Hepatobiliary and pancreas spotters
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Hepatocellular Carcinoma - NOS
Abundant vascular channels
Cells arranged in trabeculae > Solid > Pseudoglandular.
Moderate abundant cytoplasm (well differentiated)
Fine vacuoles - Fat / Glycogen
Round nucleus with nucleoli
HCC - Fibrolamellar
Cytological features similar to HCC - NOS
Intratumoral lamellar fibres
DD - FNH, Cirrhosis
Chronic venous congestion - liver
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
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)
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.
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
Ovarian type stroma positive for ER/PR
Malignant ones show stromal invasion
Glandsm tubules, cribriform patters
Polygonal cells with ductal differentiation
Invasion into liver parenchyma
Colloid adenocarcinoma - GB
>90% is mucinous component.
No signet ring cells - otherwise suggests mucinous adenocarcinoma - GB
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.
Vessels in smooth muscle and fibrous stroma.
Hobnailing of endothelial cells