This document provides an overview of liver biopsy interpretation. It discusses the indications for liver biopsy, techniques used, histological examination and staining, and the approach to interpreting different pathological conditions of the liver seen on biopsy. Key points include the use of biopsy to diagnose and assess liver damage and prognosis, techniques including percutaneous and transjugular biopsies, examining features such as necrosis, inflammation, fibrosis and cirrhosis, and interpreting conditions like viral hepatitis, autoimmune hepatitis, non-alcoholic fatty liver disease, and hemochromatosis.
This document provides information about liver biopsy techniques, indications, contraindications, complications, specimen processing, and microscopic interpretation. It discusses the four methods of obtaining a biopsy - percutaneous, laparoscopic, laparotomy, and transvenous. Percutaneous biopsy is most common and can be ultrasound or CT-guided. Indications include diagnosing and staging liver diseases. Contraindications are factors increasing bleeding risk. Potential complications include pain, hemorrhage, and injury to other organs. Specimen processing involves fixation and staining for light and electron microscopy. Microscopic interpretation examines architecture, inflammation, necrosis, deposition, and more to diagnose liver conditions.
This document provides an overview of liver biopsy procedures and pathological interpretation. It discusses the indications for liver biopsy, techniques such as percutaneous and transvenous biopsies, processing biopsy samples, and approaching interpretation. Key aspects to evaluate include architecture, hepatocellular changes, inflammation, and patterns of injury that can indicate conditions like acute hepatitis, chronic hepatitis, cirrhosis, and other metabolic diseases. Grading systems are also described to assess necroinflammatory activity and fibrosis staging.
Bone marrow examination is an important diagnostic tool that provides essential information through bone marrow aspiration and biopsy. Key points:
- Bone marrow examination history dates back to early 1900s with advancements in biopsy techniques and sample collection methods.
- Indications include evaluation of blood cell disorders, infections, cancers, and other conditions. Complications can include pain, bleeding, and infection.
- Aspiration provides cytological details for staining and testing while biopsy assesses cellularity, infiltration, and pathology in tissue samples.
- The posterior iliac crest is the preferred site for aspiration and biopsy using specialized bone marrow needles and procedures. Differential cell counts, morphology, and other analyses are used to evaluate
Bone marrow aspiration & trephine biopsySanjeev Kumar
Bone marrow aspiration & trephine biopsy, Complication of BM Aspiration, Clinical significance, Indication of Bone Marrow Aspiration and Biopsy, Types Of Needles, Site for Bone Marrow Biopsy And Aspiration, types Of Smear for Bone Marrow, Advantages of Bone Marrow Trephine Biopsy
FNAC is a minimally invasive procedure used to diagnose palpable masses. It was first described in 1930 and became popular in the 1950s. FNAC samples lesions in the breast, thyroid, soft tissues and other accessible areas like the testicles, prostate, bones and lungs. It requires clinical skills like anatomy knowledge and physical exam proficiency. FNAC has advantages of not requiring anesthesia, being low cost, allowing repeat sampling with few complications. The procedure involves aspiration of the mass and smearing cell samples on slides for microscopic examination.
Bone marrow biopsy and aspiration provide qualitative and quantitative assessment of hematopoiesis. It can help make diagnoses of blood disorders like anemia and help stage diseases like lymphoma. The bone marrow has a structured organization with hematopoietic and stromal components. Biopsy and aspiration samples are analyzed microscopically after staining to evaluate cellularity, maturation of blood cell lineages, iron stores, and detect any abnormalities. This procedure helps diagnose conditions affecting the bone marrow including infections, storage diseases, and cancers.
The bethesda system for reporting thyroid cytopathology dhanya89
The Bethesda System for Reporting Thyroid Cytopathology document outlines the standardized categories for reporting thyroid fine needle aspiration biopsy results. The categories include: Nondiagnostic/Unsatisfactory, Benign, Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance, Follicular Neoplasm/Suspicious for Follicular Neoplasm, Suspicious for Malignancy, and Malignant. Each category has specific criteria for cellularity, architecture, and nuclear features to provide consistent terminology for thyroid FNA interpretation and patient management.
This document provides information on endoscopic gastrointestinal biopsies and their interpretation. It discusses endoscopy techniques and tools used to visualize the gastrointestinal tract and obtain biopsies. Key points include types of endoscopes, handling of biopsy specimens, processing for histological examination, common indications for endoscopy of the upper gastrointestinal tract, and histological findings and interpretations for conditions of the esophagus and stomach, including chronic gastritis, Helicobacter pylori infection, Barrett's esophagus, and polypoid lesions.
This document provides information about liver biopsy techniques, indications, contraindications, complications, specimen processing, and microscopic interpretation. It discusses the four methods of obtaining a biopsy - percutaneous, laparoscopic, laparotomy, and transvenous. Percutaneous biopsy is most common and can be ultrasound or CT-guided. Indications include diagnosing and staging liver diseases. Contraindications are factors increasing bleeding risk. Potential complications include pain, hemorrhage, and injury to other organs. Specimen processing involves fixation and staining for light and electron microscopy. Microscopic interpretation examines architecture, inflammation, necrosis, deposition, and more to diagnose liver conditions.
This document provides an overview of liver biopsy procedures and pathological interpretation. It discusses the indications for liver biopsy, techniques such as percutaneous and transvenous biopsies, processing biopsy samples, and approaching interpretation. Key aspects to evaluate include architecture, hepatocellular changes, inflammation, and patterns of injury that can indicate conditions like acute hepatitis, chronic hepatitis, cirrhosis, and other metabolic diseases. Grading systems are also described to assess necroinflammatory activity and fibrosis staging.
Bone marrow examination is an important diagnostic tool that provides essential information through bone marrow aspiration and biopsy. Key points:
- Bone marrow examination history dates back to early 1900s with advancements in biopsy techniques and sample collection methods.
- Indications include evaluation of blood cell disorders, infections, cancers, and other conditions. Complications can include pain, bleeding, and infection.
- Aspiration provides cytological details for staining and testing while biopsy assesses cellularity, infiltration, and pathology in tissue samples.
- The posterior iliac crest is the preferred site for aspiration and biopsy using specialized bone marrow needles and procedures. Differential cell counts, morphology, and other analyses are used to evaluate
Bone marrow aspiration & trephine biopsySanjeev Kumar
Bone marrow aspiration & trephine biopsy, Complication of BM Aspiration, Clinical significance, Indication of Bone Marrow Aspiration and Biopsy, Types Of Needles, Site for Bone Marrow Biopsy And Aspiration, types Of Smear for Bone Marrow, Advantages of Bone Marrow Trephine Biopsy
FNAC is a minimally invasive procedure used to diagnose palpable masses. It was first described in 1930 and became popular in the 1950s. FNAC samples lesions in the breast, thyroid, soft tissues and other accessible areas like the testicles, prostate, bones and lungs. It requires clinical skills like anatomy knowledge and physical exam proficiency. FNAC has advantages of not requiring anesthesia, being low cost, allowing repeat sampling with few complications. The procedure involves aspiration of the mass and smearing cell samples on slides for microscopic examination.
Bone marrow biopsy and aspiration provide qualitative and quantitative assessment of hematopoiesis. It can help make diagnoses of blood disorders like anemia and help stage diseases like lymphoma. The bone marrow has a structured organization with hematopoietic and stromal components. Biopsy and aspiration samples are analyzed microscopically after staining to evaluate cellularity, maturation of blood cell lineages, iron stores, and detect any abnormalities. This procedure helps diagnose conditions affecting the bone marrow including infections, storage diseases, and cancers.
The bethesda system for reporting thyroid cytopathology dhanya89
The Bethesda System for Reporting Thyroid Cytopathology document outlines the standardized categories for reporting thyroid fine needle aspiration biopsy results. The categories include: Nondiagnostic/Unsatisfactory, Benign, Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance, Follicular Neoplasm/Suspicious for Follicular Neoplasm, Suspicious for Malignancy, and Malignant. Each category has specific criteria for cellularity, architecture, and nuclear features to provide consistent terminology for thyroid FNA interpretation and patient management.
This document provides information on endoscopic gastrointestinal biopsies and their interpretation. It discusses endoscopy techniques and tools used to visualize the gastrointestinal tract and obtain biopsies. Key points include types of endoscopes, handling of biopsy specimens, processing for histological examination, common indications for endoscopy of the upper gastrointestinal tract, and histological findings and interpretations for conditions of the esophagus and stomach, including chronic gastritis, Helicobacter pylori infection, Barrett's esophagus, and polypoid lesions.
