1. Faculty of allied medical sciences
Histopathology and cytology
(MLHC-201)

2. Liver Pathology Supervision : Prof. Dr. Noha Ragab

3. Outcomes
By the end of this lecture, the student will be able to identify: 1-Steatosis 2-Benign tumours of the liver 3-Malignant tumours of the liver

4. 1. Fatty changes (steatosis)
It is a reversible condition
Grossly :
Liver enlargement, yellow and greasy
Microscopically:
Centrilobular micro-vesicular steatosis (reversible)
Eventual fibrosis around the central vein (irreversible)

5. Fatty changes (steatosis)
This liver is slightly enlarged and has a pale yellow appearance, seen both on the capsule and cut surface.

6. The lipid accumulates in the hepatocytes as vacuoles.
Fatty changes (steatosis)
The lipid accumulates in the hepatocytes as vacuoles.
These vacuoles have a clear appearance with H&E staining.

7. LIVER TUMORS

8. BENIGN LIVER TUMORS

9. Hemangioma Most common primary tumor of the liver
It is a benign vascular tumor
Grossly:
Subcapsular, red spongy mass
It is often asymptomatic and detected incidentally

10. Hemangioma
This is a benign hemangioma of the liver just beneath the capsule.

11. Hepatic adenoma (Liver cell adenoma)
Young women
Related to oral contraceptive use
Sub-capsular adenoma may rupture, causing intra peritoneal hemorrhage
Microscopically:
Resembles normal liver except for lack of portal tracts
It may regress after oral contraceptive is discontinued

12. Hepatic adenoma

13. Hepatic adenoma

14. The hepatic adenoma is composed of cells that closely resemble normal hepatocytes, but the neoplastic liver tissue is disorganized hepatocyte cords and does not contain a normal lobular architecture

15. MALIGNANT LIVER TUMORS

16. Hepatocellular carcinoma (HCC)
Definition:
Hepatocellular Carcinoma (HCC) is a Malignant Tumor that Derives from Hepatocytes or Their Precursors

17. Risk factors include the following:
1-HEPATITIS B:
There is a strong association between HBV infection and HCC.
Most (>80%) cases of HCC associated with HBV infection occur in patients with cirrhosis.
The repeated cycles of liver cell regeneration in chronic hepatitis initiate the emergence of a neoplastic clone.
The worldwide use of a vaccine for HBV should significantly decrease the prevalence of HCC in the future.

18. 2-HEPATITIS C: 3-Haemochromatosis 4-Alcoholic cirrhosis
HCV infection is present in about 50% of cases of HCC.
Most patients infected with HCV who develop HCC have underlying cirrhosis.
3-Haemochromatosis
4-Alcoholic cirrhosis

19. Pathological picture:
Grossly:
HCCs appear grossly as soft, hemorrhagic tan masses in the liver.
In some cases, a large solitary tumor occupies a portion of the liver; in other instances, many smaller tumors are found.

20. The tumor has a tendency to grow into portal veins and may extend into the vena cava and even the right atrium through the hepatic veins.
Metastases occur widely, although the most common sites are the lungs and portal lymph nodes.

21. Hepatocellular carcinoma

22. Microscopic patterns of HCC:
A number of histologic patterns are recognized:
1- Trabecular pattern:
The tumor cells are arranged in trabeculae or plates that resemble the normal liver. The plates are separated by endothelium-lined sinusoids.

23. Trabecular pattern of Hepatocellular Carcinoma

24. 2- Pseudoglandular pattern
(adenoid, acinar)
In this variety, malignant hepatocytes are arranged around a lumen and thus resemble glands. The lumina may contain bile.

25. Pseudoglandular pattern of Hepatocellular Carcinoma

26. 3- Fibrolamellar HCC
The tumor is composed of large, eosinophilic, neoplastic hepatocytes arranged in clusters and surrounded by delicate collagen fibers.
The prognosis is considered more favorable than in most cases of HCC.

27. Fibrolamellar HCC

28. Clinical Features:
HCC usually presents as a painful and enlarging mass in the liver.
HCC may be associated with a variety of paraneoplastic manifestations (e.g., polycythemia, hypoglycemia, hypercalcemia) as a result of ectopic hormone production by the tumor.
Alpha-Fetoprotein levels are often elevated in HCC

29. Metastatic tumors to the liver:
Metastatic Cancer is the Most Common Malignant Tumor of the Liver
Metastatic cancers, including the gastrointestinal tract, breast, and lung. Also pancreatic carcinoma and malignant melanoma.
The first indication of a metastatic tumor is frequently an unexplained increase in the serum alkaline phosphatase level.
Most patients die within a year of the diagnosis of

30. Metastatic tumors to the liver

31. Metastatic tumors to the liver

32. Questions
1- What are the microscopic characters of steatosis ? 2- What are the microscopic characters of hepatic adenoma ? 3- Define Hepatocellular carcinoma. 4- What is the first indication of a metastatic tumour ?

33. سيتم إجراء امتحان العملى يوم الاحد الموافق 29/12/2013 فى مدرج G516 .
Practical Exam
سيتم إجراء امتحان العملى يوم الاحد الموافق 29/12/2013 فى مدرج G516 .
على ان يتم حضور المجموعة الاولى من 10: 30و المجموعة الثانية من .12: 30

34. THANK YOU AND GOOD LUCK