Unit 4 - Liver Labs Flashcards
History: Tissue from a rotund cat that has been hiding out under the stairs and has not eaten for several days following the purchase of a kitten. She is currently jaundiced.
Describe the tissue.
The liver is diffusely enlarged with rounded edges, is pale yellow in color, greasy, friable and has an accentuated lobular pattern.
History: Tissue from a rotund cat that has been hiding out under the stairs and has not eaten for several days following the purchase of a kitten. She is currently jaundiced.
What is your most likely morphological diagnosis?
Liver: severe diffuse hepatic lipidosis
History: Tissue from a rotund cat that has been hiding out under the stairs and has not eaten for several days following the purchase of a kitten. She is currently jaundiced.
Based on the history and gross changes, propose a pathogenesis for the development of these liver lesions in the cat.
This is a case of feline idiopathic hepatic lipidosis. This condition generally occurs in overweight cats following a period of anorexia.
Obese cat ⇒ anorexia (idiopathic, or secondary to another disease process) ⇒ mobilization of fat stores (fatty acids) ⇒ not eating so there is a lack of protein for lipoprotein synthesis and an inability to remove excess lipid from the liver ⇒ lipid accumulates in liver ⇒ hepatic lipidosis
History: Tissue from a rotund cat that has been hiding out under the stairs and has not eaten for several days following the purchase of a kitten. She is currently jaundiced.
You harvested a piece of liver and put it in formalin and noticed something odd. What might you have noticed when the liver was put in formalin?
The liver would float
History: Liver from an 8 year old mixed-breed canine that presented with icterus and a distended abdomen due to clear fluid.
Describe the tissue:
The liver is small, diffusely pale and firm with numerous, widely-disseminated, irregular nodules protruding from the surface. These nodules vary from a few millimeters up to 0.5 cm in diameter and are the same color and consistence as adjacent liver. The tissue separating nodules is firmer than the nodules. The liver is diffusely pale (a mottled tan color) and has bands of firm grey (fibrous) tissue dissecting the parenchyma in cross section.
History: Liver from an 8 year old mixed-breed canine that presented with icterus and a distended abdomen due to clear fluid.
Give a morphological diagnosis:
Liver: Chronic diffuse hepatic fibrosis with nodular regeneration
History: Liver from an 8 year old mixed-breed canine that presented with icterus and a distended abdomen due to clear fluid.
What is the medical term for a liver with these gross lesions?
Hepatic cirrhosis
History: Liver from an 8 year old mixed-breed canine that presented with icterus and a distended abdomen due to clear fluid.
What are the expected histopathological changes?
Bridging fibrosis, nodular regeneration, biliary proliferation, ± chronic inflammation
History: Liver from an 8 year old mixed-breed canine that presented with icterus and a distended abdomen due to clear fluid.
What are two separate mechanisms whereby the liver lesions could lead to the abdominal distension?
Decreased functional liver mass → decreased protein production (ex: albumin) → decreased oncotic pressure → fluid leakage into extracellular spaces (abdominal cavity)
Portal fibrosis → portal hypertension → increased hydrostatic pressure in the portal vasculature → ascites.
History: Tissue from an 8.55 year old, male, Springer Spaniel. The animal had developed slowly progressive lethargy, depression and abdominal fluid. Serum chemistries: Alk Phos and AST were slightly elevated. BUN, Total protein and Albumin were decreased.
Describe the tissue:
All liver lobes have multifocal to coalescing firm, irregular, tan to cream-colored nodules that vary in size from 0.3-6 cm in diameter and often have a central depression (umbilicated). There are two, similar larger nodules that are approximately 5 cm in diameter. When sectioned, these nodules are composed of uniform cream-colored tissue, often with a central cavity.
History: Tissue from an 8.55 year old, male, Springer Spaniel. The animal had developed slowly progressive lethargy, depression and abdominal fluid. Serum chemistries: Alk Phos and AST were slightly elevated. BUN, Total protein and Albumin were decreased.