Histopathological Grossing of Kidney Tumors with the common gross differentials encountered,
reference - TATA memorial grossing techniques , Rosai and ackerman surgical pathology , Fletcher , Springer histopathology Specimen
This document discusses various types of intestinal ulcers, their pathogenesis, gross appearance, histology, and complications. It covers peptic, infection-related, immune-mediated, and malignant ulcers. Specific ulcer types discussed include duodenal peptic, typhoid, tuberculosis, amoebic, pseudomembranous colitis, CMV colitis, ulcerative colitis, Crohn's disease, graft-versus-host disease, and carcinoma. For each type, it provides information on the causative pathogen, how the ulcers form, their gross appearance, characteristic microscopic features, and potential complications.
Small round cell tumors are a group of highly aggressive cancers composed of small, undifferentiated cells. The diagnostic approach involves clinical findings, imaging, pathology, and molecular genetics testing. Key small round cell tumors in pediatric patients include Ewing sarcoma, neuroblastoma, nephroblastoma, rhabdomyosarcoma, medulloblastoma, retinoblastoma, and lymphoblastic lymphoma. Immunohistochemistry and genetic testing are used to determine the specific tumor type to help guide treatment.
This document provides an overview of non-Hodgkin's lymphoma (NHL), including:
1. NHL is a heterogeneous group of malignant diseases of the lymphoid system that is defined and has varying epidemiology, classification, risk factors, pathogenesis, clinical features, investigations, and treatment.
2. NHL is classified in several systems, most recently the WHO system from 2008, which categorizes NHL into B-cell and T/NK-cell lymphomas that can be indolent or aggressive.
3. Specific subtypes like diffuse large B-cell lymphoma, follicular lymphoma, and Burkitt's lymphoma have unique characteristics and clinical presentations.
Sputum examination provides important diagnostic information by analyzing material coughed up from the lungs and respiratory tract. Key indications for sputum examination include identifying the causative organism in suspected lower respiratory infections like pneumonia or tuberculosis. Sputum samples can also be examined cytologically to detect malignant cells or investigate other infections. Proper collection and transport of sputum samples is important for microbiological culture and other tests. Staining and microscopic examination of sputum looks for bacteria, fungi, parasites and other pathogenic organisms. Molecular tests like PCR provide a rapid and sensitive method for tuberculosis diagnosis.
The document discusses various cystic diseases of the liver including pyogenic liver abscess, amebic liver abscess, hydatid cysts, simple hepatic cysts, polycystic liver disease, cystadenoma, and cystadenocarcinoma. It provides details on the presentation, imaging, and management of these conditions with a focus on pyogenic liver abscess including risk factors, complications, and surgical versus non-surgical treatment approaches.
This document provides guidance on grossing colorectal specimens, including colon and rectal resection specimens. It discusses:
- Key steps for gross examination including measuring specimens, identifying structures, and evaluating resection margins and lymph nodes
- Anatomy of the colon and relationships to peritoneum
- Identification and sampling of lesions such as polyps, tumors, and areas of inflammation
- Unique handling considerations for rectal specimens including evaluation of the mesorectum
The document emphasizes the importance of thorough gross examination and appropriate sampling to accurately assess resection margins, lymph node status, and other prognostic factors.
The document discusses chronic lymphocytic leukemia (CLL), including its definition, epidemiology, etiology, pathogenesis, clinical symptoms, diagnosis, staging, prognosis, and treatment. Some key points:
- CLL is characterized by the proliferation and accumulation of small, mature lymphocytes in the blood, bone marrow, and lymphoid tissues. It most commonly affects elderly adults.
- Diagnosis is based on blood cell counts and immunophenotyping of lymphocytes. Prognosis depends on factors like clinical stage, genomic abnormalities, and biomarker expression levels.
- Treatment involves chemotherapy, chemoimmunotherapy, targeted therapies, and supportive care. The appropriate treatment approach depends on a patient's risk
This document discusses non-Hodgkin's lymphomas, including its definition, epidemiology, classification systems, clinical features, treatment approaches, and outcomes. It defines NHL as a malignant disease of the lymphatic system that is histologically and clinically heterogeneous. Treatment outcomes depend on risk factors such as age, disease stage, organ involvement, and performance status. Standard first-line chemotherapy such as CHOP results in remission rates of 50-80% but permanent cures in only 40-60% of patients. High-risk patients may benefit from intensive chemotherapy and stem cell transplantation.
Fine Needle Aspiration Cytology (FNAC) is a simple, quick and inexpensive method that is used to sample superficial masses like those found in the neck and is usually performed in the outpatient clinic.
The document discusses the development and benefits of the Milan System for Reporting Salivary Gland Cytopathology. It aims to standardize terminology for salivary gland FNA reports which previously lacked uniformity. The system categorizes specimens as non-diagnostic, non-neoplastic, atypia of undetermined significance, neoplastic (benign or uncertain malignant potential), suspicious for malignancy, or malignant. It is intended to improve communication between pathologists and clinicians, enhance patient care, and facilitate research by allowing standardized data collection across institutions. While validation is ongoing, the system provides a practical framework for uniform reporting of salivary gland cytology.
This document discusses bone marrow examination, including its purpose, types (aspiration and biopsy), indications, contraindications, procedure details, instruments used, complications, and findings in conditions like iron deficiency anemia and megaloblastic anemia. Bone marrow examination assesses hematopoiesis through aspiration or biopsy of the medullary cavity in bones. Aspiration is used to evaluate cellularity and differentials while biopsy allows evaluation of morphology, architecture, and focal lesions. Common sites include the iliac crest and sternum.
This document discusses the importance and techniques for grossing gastrointestinal specimens. It is important to appropriately sample lesions and tumors to define their size, depth of invasion, and lymph node status in order to stage tumors and convey information to surgeons about resection adequacy. Unique aspects of gastrointestinal specimens include their tubular structures and the use of serosa versus circumferential margin in determining depth of invasion. Key steps are to sample the tumor site extensively, look for lymph nodes along curvatures, section polyps at their bases, sample the tip of appendices, and take full thickness sections of organs and lesions. Questions are welcomed.
This document discusses various non-neoplastic and neoplastic conditions that can cause lymphadenopathy. It focuses on filariasis as a cause of non-neoplastic lymphadenopathy. Filarial parasites can infect the lymphatics and lymph nodes, causing inflammation and blockage. On pathology, the lymph nodes show an intense inflammatory reaction around dead or dying larvae with eosinophils and multinucleated giant cells. Rarely, microfilaria can be seen embedded in the lymph node tissue. The document emphasizes that a diligent search is needed to identify the parasite and make an accurate diagnosis.
1) The document discusses various precancerous lesions of the colon and rectum, including adenomas, hyperplastic polyps, sessile serrated lesions, and traditional serrated adenomas.
2) It describes the histological features and progression of these lesions, noting that sessile serrated lesions and traditional serrated adenomas have a significant malignant potential, whereas hyperplastic polyps have a very low malignant potential.
3) Two pathways of colorectal carcinogenesis are discussed: the classic adenoma-carcinoma sequence and the serrated neoplastic pathway, which involves certain serrated polyps.
Bone marrow procedures involve bone marrow aspiration and trephine biopsy to examine the bone marrow. Bone marrow aspiration is a simple, safe outpatient procedure that allows examination of individual cells and their morphology. Trephine biopsy provides larger samples for examining marrow structure and architecture, and is valuable for diagnosing conditions with a "dry tap". Proper techniques and precautions are important to perform bone marrow procedures safely and obtain adequate samples for diagnosis.
This document discusses multiple myeloma (MM), a plasma cell malignancy characterized by proliferation of monoclonal plasma cells in the bone marrow. Key points include: MM commonly precedes other premalignant conditions like MGUS; genetic defects contribute to disease heterogeneity and drug resistance; MM causes skeletal destruction and can involve other organ systems; diagnosis involves tests like serum and urine protein assays, bone marrow biopsy, and imaging; and treatment involves chemotherapy while considering prognostic factors like tumor mass, hypercalcemia, and renal impairment.
Bone marrow aspiration and biopsy are procedures used to examine bone marrow and diagnose blood disorders. Bone marrow aspiration involves inserting a special needle into the bone marrow to obtain a tissue sample. Bone marrow biopsy involves removing a small core of bone marrow using a rotating needle. The posterior iliac crest is the most common site used. Bone marrow samples are examined under a microscope to identify blood cell components and detect any abnormalities that help diagnose conditions like leukemia, lymphoma, and myeloma. Nurses play an important role in preparing equipment, assisting during the procedure, and monitoring the patient afterwards.
