Hepatobiliary Patho Pots

Question 1

G: Acute Haemorrhagic Cholecystitis (5)

Answer 1

1. gallbladder is enlarged and turgid
2. wall shows edema and subserosal haemorrhage
3. fibropurulent exudates on serosal surface
4. mucosa is ulcerated with necrotic slough
5. mucosa is bile-stained: dark reddish wall

Question 2

H: acute haemorrhagic cholecystitis (3)

Answer 2

1. gallbladder wall shows mucosal ulceration
2. wall shows oedema and congestion, some haemorrhage
3. inflammatory infiltrates: neutrophils

Question 3

G: Chronic Cholecystitis (5)

Answer 3

1. gallbladder wall is thickened from hypertrophy and rigid from fibrosis, gallbladder appears smaller
2. no haemorrhage (compare to acute)
3. mucosal surface smooth (compare to ulcerated and necrotic slough in acute)
4. presence of calculus
5. no suppuration

Question 4

H: Chronic Cholecystitis (3)

Answer 4

1. Rokitansky-Aschoff Sinus: mucosal outpouchings in wall due to bile being forced through, secondary to increased intraluminal pressure from hypertrophy
2. porcelain gallbladder: chronic inflammatory exudates - lymphocytes and plasma cells - with dystrophic calcification
3. wall shows fibrosis

Question 5

G: Gallbladder Adenocarcinoma (4)

Answer 5

1. gallbladder mucosal surface is ulcerated and irregular
2. infiltrative growth, ill defined
3. cut surface is pale with necrosis
4. adherent liver

Question 6

H: Gallbladder Adenocarcinoma (3)

Answer 6

1. liver adhered to gallbladder
2. thickened gallbladder wall infiltrated by tumour
3. irregular, poorly formed glands showing typical malignant features

Question 7

G: Chronic Venous Congestion (5)

Answer 7

1. diffusely enlarged liver
2. loss of sharp edges - soft, rounded edges
3. bulging cut surface
4. cut surface shows mottled nutmeg appearance due to congestion
5. haemorrhage in centrilobular regions interspersed with intact portal tracts

Question 8

H: Chronic Venous Congestion (4)

Answer 8

1. necrosis of hepatocytes surrounding central veins due to relative ischaemia
2. small areas of fatty change - lipid accumulation of hepatocytes
3. congested sinusoids
4. intact portal tracts - low power shows alternating light necrotic areas and darker hepatocytes

Question 9

G: Fatty Change Liver (4)

Answer 9

1. Diffusely enlarged liver
2. Soft, rounded edges - loss of sharp edges
3. Surface is pale and yellowish - from lipid accumulation
4. no discrete lesions of cirrhosis

Question 10

H: Fatty Change Liver (2)

Answer 10

1. alternating dark and pale areas (darker is normal hepatocytes surrounding portal tracts)
2. hepatocytes has intracytoplasmic lipid vacuoles - cause hepatocytes to be enlarged

Question 11

G: Amyloidosis in liver (4)

Answer 11

1. liver is diffusely enlarged
2. parenchyma is firm and homogenous dark brown discolouration
3. waxy, smooth cut surface
4. no cirrhosis or discrete lesion

Question 12

G: Biliary Atresia (3)

Answer 12

1. Liver is contracted, finely nodular and bile-stained
2. capsular surface shows nodular outline in keeping with cirrhosis
3. distal common bile duct if atresic

Question 13

G: Congenital polycystic Disease in Liver (4)

Answer 13

1. Cut surface shows multiple cysts of varying sizes
2. cysts are thin-walled and smooth surfaced
3. haemorrhage into cysts
4. liver is irregularly enlarged

Question 14

G&H: Cystic Liver (3)

Answer 14

1. Solitary unilocular cyst with thin wall
2. inner surface is smooth - no papillary excrescences
3. cysts probably lined by glandular bile duct epithelium

Question 15

G: Liver Cirrhosis - with oesophageal varices (4)

Answer 15

1. liver is contracted (shrunken) and firm
2. liver surface is nodular
3. cut surface shows diffused parenchymal replacement by tan-coloured nodules of variable sizes surrounded by fibrous septa
4. oesophagus shows engorged and tortuous submucosal veins

Question 16

H: Liver Cirrhosis (4)

Answer 16

1. low power: nodule surrounded by fibrous septa
2. high power: nodule surrounded by rim of lymphocytes
3. within nodules, sinusoids, kupffer cells and hepatocytes are intact
4. bile stasis in bile ductules

Question 17

G: Metastatic Adenocarcinoma: Liver (5)

Answer 17

1. background not cirrhotic (nodules are larger with no fibrous septa
2. cut surface is rough with fleshy appearance
3. multiple nodules, circumscribed with invasive borders
4. some haemorrhage and necrosis
5. liver is enlarged with soft rounded edges

Question 18

H: Metastatic Adenocarcinoma of Liver (2)

Answer 18

1. multiple nodules - iregular infiltrative glands lined by cytologically malignant cells
2. central necrosis present
   immunohistochemistry - specific markers to determine phenotype of malignant cells to differenciate between primary and secondary adenocarcinoma

Question 19

G: Acute Haemorrhagic Pancreatitis (3)

Answer 19

1. pancreas is edematous
2. haemorrhagic
3. fatty necrosis

Question 20

H: Acute Haemorrhagic pancreatitis (3)

Answer 20

1. inflammatory infiltrates: neutrophils
2. interstitial edema
3. fatty necrosis with adipocytes containing calcium deposits

Question 21

G: Ampullary Carcinoma (4)

Answer 21

1. polypoid tumour arising from ampulla of vater, growing into duodenal lumen
2. obstruction of bile duct
3. ulceration of duodenal wall - hematemesis/ melena
4. parenchyma of pancreas is lobulated

Question 22

H: ampullary carcinoma (3)

Answer 22

1. polypoid growth from ampulla into duodenum
2. shows complex glandular structures
3. glands lined by cytologically malignant cells

Question 23

G: Pancreatic Adenocarcinoma (3)

Answer 23

1. pancreatic parenchyma replaced by ill-defined invasive mass
2. mass is pale
3. areas of necrosis, haemorrhage

Question 24

H: Pancreatic Adenocarcinoma (5)

Answer 24

1. proliferation of malignant haphazardly arranged glands and destruction of parenchymal tissue
2. glandular cells with irregular, enlarged nuclei with prominent nucleoli
3. desmoplastic stroma
4. pancreatic duct is dilated
5. look for lymph node involvement