1. Practical 1 Fatty change 28/2/2016

2. Contents Slide: Fatty change- liver Jar: Fatty liver Case 1 discussion

3. How to examine a slide 1.Examine the slide by the naked eye to see the general structure e.g appendix, blood vessel,…etc 2.Examine by the lowest power to see the general structure of the organ + to localize the site of the lesion 3.By the intermediate power, examine the area of the lesion and describe it 4.The highest power is used only if you want to examine special types of cells e.g, plasma cells, esinophils….etc. 5.The higher the power you use, the smaller the area you see under the microscope

4. Slide (1) Fatty change liver There is preserved lobular architecture of the liver. Some hepatocytes show small fat vacuoles inside the cytoplasm with central nuclei (microvesicular steatosis) Some hepatocytes are distended with clear fat vacuoles which push the nucleus to one side (macrovesicular steatosis- signet ring appearance)

5. Remember normal liver

14. How to comment on a given jar Gross description of Pathology Jars NE: any mass 3S 3C Size, Shape, Surface Color, Consistency, C/S Border (or capsule), Number Cavity or Cyst Size, Shape, Surface Wall, Lining, Content

15. Fatty change of liver Specimen: A triangular-shaped slice of liver: Surface: The liver has shreddy peritoneal covering and smooth outer surface. Color: Yellow. Consistency: Soft. Cut section: Shows rounded edges (sharp due to preservative) with yellow surface and greasy to touch.

20. Case study of first session A 55-year-old obese, diabetic patient presents with symptoms of liver disease and is found to have mildly elevated liver enzymes. A liver biopsy examined with a routine hematoxylin and eosin (H&E) stain reveals abnormal clear vacuoles in the cytoplasm of most of the hepatocytes

21. Case I What is your diagnosis of the case? What is the gross and microscopc picture of the case? What is the substance that most likely form these cytoplasmic vacuoles in this case? What is the pathogenesis of this case? How to confirm your diagnosis by special stains? Is this lesion reversible or not?

22. Case I Diagnosis…. Fatty change liver Substance inside hepatocytes… triglycerides Pathogenesis….. Confirm the dagnosis by special stains on frozen section The case is reversible

23. Gross picture… describe

24. Microscopic picture…. describe