Cytologic assessment of bronchopulmonary lesionsAseem Jain
This document provides an overview of cytologic assessment of bronchopulmonary lesions. It discusses the normal histology of the respiratory system and various cytologic sampling techniques used to evaluate the lungs, such as sputum samples, bronchial brushings, washings and lavage. The cytology of normal respiratory cells and endogenous material is described. A variety of benign pulmonary conditions and infectious processes are outlined. Specific lung diseases like tuberculosis, sarcoidosis and nocardiosis are discussed through their characteristic cytologic findings.
This document provides an overview of fine needle aspiration cytology (FNAC). It discusses the history, advantages, limitations, equipment, techniques, processing, complications, and applications of FNAC for diagnosing lesions in the salivary gland, oral cavity, and other areas. FNAC is a simple, economical technique that can provide a rapid diagnosis without the need for an open biopsy. It describes the evaluation of FNAC samples under the microscope for diagnosing various conditions.
The document discusses the anatomy and function of the liver. It provides details on different types of liver biopsies including percutaneous, transjugular, and laparoscopic biopsies. The key indications for liver biopsy are diagnosing and evaluating various liver diseases, while risks include pain, bleeding, and rare life-threatening complications. Percutaneous biopsy is the most common approach but transjugular may be preferred in patients with coagulopathy.
A liver biopsy involves using a needle to take a small sample of liver tissue for examination under a microscope. An ultrasound is used to guide the needle to the correct location in the liver. A biopsy may be performed to determine the severity or specific type of liver disease present. Examining the biopsy under a microscope can provide information about conditions like cirrhosis, hepatitis, fatty liver disease, and hepatocellular carcinoma by looking at changes to the liver's lobules and cells.
Histopathological Grossing of Kidney Tumors with the common gross differentials encountered,
reference - TATA memorial grossing techniques , Rosai and ackerman surgical pathology , Fletcher , Springer histopathology Specimen
This document discusses various types of intestinal ulcers, their pathogenesis, gross appearance, histology, and complications. It covers peptic, infection-related, immune-mediated, and malignant ulcers. Specific ulcer types discussed include duodenal peptic, typhoid, tuberculosis, amoebic, pseudomembranous colitis, CMV colitis, ulcerative colitis, Crohn's disease, graft-versus-host disease, and carcinoma. For each type, it provides information on the causative pathogen, how the ulcers form, their gross appearance, characteristic microscopic features, and potential complications.
Small round cell tumors are a group of highly aggressive cancers composed of small, undifferentiated cells. The diagnostic approach involves clinical findings, imaging, pathology, and molecular genetics testing. Key small round cell tumors in pediatric patients include Ewing sarcoma, neuroblastoma, nephroblastoma, rhabdomyosarcoma, medulloblastoma, retinoblastoma, and lymphoblastic lymphoma. Immunohistochemistry and genetic testing are used to determine the specific tumor type to help guide treatment.
This document provides an overview of non-Hodgkin's lymphoma (NHL), including:
1. NHL is a heterogeneous group of malignant diseases of the lymphoid system that is defined and has varying epidemiology, classification, risk factors, pathogenesis, clinical features, investigations, and treatment.
2. NHL is classified in several systems, most recently the WHO system from 2008, which categorizes NHL into B-cell and T/NK-cell lymphomas that can be indolent or aggressive.
3. Specific subtypes like diffuse large B-cell lymphoma, follicular lymphoma, and Burkitt's lymphoma have unique characteristics and clinical presentations.
Sputum examination provides important diagnostic information by analyzing material coughed up from the lungs and respiratory tract. Key indications for sputum examination include identifying the causative organism in suspected lower respiratory infections like pneumonia or tuberculosis. Sputum samples can also be examined cytologically to detect malignant cells or investigate other infections. Proper collection and transport of sputum samples is important for microbiological culture and other tests. Staining and microscopic examination of sputum looks for bacteria, fungi, parasites and other pathogenic organisms. Molecular tests like PCR provide a rapid and sensitive method for tuberculosis diagnosis.
The document discusses various cystic diseases of the liver including pyogenic liver abscess, amebic liver abscess, hydatid cysts, simple hepatic cysts, polycystic liver disease, cystadenoma, and cystadenocarcinoma. It provides details on the presentation, imaging, and management of these conditions with a focus on pyogenic liver abscess including risk factors, complications, and surgical versus non-surgical treatment approaches.
This document provides guidance on grossing colorectal specimens, including colon and rectal resection specimens. It discusses:
- Key steps for gross examination including measuring specimens, identifying structures, and evaluating resection margins and lymph nodes
- Anatomy of the colon and relationships to peritoneum
- Identification and sampling of lesions such as polyps, tumors, and areas of inflammation
- Unique handling considerations for rectal specimens including evaluation of the mesorectum
The document emphasizes the importance of thorough gross examination and appropriate sampling to accurately assess resection margins, lymph node status, and other prognostic factors.
The document discusses chronic lymphocytic leukemia (CLL), including its definition, epidemiology, etiology, pathogenesis, clinical symptoms, diagnosis, staging, prognosis, and treatment. Some key points:
- CLL is characterized by the proliferation and accumulation of small, mature lymphocytes in the blood, bone marrow, and lymphoid tissues. It most commonly affects elderly adults.
- Diagnosis is based on blood cell counts and immunophenotyping of lymphocytes. Prognosis depends on factors like clinical stage, genomic abnormalities, and biomarker expression levels.
- Treatment involves chemotherapy, chemoimmunotherapy, targeted therapies, and supportive care. The appropriate treatment approach depends on a patient's risk
This document discusses non-Hodgkin's lymphomas, including its definition, epidemiology, classification systems, clinical features, treatment approaches, and outcomes. It defines NHL as a malignant disease of the lymphatic system that is histologically and clinically heterogeneous. Treatment outcomes depend on risk factors such as age, disease stage, organ involvement, and performance status. Standard first-line chemotherapy such as CHOP results in remission rates of 50-80% but permanent cures in only 40-60% of patients. High-risk patients may benefit from intensive chemotherapy and stem cell transplantation.
Fine Needle Aspiration Cytology (FNAC) is a simple, quick and inexpensive method that is used to sample superficial masses like those found in the neck and is usually performed in the outpatient clinic.
The document discusses the development and benefits of the Milan System for Reporting Salivary Gland Cytopathology. It aims to standardize terminology for salivary gland FNA reports which previously lacked uniformity. The system categorizes specimens as non-diagnostic, non-neoplastic, atypia of undetermined significance, neoplastic (benign or uncertain malignant potential), suspicious for malignancy, or malignant. It is intended to improve communication between pathologists and clinicians, enhance patient care, and facilitate research by allowing standardized data collection across institutions. While validation is ongoing, the system provides a practical framework for uniform reporting of salivary gland cytology.
This document discusses bone marrow examination, including its purpose, types (aspiration and biopsy), indications, contraindications, procedure details, instruments used, complications, and findings in conditions like iron deficiency anemia and megaloblastic anemia. Bone marrow examination assesses hematopoiesis through aspiration or biopsy of the medullary cavity in bones. Aspiration is used to evaluate cellularity and differentials while biopsy allows evaluation of morphology, architecture, and focal lesions. Common sites include the iliac crest and sternum.
This document discusses the importance and techniques for grossing gastrointestinal specimens. It is important to appropriately sample lesions and tumors to define their size, depth of invasion, and lymph node status in order to stage tumors and convey information to surgeons about resection adequacy. Unique aspects of gastrointestinal specimens include their tubular structures and the use of serosa versus circumferential margin in determining depth of invasion. Key steps are to sample the tumor site extensively, look for lymph nodes along curvatures, section polyps at their bases, sample the tip of appendices, and take full thickness sections of organs and lesions. Questions are welcomed.
This document discusses various non-neoplastic and neoplastic conditions that can cause lymphadenopathy. It focuses on filariasis as a cause of non-neoplastic lymphadenopathy. Filarial parasites can infect the lymphatics and lymph nodes, causing inflammation and blockage. On pathology, the lymph nodes show an intense inflammatory reaction around dead or dying larvae with eosinophils and multinucleated giant cells. Rarely, microfilaria can be seen embedded in the lymph node tissue. The document emphasizes that a diligent search is needed to identify the parasite and make an accurate diagnosis.
1) The document discusses various precancerous lesions of the colon and rectum, including adenomas, hyperplastic polyps, sessile serrated lesions, and traditional serrated adenomas.
2) It describes the histological features and progression of these lesions, noting that sessile serrated lesions and traditional serrated adenomas have a significant malignant potential, whereas hyperplastic polyps have a very low malignant potential.