Give a morphologic diagnosis.
Chronic, multifocal, disseminated, umbilicated hepatic masses (nodules).
History: Tissue from an 8.55 year old, male, Springer Spaniel. The animal had developed slowly progressive lethargy, depression and abdominal fluid. Serum chemistries: Alk Phos and AST were slightly elevated. BUN, Total protein and Albumin were decreased.
List 2-3 potential differentials for the liver lesions.
- Cholangiocarcinoma or primary hepatocellular carcinoma with extensive intrahepatic metastases
- Multifocal liver metastases (GI tumor, pancreatic tumor)
- Multifocal liver granulomas
History: Tissue from an 8.55 year old, male, Springer Spaniel. The animal had developed slowly progressive lethargy, depression and abdominal fluid. Serum chemistries: Alk Phos and AST were slightly elevated. BUN, Total protein and Albumin were decreased.
If this were a primary tumor of the liver, what is the expected biologic behavior of this tumor?
This was a cholangiocarcinoma. These are malignant tumors and the expected behavior is:
- Highly invasive
- Metastasis 60-88%
- Intrahepatic metastasis (this case is a good example of the intrahepatic metastases)
- Regional LN’s
- Lungs
History: Tissue from a two year old female intact Hereford, presented to ISU Food Animal Medicine and Surgery on 8/17/18 for anorexia, lethargy, and possible hardware disease.
Describe the tissue:
Liver: Low numbers of widely scattered, multifocal, white, circular nodules were dispersed randomly throughout liver sections, ranging in size from 3 mm to 6 mm diameter. These nodules were surrounded by a moderately thick, firm dense white capsule (fibrous capsule) and contain varying amounts of central tan/brown friable exudate. On the surface of the liver, the capsule adjacent to these nodules is moderately thickened by dense firm white tissue (fibrosis) that radiates out from the central nodules.
History: Tissue from a two year old female intact Hereford, presented to ISU Food Animal Medicine and Surgery on 8/17/18 for anorexia, lethargy, and possible hardware disease.
Provide an appropriate morphologic diagnosis
Liver: Multifocal, moderate chronic, hepatic abscesses
History: Tissue from a two year old female intact Hereford, presented to ISU Food Animal Medicine and Surgery on 8/17/18 for anorexia, lethargy, and possible hardware disease.
An impression smear of these lesions reveals necrotic cellular debris and neutrophils? Provide an appropriate morphologic diagnosis based on the impression smear results:
Liver: Chronic multifocal, necrosuppurative hepatitis
History: Tissue from a two year old female intact Hereford, presented to ISU Food Animal Medicine and Surgery on 8/17/18 for anorexia, lethargy, and possible hardware disease.
The pattern and distribution of lesions, along with the type of lesion can help to narrow the list of differentials and ultimately determine the underlying cause.
- What does the pattern suggest?
- What type of agent is most likely to cause necrotizing and suppurative lesions?
a. The multifocal random pattern would suggest blood borne dissemination to the liver.
b. Blood-borne bacteria infection.In the case, large numbers of gram positive bacteria were identified within the lesions.
History: Tissue from a two year old female intact Hereford, presented to ISU Food Animal Medicine and Surgery on 8/17/18 for anorexia, lethargy, and possible hardware disease.
Similar multifocal random lesions were not identified in the lung, kidney, or spleen. What is the likely source of the infection in this case?
Disruption of mucosal integrity in the gastrointestinal tract. Liver infected via the portal circulation. In this case the hardware disease.
History: Tissue from a slaughtered pig (A) and slaughtered bovine (B). Both of these livers were condemned at slaughter.
Describe the tissue:
The liver (A) has multifocal and coalescing, ill-defined areas of pallor that are often slightly depressed and that range in size from 0.5 to 3 cm.Hepatic lobules are extensively outlined by thick bands of fibrous connective tissue.The liver appears much more firm than normal.
