Hepatobiliary and pancreas spotters

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Hepatocellular Carcinoma - NOS

  • Abundant vascular channels

  • Cells arranged in trabeculae > Solid > Pseudoglandular.

  • Polygonal cells

  • Moderate abundant cytoplasm (well differentiated)

  • Intracytoplasmic features:

    • Fine vacuoles - Fat / Glycogen

    • Pale bodies

    • Hyaline bodies

    • Bile

  • Round nucleus with nucleoli

HCC - Fibrolamellar

  • Cytological features similar to HCC - NOS

  • Intratumoral lamellar fibres

  • DD - FNH, Cirrhosis


Chronic venous congestion - liver

  • Hepatocytes:

    • Periportal cells show intracytoplasmic vacuoles filled with fat and glycogen.

    • Semitransparent vacuoles - Hydropic degeneration

    • Around the central vein, cells show lipofuscin pigment.

  • Sinusoids filled with blood.

  • Cells are still arranged in cords

Xanthogranulomatous cholecystitis

  • Lamina propria of GB shows Foamy macrophages in sheets.

  • Other features of chronic cholecystitis with acute inflammation.

Extrahepatic Biliary Atresia

  • Bridging fibrosis - Two portal tracts are joined by a band of fibrotic tissue.

  • Portal edema - spaces in portal tract stroma.

  • Ductular reaction - Proliferation of new bile ducts.

  • Hepatocytes at high magnification shows cholestasis (Bile pigment) and giant cell transformation.

Hepatocellular adenoma - HNF1A inactivated

  • Also called H-HCA

  • Unencapsulated nodule composed of hepatocytes in trabeculae and pseudoglands.

  • Cells are indistinguishable from benign liver.

  • Steatosis, clearing may occur.

  • Atypia is seen in b-HCA (beta catenin activated).

  • Ductular reaction and sinusoidal dilatation is seen in IHCA (inflammatory)

Malakoplakia

  • Manifestation of infection by enteric bacteria.

  • Affects liver, gall bladdder and pancreas. (Most common is renal system)

  • Sheets of large histiocytes with granular cytoplasm - Michealis Gutman bodies.

  • Contains iron and calcium granules - PAS positive.

Hydatid cyst

  • Two distinct thick layers

  • Outer one - near normal liver and dense lymphocytic infiltrate - is acellular, laminated collagen layer

  • Inner one is germinal layer with nucleated cells

  • Non viable protoscolices will be seen in lumen

Focal nodular hyperplasia

  • Bands seperate parenchyma into nodules

  • Thick walled vessels

  • Ductular reaction,

Biliary cystadenoma

  • Mucinous epithelium

  • Ovarian type stroma positive for ER/PR

  • Malignant ones show stromal invasion

Intrahepatic cholangiocarcinoma

  • Glandsm tubules, cribriform patters

  • Polygonal cells with ductal differentiation

  • Invasion into liver parenchyma

  • Desmoplastic stroma

Colloid adenocarcinoma - GB

  • >90% is mucinous component.

  • No signet ring cells - otherwise suggests mucinous adenocarcinoma - GB

Hilar cholangiocarcinoma

  • Klatskin tumour

  • Hilum with portion of Common hepatic artery on top and fibrous stroma.

  • Tubules of long columnar cells, loss of polarity, no intact basement membrane.

  • Perineural invasion is a classical finding of Klatskin tumour.

Hepatic Angiomyolipoma

  • Very rare

  • Vessels in smooth muscle and fibrous stroma.

  • Hobnailing of endothelial cells