3) Two pathways of colorectal carcinogenesis are discussed: the classic adenoma-carcinoma sequence and the serrated neoplastic pathway, which involves certain serrated polyps.
Bone marrow procedures involve bone marrow aspiration and trephine biopsy to examine the bone marrow. Bone marrow aspiration is a simple, safe outpatient procedure that allows examination of individual cells and their morphology. Trephine biopsy provides larger samples for examining marrow structure and architecture, and is valuable for diagnosing conditions with a "dry tap". Proper techniques and precautions are important to perform bone marrow procedures safely and obtain adequate samples for diagnosis.
This document discusses multiple myeloma (MM), a plasma cell malignancy characterized by proliferation of monoclonal plasma cells in the bone marrow. Key points include: MM commonly precedes other premalignant conditions like MGUS; genetic defects contribute to disease heterogeneity and drug resistance; MM causes skeletal destruction and can involve other organ systems; diagnosis involves tests like serum and urine protein assays, bone marrow biopsy, and imaging; and treatment involves chemotherapy while considering prognostic factors like tumor mass, hypercalcemia, and renal impairment.
Bone marrow aspiration and biopsy are procedures used to examine bone marrow and diagnose blood disorders. Bone marrow aspiration involves inserting a special needle into the bone marrow to obtain a tissue sample. Bone marrow biopsy involves removing a small core of bone marrow using a rotating needle. The posterior iliac crest is the most common site used. Bone marrow samples are examined under a microscope to identify blood cell components and detect any abnormalities that help diagnose conditions like leukemia, lymphoma, and myeloma. Nurses play an important role in preparing equipment, assisting during the procedure, and monitoring the patient afterwards.
Cytologic assessment of bronchopulmonary lesionsAseem Jain
This document provides an overview of cytologic assessment of bronchopulmonary lesions. It discusses the normal histology of the respiratory system and various cytologic sampling techniques used to evaluate the lungs, such as sputum samples, bronchial brushings, washings and lavage. The cytology of normal respiratory cells and endogenous material is described. A variety of benign pulmonary conditions and infectious processes are outlined. Specific lung diseases like tuberculosis, sarcoidosis and nocardiosis are discussed through their characteristic cytologic findings.
This document provides an overview of fine needle aspiration cytology (FNAC). It discusses the history, advantages, limitations, equipment, techniques, processing, complications, and applications of FNAC for diagnosing lesions in the salivary gland, oral cavity, and other areas. FNAC is a simple, economical technique that can provide a rapid diagnosis without the need for an open biopsy. It describes the evaluation of FNAC samples under the microscope for diagnosing various conditions.
The document discusses the anatomy and function of the liver. It provides details on different types of liver biopsies including percutaneous, transjugular, and laparoscopic biopsies. The key indications for liver biopsy are diagnosing and evaluating various liver diseases, while risks include pain, bleeding, and rare life-threatening complications. Percutaneous biopsy is the most common approach but transjugular may be preferred in patients with coagulopathy.
A liver biopsy involves using a needle to take a small sample of liver tissue for examination under a microscope. An ultrasound is used to guide the needle to the correct location in the liver. A biopsy may be performed to determine the severity or specific type of liver disease present. Examining the biopsy under a microscope can provide information about conditions like cirrhosis, hepatitis, fatty liver disease, and hepatocellular carcinoma by looking at changes to the liver's lobules and cells.
Liver biopsy remains the gold standard for diagnosing chronic liver disease and assessing inflammation and fibrosis. While non-invasive modalities are being developed and evaluated, liver biopsy provides valuable information for both diagnosis and management of many liver diseases. It allows quantification of necrosis, inflammation, fibrosis and fat content which is important for evaluating disease progression. Liver biopsy also provides adequate tissue for special staining and assessing other pathologies. While it carries some risk, liver biopsy has low mortality and morbidity when performed properly by an experienced practitioner.
1- This document discusses the use of histological stains and scoring systems for assessing chronic liver disease on liver biopsy specimens.
2- It provides descriptions of the Ishak and METAVIR scoring systems which are commonly used to grade necroinflammatory activity and stage fibrosis in chronic hepatitis C.
3- Guidelines are given for optimal liver biopsy technique and interpretation of stains to diagnose specific liver diseases.
Esophagitis is inflammation of the esophagus that can have various causes like acid reflux, infections, medications, radiation, and more. Common symptoms include dysphagia, heartburn, and painful swallowing. Diagnosis involves endoscopy and biopsy. Treatment depends on the underlying cause but may include lifestyle changes, antacids, H2 blockers, proton pump inhibitors, and surgery in some cases. Complications can include strictures and Barrett's esophagus.
The document discusses patterns of hepatic injury including degeneration, intracellular accumulation, necrosis, apoptosis, inflammation, fibrosis, and failure. Specific types of liver disease are also examined such as alcoholic liver disease which can cause steatosis, hepatitis, and cirrhosis due to effects of alcohol metabolism including induction of cytochrome P450 and increased lipid biosynthesis. Chronic alcohol intake over many years can lead to severe and irreversible liver injury.
This document discusses various esophageal disorders including structural disorders like hiatal hernia and rings, motility disorders like achalasia, and conditions caused by reflux like GERD and Barrett's esophagus. It provides details on the causes, symptoms, diagnoses and treatments of these common esophageal problems.
This document provides information about a barium swallow procedure. It discusses:
1. A barium swallow examines the esophagus and stomach using barium sulfate as a contrast agent. It can detect conditions like dysphagia, gastroesophageal reflux, and tumors.
2. The procedure involves giving the patient barium suspensions to swallow in various positions so that constrictions, sphincters, and motility can be evaluated.
3. Findings of common esophageal conditions are described such as webs, rings, hernias, varices and motility disorders. Complications of the test like barium leakage are also mentioned.
This document provides information about the liver and cirrhosis. It begins with the normal histology and architecture of the liver. It then discusses cirrhosis, defining it as a degenerative disease marked by excess connective tissue formation. Cirrhosis is characterized by bridging fibrous septa, parenchymal nodules, and disruption of liver architecture. The document discusses the classification, etiology, pathogenesis, clinical features, and complications of cirrhosis.
- Viral hepatitis can present asymptomatically, symptomatically before jaundice, or progress to fulminant hepatitis or chronic hepatitis. Diagnosis involves blood tests to check liver enzymes and serology or molecular testing to determine the virus.
- Liver abscesses can be pyogenic (most common), amebic, or fungal. Amebic abscesses are caused by Entamoeba histolytica and present with fever, abdominal pain, and hepatomegaly. Pyogenic abscesses require drainage if large or not improving with antibiotics.
- Hydatid cysts are caused by the tapeworm Echinococcus granulosus. Surgical removal is usually required for large or infected cysts while
The document provides an overview of liver disease, including:
1) Jaundice and cholestasis which can occur due to increased bilirubin production, decreased uptake by hepatocytes, or impaired excretion.
2) Liver failure which can be acute or chronic, and results in hepatic encephalopathy, coagulopathy, and other systemic effects.
3) Cirrhosis, defined as diffuse liver scarring leading to regenerative nodules and altered vasculature, with complications including liver failure, portal hypertension, ascites, and hepatocellular carcinoma.
This document provides an overview of liver anatomy, functions, and diseases. It describes the liver's structure including liver cells, bile drainage system, and blood supply. The liver's key functions are metabolism, protein synthesis, storage, detoxification, and bile production. Investigation of liver diseases includes blood tests, imaging, and biopsy. Common liver diseases discussed are jaundice, cholestasis, liver failure, and cirrhosis. Cirrhosis is the end-stage of chronic liver disease and can result from infections, toxins, autoimmune conditions, and other etiologies.
Transplant rejection occurs when the immune system of the transplant recipient attacks and destroys the transplanted organ or tissue, perceiving it as foreign. There are several types of rejection including hyperacute, acute, and chronic rejection. Acute rejection occurs within days or weeks after transplantation and is usually T-cell mediated, while chronic rejection develops over months to years and is characterized by accelerated arteriosclerosis and fibrosis. Pathologists play an important role in diagnosing rejection by examining biopsy samples of transplanted organs and applying standardized grading systems to classify the type and severity of rejection.
This document discusses liver abscesses, specifically amoebic and pyogenic types. It provides details on:
- Amoebic liver abscess is caused by the protozoan Entamoeba histolytica and presents with right upper quadrant pain. Diagnosis involves imaging and serology. Treatment is metronidazole along with luminal agents.