(B) The liver is markedly and diffusely pale tan/yellow in color.There are irregular 1 mm in diameter black tracts throughout the liver
History: Tissue from a slaughtered pig (A) and slaughtered bovine (B). Both of these livers were condemned at slaughter.
Give a morphologic diagnosis for each specimen.
- Chronic multifocal to coalescing fibrosing hepatitis (hepatic fibrosis)
- Liver: diffuse palor with multifocal black tracts
History: Tissue from a slaughtered pig (A) and slaughtered bovine (B). Both of these livers were condemned at slaughter.
What is the likely cause of this liver lesion in each species?
- Pig: ascarid larval migration
- Bovine: liver fluke larval migration.
History: Tissue from a slaughtered pig (A) and slaughtered bovine (B). Both of these livers were condemned at slaughter.
Briefly outline the pathogenesis of this condition in the pig.
Ingestion of large numbers of Ascaris suum eggs ⇒ eggs hatch in the intestine ⇒ larvae migrate through the liver, diaphragm and then into the lung ⇒ while migrating through the liver, large numbers of larvae can result in necrosis and inflammation leading to fibrosis ⇒ larvae are coughed up, swallowed and mature to adults in the intestine.
History: Tissues from a 14 year old male neutered Sheltie presented to ISU for several day history of anorexia and vomiting. Several week history of weight loss. Bili 5.0, ALP>>>ALT, alb 2.1; hepatomegaly
Describe the tissue:
Liver: The liver contained numerous multifocal, round to umbilicated, firm, cream-color nodules that varied in size from 1 -7mm in diameter and were disseminated throughout all liver lobes.
History: Tissues from a 14 year old male neutered Sheltie presented to ISU for several day history of anorexia and vomiting. Several week history of weight loss. Bili 5.0, ALP>>>ALT, alb 2.1; hepatomegaly
Provide appropriate morphologic diagnoses.
Liver: multifocal, chronic hepatic masses
History: Tissues from a 14 year old male neutered Sheltie presented to ISU for several day history of anorexia and vomiting. Several week history of weight loss. Bili 5.0, ALP>>>ALT, alb 2.1; hepatomegaly
What are your top differentials for these masses?
Primary liver tumor with intrahepatic metastases
Liver metastases.
History: Tissues from a 14 year old male neutered Sheltie presented to ISU for several day history of anorexia and vomiting. Several week history of weight loss. Bili 5.0, ALP>>>ALT, alb 2.1; hepatomegaly
Which are more common, primary liver tumors or metastatic disease to the liver?
Mets are 2.5 times more common than 1°liver tumors
History: Tissues from a 14 year old male neutered Sheltie presented to ISU for several day history of anorexia and vomiting. Several week history of weight loss. Bili 5.0, ALP>>>ALT, alb 2.1; hepatomegaly
Let us assume that these are liver metastases, where might you search for a primary tumor.
- Intestinal carcinoma, Exocrine pancreatic carcinoma, Islet cell carcinoma, Splenic hemangiosarcoma
- This animal had an Ulcerated Intestinal Carcinoma in the duodenum
History: Tissues from a 13.71 year old male canine with a history of progressive paraparesis.
Describe the tissue.
Liver: The liver contains multiple nodules that vary in size from 0.5 – 3 cm in diameter.These nodules are the same consistency and color as the adjacent hepatic parenchyma.
History: Tissues from a 13.71 year old male canine with a history of progressive paraparesis.
Give morphologic diagnoses for the changes in the liver.
Liver: chronic, multifocal hepatic nodules
History: Tissues from a 13.71 year old male canine with a history of progressive paraparesis.
What is the likely clinical significance of these lesions?
These are most likely hepatic nodular hyperplasia, which is a common lesion in old dogs and usually has no clinical significance (i.e. an incidental finding).
