclear factor 1α (HNF-1α)
mutations-benign hepatocytes, bld vessels, NO b.d.’s
FOCAL NODULAR HYPERPLASIA (FNH)-malformation: central scar with artery,
outgrowth of cirrhosis-like mass
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HCC
•75% of pts have cirrhosis•75% are serum AFP +•75% are serum AFP +•Risks: Cirrhosis due to HBV, HCV, alcohol, hemochromatosis•Invades veins: portal vein/hepatic vein/IVC- to lungs
Hepatocellular carcinoma (HCC)
FIBROLAMELLAR Ca: young, no risks-better prognosis with resection/tx
Nocirrhosis
Cholangiocarcinoma(bile duct Ca)
Cholangiocarcinomaassociated with:•Liver flukes:
-Clonorchis sinensis-Opisthorcis viverrini
•PSC•Gallstone disease,hepatolithiasis
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Liver Transplantation
•Cirrhosis-HBV, HCV
• PBCPBC• PSC• Extrahepatic biliary
atresia• AFLD/NAFLD•Metabolic disorders
Portal tract
HLA II
T
Acute Rejection
BD
endothelium
1. Acute rejection: triad2. Preservation injury
(ischemia/reperfusion)
inflammation
bile duct damageendotheliitis
Liver Transplantation PathologyLiver Transplantation Pathology
( p )3. CMV hepatitis
4. Recurrent original disease5. De novo autoimmune hepatitis6. Chronic rejection
6 mos.
DameSheila Sherlock
The Royal FreeyHospitalLondon, U.K.
“Diseases of the Liver & Biliary System”
Peter J. Scheuer Hans Popper
Peter J. Scheuer, M.D.
Royal Free HospitalProf. of Histopathology
“Liver Biopsy Interpretation”-1st Edition: 1968-7th Edition: 2005
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