- Pyogenic liver abscess is usually polymicrobial in origin and often associated with biliary obstruction. Imaging shows hypoattenuating lesions that may be drained percutaneously along with antibiotics.
- Key differences between the two types include demographic factors, number/location of lesions, and diagnostic test results. Prognosis depends on factors like abscess size
Cirrhosis is the end stage of chronic liver disease caused by various chronic stress factors that damage the liver over time. This results in progressive fibrosis that destroys the liver's normal structure and function. Common causes include alcohol, hepatitis B/C, toxins, and unknown factors. Complications arise from portal hypertension and liver dysfunction, such as ascites, hepatic encephalopathy, and bleeding disorders. Management focuses on treating complications, slowing fibrosis, and preventing further liver damage through lifestyle changes and medications.
The document discusses the anatomy, physiology, and common diseases of the liver. It begins with a brief history of liver surgery and anatomy including liver innervation and lymph drainage. It then covers liver physiology including metabolism of nutrients, proteins, and drugs. Common liver diseases are summarized such as viral hepatitis, alcohol-related disease, cirrhosis, portal hypertension, and liver cancer. Specific conditions like fatty liver disease, jaundice, acute liver failure, and infections are also reviewed. Imaging findings and treatments for various benign and malignant liver lesions are mentioned.
Transplant pathologists play an essential role in organ transplantation by evaluating biopsies of failing organs, matching donor and recipient tissues, assessing donor organ viability, and monitoring for rejection or complications through histopathological examination of biopsies. Key tasks include initial patient evaluation, blood and tissue typing to ensure compatibility, evaluating donor organs, and monitoring allografts over time with protocol biopsies to diagnose issues like acute or chronic rejection, infection, drug toxicity, or disease recurrence. The pathologist aims to ensure transplant success and identify any issues requiring clinical intervention.
This document provides an overview of cirrhosis and its complications. It defines cirrhosis as a chronic liver disease characterized by diffuse fibrosis and nodular regeneration. The main causes are chronic viral hepatitis, alcohol, and non-alcoholic fatty liver disease. Complications include portal hypertension, ascites, hepatic encephalopathy, and hepatorenal syndrome. Diagnosis involves clinical evaluation, labs, imaging, and sometimes biopsy. Treatment focuses on managing complications, addressing the underlying cause, and potentially liver transplantation for decompensated cirrhosis.
The document provides details about the anatomy, physiology, and common infections and lesions of the liver. It describes the liver's location, blood supply, segmentation, bile ducts and veins. It discusses the liver's roles in metabolizing drugs, processing nutrients, and maintaining glucose levels. Common infections covered include pyogenic abscesses, amebic abscesses, hydatid disease, ascariasis, and schistosomiasis. Benign lesions discussed are congenital cysts.
This document provides an overview of the anatomy, histology, embryology, physiology and pathology of the pancreas. Some key points:
- The pancreas is a retroperitoneal organ that extends from the duodenum to the spleen. It has three parts - head, body and tail.
- It has both exocrine and endocrine functions. Exocrine cells secrete enzymes like trypsinogen and amylase. Endocrine cells are clustered in islets of Langerhans.
- Acute pancreatitis is commonly caused by gallstones or alcohol and results from premature enzyme activation within the pancreas. Chronic pancreatitis involves irreversible inflammation and fibrosis over many years.
1. Autosomal dominant polycystic kidney disease (ADPKD) is characterized by multiple renal cysts that increase in size and number over time, eventually leading to kidney failure in half of patients by age 60.
2. ADPKD is caused by mutations in genes that regulate renal tubule cell proliferation and results in the monoclonal expansion of tubular epithelial cells.
3. Clinical manifestations include chronic flank pain, urinary tract infections, kidney stones, hypertension, liver cysts, and cerebral aneurysms. Treatment focuses on blood pressure control and management of complications.
This document discusses tubulointerstitial disorders, which are diseases affecting the renal tubules and interstitium. Tubulointerstitial disorders are distinguished from glomerular diseases by the absence of nephritic or nephrotic syndrome and the presence of tubular dysfunction manifesting as defects in concentration ability, polyuria, nocturia, and metabolic acidosis. Common tubulointerstitial disorders discussed include acute tubular necrosis, tubulointerstitial nephritis, pyelonephritis, drug-induced tubulointerstitial nephritis, analgesic nephropathy, and diseases causing hypercalcemia and nephrocalcinosis.
Non Cirrhotic Portal Fibrosis (NCPF) is a syndrome of obscure etiology characterized by obliterative portovenopathy leading to portal hypertension and massive splenomegaly in young adults from low socioeconomic backgrounds. The exact cause is unknown but is hypothesized to be related to malnutrition, recurrent infections, exposure to toxins or metals. Pathology shows sclerosis of portal vein branches. Clinical features include gastrointestinal bleeding, splenomegaly, and abdominal pain. Management involves controlling acute bleeding episodes and preventing rebleeding through medications or surgery like portosystemic shunts. Prognosis is generally good if bleeding can be controlled.
This document discusses portal hypertension and variceal bleeding. It begins by describing portal hemodynamics and defining clinically significant portal hypertension as a hepatic venous pressure gradient (HVPG) greater than 10-12 mm Hg.
The etiology of portal hypertension is categorized as prehepatic, hepatic, or posthepatic. Prehepatic causes include portal/splenic vein thrombosis. Hepatic causes include cirrhosis, which leads to fibrosis and increased production of vasoconstrictors. Posthepatic causes include Budd-Chiari syndrome.
Complications of portal hypertension include variceal bleeding, ascites, hepatic encephalopathy, and hepatorenal syndrome. Investigations for diagnosis include ultrasound Doppler,
This document provides an overview of liver pathology, covering the anatomy and histology of the normal liver, as well as pathological conditions including viral hepatitis, cirrhosis, tumors, and other disorders. Key points discussed include the lobular structure of the liver, patterns of inflammation and necrosis seen in viral hepatitis, characteristics of cirrhosis including macronodular and micronodular types, features of hepatocellular carcinoma and cholangiocarcinoma, and abnormalities involving fatty change, vascular disorders, and pigmentation. Liver biopsy is described as the gold standard for diagnosis, with assessment of architecture, inflammation, necrosis, and other features.
This document summarizes recent updates to the 2016 WHO classification of non-Hodgkin's lymphomas compared to the 2008 classification. It discusses revisions to categories of mature B-cell and T/NK-cell neoplasms. Key changes include recognizing indolent variants of mantle cell lymphoma, reclassifying in situ follicular neoplasia, and identifying provisional entities such as large B-cell lymphoma with IRF4 rearrangement. Next-generation sequencing has provided insights into molecular markers that aid diagnosis, such as BRAF mutations in hairy cell leukemia and MYD88 mutations in lymphoplasmacytic lymphoma/Waldenstrom macroglobulinemia.
This document provides an overview of recent updates to the WHO classification of central nervous system tumors based on the 2016 guidelines. Key points include:
- Incorporation of molecular parameters like IDH, ATRX, and 1p/19q status into tumor classifications to improve diagnostic accuracy.
- Diffuse gliomas are now classified based on shared genetic drivers rather than histology alone. Entities like oligoastrocytoma are discouraged.
- Newly recognized entities include epithelioid glioblastoma and glioblastoma with a primitive neuronal component showing MYC/MYCN amplification.
- The diagnosis of oligodendroglioma now requires both IDH mutation and 1p/
Molecular profiling of breast cancer can classify tumor types, identify appropriate therapeutic targets, determine prognosis, and predict treatment response. Techniques include immunohistochemistry, fluorescence in situ hybridization, reverse transcription PCR, microarrays, and next generation sequencing to analyze protein expression, gene copy number, mutations, and gene expression levels. Breast cancers are classified into intrinsic subtypes including luminal A/B, HER2-enriched, basal-like, and claudin-low based on distinct gene expression patterns that predict clinical behavior and response to therapy.
1. Cytogenetics is the study of chromosomes and abnormalities involving changes in number or structure. Key milestones included the discovery and counting of chromosomes and development of techniques like karyotyping.
2. Cytogenetic analysis involves culturing cells, arresting cell division, staining and analyzing chromosomes to identify abnormalities. It is used to diagnose conditions like Down syndrome, Edwards syndrome, Patau syndrome, Turner syndrome, and Klinefelter syndrome which are caused by gains or losses of whole chromosomes.
3. Chromosomal abnormalities can be numerical, involving extra or missing chromosomes, or structural with changes like translocations, deletions, or duplications. These abnormalities are associated with developmental delays, birth defects,
This document provides an overview of amyloidosis, including:
- Amyloidosis is caused by the extracellular deposition of misfolded proteins forming fibrils. There are different types classified by the precursor protein involved.
- Systemic forms include AL amyloidosis associated with plasma cell disorders and AA amyloidosis associated with inflammatory conditions.
- Diagnosis involves biopsy of tissues like fat pad or organs stained with Congo red to identify amyloid deposits. Immunohistochemistry identifies the precursor protein type.
- Organ involvement varies but kidney, heart, liver and spleen are commonly affected. Clinical manifestations depend on the organs involved and may include proteinuria, heart failure, hepatomegaly or neurological symptoms.
This document provides background information on microsatellite instability (MSI). It discusses how microsatellites are short repetitive sequences prone to mutations during DNA replication due to slipped strand mispairing or unequal crossing over. MSI occurs when mutations inactivate DNA mismatch repair genes, leading to length alterations in microsatellite regions. This causes microsatellite instability, which is seen in certain cancers like colorectal cancer and can be assessed through testing tumor DNA for instability in microsatellite markers. Immunohistochemistry for mismatch repair proteins or direct testing for MSI can help identify tumors associated with defective mismatch repair and microsatellite instability.
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Leveraging Generative AI to Drive Nonprofit InnovationTechSoup
In this webinar, participants learned how to utilize Generative AI to streamline operations and elevate member engagement. Amazon Web Service experts provided a customer specific use cases and dived into low/no-code tools that are quick and easy to deploy through Amazon Web Service (AWS.)
2. Contents
• Indications of liver biopsy
• Lab investigations
• Techniques of liver biopsy
• Needles of liver biopsy
• Processing and staining
• Normal histology
• Approach to liver biopsy interpretation
• Interpretation of different pathological
conditions
3. Indications of liver biopsy
• Make or confirm the diagnosis
• Assess the severity of liver damage
• Assess the prognosis of a given case
• Monitor the response to the treatment
4. Clinical and lab investigations
• History and general physical examination
• Lab investigation
– Liver function tests
– CBC
– Prothrombin time, aPTT
– Bleeding time
– Clotting time
– USG,CT, MRI
7. 2. Transvenous (Transjugular)
• Done in coagulation
disorders or ascites
• Performed in a vascular
catheterisation laboratory
with videofluoroscopy
equipment and proper
cardiac monitoring
8. 3. Laparoscopic liver biopsy
• Transvenous liver
biopsy is not available,
• In patients who have a
combination of a focal
liver lesion and a
coagulopathy.
9. Needles for liver biopsy
Broadly classified into
• Suction needles
– Menghini,
– Klatskin,
• Cutting needles
– Vim-Silverman,
– Tru-cut (commonly used)
• Spring-loaded cutting needles that have a
triggering mechanism.
15. Special stains
Perls prussian blue for iron, heoatocytes
have taken the blue stain
PAS positive in glycogen storage right
side and after treating it with diastase,
left side
16. Special stains
PAS+diastase for aplha1 antitrypsin deficiency
Hapatocytes have taken magenta color
Oil Red O stain highlighting fat
globules in a frozen section of the
liver.
17. Special stains
Rhodanin stain for copper, hepatocytes have
taken orange red color in the upper nodule
Congo red stain orange-staining of
vascular amyloid deposition,
characteristic apple-green
birefringence under polarized
microscopy (inset)
18. Special stains
Orcein stain for elastic fibres is positive in two
portal tracts (P) but not in the intervening area of
collapse. A necrotic bridge (arrow) is also negative.
Inset: This contrasts with an elastic fibre-rich
septum in chronic liver disease.
P
P
Reticulin stain of micronodular cirrhosis
Stains collagen
19. Adequacy of liver biopsy
• Biopsy length - > 1 cm
• At least 10 portal tracts should be seen
• Any amount of tissue that yields diagnosis
• Transjugular biopsy : smaller, thinner,
fragmented tissue cores (4 fragmented cores)
or at least 4-6 portal tracts
• Best is laparoscopic biopsy
20. Histology
Lobular model
• 2-3 mm diameter lobule
• Hexagonal shape
• The central hepatic vein
(terminal hepatic vein)
• Portal tracts at the
periphery
• Portal tract- portal vein,
hepatic artery, bile duct
21. Conti..
• Hepatocytes around
– central vein -centrilobular(zone3),
– portal tract - periportal (zone 1),
– in between mid zonal (zone 2)
• Hepatocytes – polygonal, central
single nucleus, cells arranged in
plates
• Sinusoids on either side of cell
plate
• Sinusoids – lined by fenestrated
endothelial cells
P
BD
22. Conti..
• Space of disse – lies below the endothelial lining
of sinusoids has stellate cells
• Kupffer cells- mononuclear phagocytic cells, on
luminal side of sinusoids
23. Conti..
Bile canaliculi – seen in between hepatocytes, 1-2 𝛍
diameter, drain into canal of hering, in turn drain into
bile duct
24. Acute Injury
Response of liver parenchyma to acute injury
• Necrosis
– Hepatocytes swells
– Blebs are formed and carry out organelles out of the
cell
– Cell rupture
– Macrophage infiltration at the site of necrosis
• Apoptosis
– Nuclear pyknosis, karyorrhexis
– Acidophilic bodies – councilman bodies
25. Disease process continues
• Spotty necrosis/ focal necrosis - Death of
individual hepatocytes or small groups of
these cells
• Confluent necrosis – widespread parenchymal
loss, a zonal loss of hepatocytes
26. • Bridging necrosis – necrosis link central veins
to portal tracts or bridge the adjacent portal
tract
• Panlobular and multilobular necrosis -
confluent necrosis involving entire single
lobules or several adjacent lobules
respectively
32. Acute viral hepatitis
• Usually Pan lobular
– Centrilobular – hepatitis B, C
– Periportal – hepatitis A
• Hepatocytes – ballooning,
pale granular cytoplasm or
shrinkage, nuclear pyknosis
– acidophilic bodies
(Councilman bodies),
• Bilirubinostasis
• Mononuclear and
lymphocytic infiltration
• Spotty necrosis
33. Acute viral hepatitis
bridging necrosis. curved lines of necrotic debris and
collapse extend from a portal tract to cetral venule.
C
P
34. Acute viral hepatitis
multilobular necrosis Portal tract (arrow) can be
identified but the parenchyma has been replaced by
inflammatory cells, necrotic debris
36. Chronic hepatitis
Classic causes of chronic hepatitis
• Hepatitis B, with or without HDV infection
• Hepatitis C
• Autoimmune hepatitis
• Drug-induced hepatitis – methotrexate, OCP,
vitamin A, acetaminophin
• Chronic hepatitis of unknown cause
37. Chronic hepatitis
The portal tract is heavily infiltrated
with lymphocytes (H&E)
Interface hepatitis-process of
inflammation and erosion of the
hepatic parenchyma at its junction
with portal tracts or fibrous septa
(H&E)
38. Chronic hepatitis
Chronic hepatitis with lobular activity. Clumps of inflammatory
cells, some of them associated with hepatocyte loss, extend
through the parenchyma. The portal tract above is inflamed.
(H&E.)
39. Chronic hepatitis B
the central part of the cytoplasm
has a homogeneous ground-glass
appearance.
Sanded nuclei – fine granular,
eiosinophilic
Cytoplasmic inclusions of HBsAg are present.
40. Chronic hepatitis C
• The portal tract is
heavily infiltrated by
lymphocytes,
• A lymphoid follicle
with germinal
center has formed
• 15-25% may have
steatosis
41. Autoimmune hepatitis
• Female predilection
• Chronic progressive hepatitis with features of
autoimmune diseases
– Genetic predisposition
– Associated with other autoimmune disorders
– Therapeutic response to immunosuppression
42. Autoimmune hepatitis
1. Type 1
– Any age (Middle aged to old age)
– Presence of antinuclear antibodies (ANA), anti
smooth muscle actin antibodies (SMA), anti
soluble liver antigen/liver- pancreas antigen(
anti-SLA/LP), anti mitochondrial (AMA)
antibodies
• Type 2
– Children and teenagers
– Anti liver kidney microsome-1 antibodies
49. Grading for chronic hepatitis
Minimal activity (grade 1).
Inflammation is confined to the portal
tracts and there is no interface
hepatitis. The lobular parenchyma is
quiescent
Mild activity (grade 2). Focal interface
hepatitis present (right periportal region) in
addition to portal tract inflammation. A few
lobular necroinflammatory foci are also
seen at right
50. Grading for chronic hepatitis
Moderate activity (grade 3). More
extensive interface hepatitis is present
than in grade 2, but involving <50% of
the circumference of most portal
tracts.
Marked activity (grade 4). The portal tract
is diffusely inflamed and shows extensive
circumferential interface hepatitis. Similar
changes affect virtually all portal tracts
with this grade of activity, often with
considerable lobular activity.
51. Cirrhosis
• Results from interplay between parenchymal
damage, fibrinogenesis, fibrinolysis and
hepatocellular regeneration
• Main Causes
– Hepatitis B, C,
– Alcohol abuse
– Biliary diseases
– Metabolic disorders
– Drugs, toxins
– Autoimmune hepatitis
– Venous out flow obstruction
53. Classification
based on size of the nodule
• Micronodule - < 3 mm
causes - Alcohol, Metabolic, Hemachromatosis, Wilson's Disease
• Macronodule - > 3 mm
causes – Viruses (B,C), Toxins, Poisoning
• Mixed – equal number of both nodules
55. Fragmented sample
Cirrhosis: fragmented sample. A specimen obtained by the biopsy
method has broken into rounded fragments peripherally
circumscribed by fibrosis, reticulin stain
56. Abnormal structures
Cirrhosis: selective sampling. A nodule has
been cored out of the connective tissue by
the biopsy procedure, but a thin layer of
connective tissue (arrow) has adhered to the
nodule margin. (Needle biopsy, reticulin.)
Cirrhosis: distorted reticulin pattern. The
distortion has resulted from abnormal
and irregular hepatocyte growth
patterns. (Needle biopsy, reticulin.)
57. Hepatocellular changes
Cirrhosis: hepatocellular regeneration. Liver-
cell plates are two or more cells thick,
indicating active growth. (Needle biopsy, H&E.)
Cirrhosis: large-cell dysplasia , nuclei of the
enlarged hepatocytes irregular in shape and
vary greatly in size and staining intensity. Cells
are multinucleated. The normal hepatocytes at
right and in the upper left-hand corner. (Wedge
biopsy, H&E.)
58. Hepatocellular changes
Cirrhosis: small-cell dysplasia (small-cell change). The hepatocytes below and to
the right have normal-sized nuclei, but their overall size is reduced. Nuclear–
cytoplasmic ratios are therefore increased. (Needle biopsy, H&E.)
59. Assessment of cause for cirrhosis
• Pattern of nodules and
fibrosis
– regular
– irregular
• Bile ducts
– Ductular reaction
– Ductopenia
– fibrosis
• Blood vessels
– Narrowing
– Ischemic changes
• Steatohepatitis
• Evidence of viral
infection
• Abnormal deposits
– Iron
– Copper, copper-
associated protein
– α1-Antitrypsin globules
61. Alcoholic liver disease
3 forms of alcoholic liver injury
• Hepatocellular steatosis
• Alcoholic hepatitis (steatohepatitis)
• Steatofibrosis
62. Hepatic steatosis
There are large fat vacuoles in perivenular hepatocytes, displacing the
nuclei to the edges of the cells. (Needle biopsy, H&E.)
63. Steatohepatitis
Alcoholic steatohepatitis. Ballooning, necrosis,.
Inflammatory cells, mainly neutrophils. contain
densely stained Mallory bodies (arrows). Many
hepatocytes contain large fat vacuoles. (Needle
biopsy, H&E.) ASH cannot be differentiated from
NASH
Mallory bodies. The Mallory bodies
in this example of steatohepatitis
stain strongly for ubiquitin (arrows)
66. Non alcoholic fatty liver disease
• NAFLD is a group of conditions that have in
common the presence of hepatic steatosis (fatty
liver), in individuals who do not consume alcohol,
or do so in very small quantities (less than 20 g of
ethanol/week)
• NAFLD
– Fatty liver
– NASH
– Fibrosis
– Cirrhosis
• Associated with metabolic syndrome
67. Non alcoholic fatty liver disease
NASH predominantly mononuclear
inflammatory cell in filtrate with both small
and large fat droplets (H&E)
Steatofibrosis prominent at portal
region, extending along the sinusoids
in a chicken wire pattern around the
hepatocytes ( masson trichrome )
69. Hemochromatosis
• Excessive iron absorption, most of which is
deposited in parenchymal organs like liver,
pancreas, heart, joints, endocrine organs
• Normal iron pool 2-6 gm in adults
• 0.5 gm stored in liver (98% in hepatocytes)
• Disease manifestation appear when the iron
load > 20gm
70. Hemochromatosis
• Mutations of TFR1, TFR2, HJV, HFE gene
mutation lead to decrease production of
hepcidin and increased absorption of iron and
increased release into circulation
• Serum ferritin >1000 µg/L
• Transferrin saturation > 45%
• Serum iron > 150 µg/dl
73. Wilson disease
• Autosomal recessive disorder
• Mutation of the ATP7B gene,
• Impaired copper excretion into bile and a failure
to incorporate copper into ceruloplasmin
• Copper accumulate in liver and later brain
• Serum ceruloplasmin < 20 mg/dl
• 24 hr Urine copper > 100 𝛍g/dl
• Total serum Cu < 60 𝛍g/dl
74. Wilson’s disease
Fatty change, mild to moderate hepatocytic
necrosis, with inflammatory infiltrate,
intranuclear glycogen inclusions also seen.
The upper nodule is strongly positive
for copper, stained orange-red. The
lower nodule is completely negative.
(Wedge biopsy, rhodanine.)
75. Glycogen Storage Diseases
• A hereditary deficiency of one of the enzymes
involved in the synthesis or sequential
degradation of glycogen
• The liver is important in glycogen metabolism.
• Type 1( von Gierke) is most common for liver –
absence of glucose 6 phosphatase
76. Von Gierke disease
type I glycogen storage disease, PAS positive and after treating
with diastase hepatocytes are swollen and resemble plant cells
,the abundant glycogen displaces the organelles of affected cells
to the periphery. Sinusoids are compressed. Slender periportal
fibrous scars often develop
77. Gaucher’s disease
• Autosomal recessive disorders resulting from
mutations in the gene encoding
glucocerebrosidase
• Glucocerebrosidase - cleaves the glucose
residue from ceramide.
• The enzyme defect, glucocerebroside
accumulates in phagocytes, kupffer cells
78. Gaucher’s disease
Pale-staining, striated Kupffer cells containing stored lipid are
present within sinusoids. The affected cells compress hepatocytes
and sinusoids and may give rise to portal hypertension. Pericellular
fibrosis is a common finding
80. Niemann–Pick disease
accumulation of sphingomyelin in both hepatocytes and
macrophages. The latter are greatly swollen, foamy and
diastase–PAS-positive to a variable extent , Niemann–Pick
disease may progress to cirrhosis
81. 𝛂1- Antitrypsin deficiency
• Autosomal recessive disorder
• low levels of α1-antitrypsin
• Normal functions – inhibitors of protease,
elastase, protease 3, cathepsin G which are
released by neutrophils at the site of
inflammation
• Mutated α1-antitrypsin protein abnormally
folded inside the ER and lead to apoptosis of
cell.
82. 𝛂1- Antitrypsin deficiency
Hepatocytes near periportal region contain mutated
proteins, and stained magenta color for PAS+diastase .
May also show steatosis, necrosis and fibrosis
83. Cholestasis diseases
• Refers to impairment of
bile flow.
• In light microscope- bile
pigment within bile
canaliculi, hepatocytes
and other sites.
• Bile is seen in the form of
bile thrombi (bile plugs)
in dilated canaliculi
84. Large bile-duct obstruction
• Causes in children
– Biliary atresia
– Cystic fibrosis
– Choledochal cyst
• Causes in adults
– Gall stones
– Malignancies of biliary tree, head of pancreas
– Stricture from previous surgery
85. Large bile-duct obstruction
• Dilatation
intercanaliculi
• Portal tract edema
• Bile duct proliferation
at the margin of
portal tract
• Mild inflammatory
infiltrate
86. Chronic bile-duct obstruction and
biliary cirrhosis(secondary biliary
cirrhosis)
Bile duct obstruction persists, bile duct infarct and increasing fibrosis.
Jigsaw puzzle shape
87. Primary biliary cirrhosis
• Autoimmune disease characterized by
nonsuppurative, inflammatory destruction of
small and medium sized intrahepatic bile
ducts
• Antimitochondrial antibodies recognize E2
component of pyruvate dehydrogenase
complex of mitochondrial membrane,
• Altered MHC II of bile ductal epithelial cells
seen, causes autoactivation of T cells
90. Primary biliary cirrhosis
Ductular reaction with periportal hepatitis A lymphoid aggregate and
a follicle with a germinal Centre (arrow)
91. Primary biliary cirrhosis
Scarring; bridging necrosis, septal fibrosis There is extensive scarring with irregular
nodule formation. Aggregates of
lymphocytes mark the former sites of
bile ducts
92. Primary sclerosing cholangitis
• Inflammation and obliterative fibrosis of intrahepatic
and extrahepatic bile ducts, with dilation of preserved
segments
• Immunological mediated injury to bile duct
• T cells in periductal region
• Autoantibodies to HLA-B8, MHC antigens
• pANCA can be noted in circulation
• On cholangiographic demonstration of the
characteristic beading of bile ducts
• May be associated with inflammatory bowel disease
94. Cholestasis of sepsis
• By 3 main mechanism
1. Direct effect of intrahepatic bacterial
infection (abscess, bacterial cholangitis)
2. Ischemia relating to hypotension due to
sepsis ( when liver is cirrhotic)
3. Response to circulatory microbial products
(most common)
95. Cholestasis of sepsis
Canalicular cholestasis – bile plug at
centilobular canliculi , sometime associate with
kuffer cell activity and mild poratl tract
inflammation
Ductular cholestasis – dilated canal of hering
and bile ductules at the interface of portal
tracts and parenchyma become dilate and
contains bile plug
96. Biliary atresia
• Partial or complete obstruction of the lumen
of the extrahepati biliary tree within the first 3
months of life
• Most common cause of neonatal cholestasis
• 2 types
– Fetal type (20%)
– Perinatal type (80%)
98. Biliary atresia
An expanded, inflamed portal tract at left contains many proliferated bile
ducts, some of which are filled with inspissated bile.
99. Congenital hepatic fibrosis
• Autosomal recessive inherited condition
• Due to Ductal plate malformation
• Presents with hepatomegaly or portal
hypertension, usually in childhood but
occasionally in adults
• Associated with polycystic disease of kidney
• Misdiagnosed as cirrhosis
100. Congenital hepatic fibrosis
Several portal tracts are interconnected by bridging fibrous septa
containing ductal plate malformations. The fibrosis surrounds normal
parenchyma with a terminal venule (short arrow) preserved in a
central position. Inset: Higher magnification of the abnormal duct
structures seen at lower left (long arrow).
101. Indian childhood cirrhosis
• High mortality affecting young Indian children
(and Indian subcontinent)
• Brass- and copper-containing vessels used for
milk-feeding - identified as sources of copper
contamination
• Large amounts of copper and copper-
associated protein accumulate in affected
hepatocytes
102. Indian childhood cirrhosis
Many liver cells are swollen (centre), and surrounded by fibrosis and
mononuclear cells. Regenerating hepatocytes are organised into small
clusters. Disease progress l/t micronodular cirrhosis (H&E.)
106. Hepatocellular adenoma
Liver cells appear normal or contain fat vacuoles. Blood vessels but
no portal tracts are seen within the lesion. (H&E.)
107. Focal nodular hyperplasia (FNH)
Central scar with arteriole, periphery shows fibrous septa with bile
duct proliferation (arrow), surrounding the scar is the nodule consists
of normal hepotocytes .
108. Nodular regenerative hyperplasia(NRH)
This abnormal, nodular growth pattern is not accompanied by fibrosis and
therefore differs from cirrhosis. The parenchymal nodules (N) are often
adjacent to nodule (at left) or surrounding portal tracts. The intervening
liver shows flattened and compressed liver-cell plates and/or sinusoidal
dilatation (H/E)
N
N
109. Bile-duct adenoma
This subcapsular tumour consists of closely packed well formed bile
ducts set in a dense fibrous stroma. A dense collection of
lymphocytes is seen at the edge of the lesion (bottom). (H&E.)
110. Hemangioma
Locate beneath the capsule. Blood-filled spaces are separated
by fibrous septa. A thick capsule is seen at right. ( H&E.)
111. Hepatocellular carcinoma
• Precursors of hepatocellular carcinoma
1. Chronic cirrhosis
2. Large cell dysplasia
3. Small cell dysplasia
4. Macroregenerative nodule
5. Dysplastic nodule
113. Dysplastic nodule
The dysplastic nodule at right shows hepatocytes arranged in
pseudoacini, with a less cohesive growth pattern centrally. A cirrhotic
nodule is present at lower left. Cells show nuclear atypia , (H&E)
116. Grading of HCC
Grade 1 (well differentiated) tumours
have small, round nuclei prominent
nucleoli almost similar to those of
normal and cirrhotic liver. HandE
Grades 2 show progressive alterations in
nuclear contour, chromatin coarseness
and hyper chromaticity
117. Conti..
Grade 3- more nuclear atypia compared
to grade 2 and nuclear crowding is seen
Grade 4 shows marked anaplasia
with giant, multinucleated tumour
cells and atypical mitotic figures
118. HCC - Fibrolamellar type
Occur under the age of 30yrs, occur as single large, hard,
scirrhous tumor.Tumor cells are well differentiated, shows
oncocytic change, separated by parellel lamellae of dense
collagen bundles.
119. Heptatocellular carcinoma
• Immunostaining
1. Hep Par 1 (hepatocyte)
2. Polyclonal CEA
3. Cytokeratin 7/20 pair (−/− staining)
4. GPC-3/GS/HSP70 trio (recent and
confirmative, any 2 +ve indicates HCC)
– Glypican- 3 (GPC-3)
– Glutamine synthetase (GS)
– Heat shock protein 70 (HSP70)
120. Hepatoblastoma
• Most common liver tumor of early childhood
• Occur at the age of 3yr
• 2 variants
– Epithelial – polygonal fetal or embryonal cells
arranged in acini, tubules, papillary
– Mixed epithelial and mesenchymal – admixed
with osteoid, chondroid, striated muscle
121. Hepatoblastoma
Epithelial type - The tumour grows in cords of small
hepatocytes with a ‘light-and-dark’ cells due to the
admixed clear (glycogenated) and eosinophilic liver
cells.( H & E.)
122. cholangiocarcinoma
• Malignancy of the biliary tree, arising from the
bile duct within and outside of the liver
• Risk factors
– Chronic inflammatory conditions
– Primary sclerosing cholangitis
– Hepatolithiasis
– Fibropolycystic disease
123. Conti..
• 2 types
– Intra hepatic
– Extra hepatic (perihilar, klatskin tumor)
• Premalignant lesions – biliary intraepithelial
neoplasias (BilN)
– Low grade BilN 1 and 2
– High grade BilN3
124. cholangiocarcinoma
There are islands of adenocarcinoma in the connective tissue,
well formed glands lined by malignant tumor epithelial cells.
Lymphovascular and perivascular invasions are common
125. Liver allograft rejection
• Acute cellular rejection
– Most common within one month, but can occur
later
– Traid –
– portal inflammation,
– bile-duct damage &
– endothelitis
• Chronic rejection
– Occur after 6 months of transplantation
126. Host vs graft reaction
Acute rejection- Heterogeneous portal
inflammation consisting of lymphocytes, plasma
cells and scattered neutrophils infiltrates the bile
duct (between arrows) and the portal vein
branch at top. (Needle biopsy, H&E.)
Endotheliitis in acute rejection.
An efferent vein shows lymphocytic
infiltration of its wall. The
endothelium is focally lifted off the
underlying vein wall and partially
destroyed. (Needle biopsy, H&E.)
127. Graft vs host reaction
Chronic (ductopenic) rejection.
An hepatic artery branch (arrow) is present in the portal
tract but the corresponding interlobular bile duct has
disappeared as a result of rejection. A sparse lymphocytic
infiltrate remains. (Explanted donor liver, H&E.)
128. Vanishing duct syndrome
• Neonatal age
– Biliary atresia
– Alagalie syndrome
• Adult age
– PBC
– PSC
– Overlap syndrome
– Drug induced
– Chronic graft vs host rejection
– Idiopathic
129. Summary
• Acute severe liver injury and in advanced
stages of fibrosis/cirrhosis – etiological
diagnosis usually not possible
• Drug induced liver injury can present with any
form of liver injury. Hence we cannot exclude
if clinically suspected.
• Fibrosis with normal liver architecture –
suspect congenital hepatic fibrosis
130. Summary
• Excess iron in liver is not always
hemochromatosis. Infact most common cause
is alcoholic cirrhosis
• Clinically suspected cirrhosis but no fibrosis on
biopsy than look for NRH, and hepatic venous
outflow obstruction
• Poorly differentiated HCC and
cholangiocarcinoma difficult to differentiate –
use IHC
131.
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