A Ansari Deptt Of Pathology JNMCAMU Fatty liver Gross Description Fatty liver is caused by the excessive deposition of fats especially triglycerides in the cells of the liver The liver appears enlarged and paleyellowish in ID: 917209
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Slide1
Liver
Fatty liver
Dr.
Hena
A.
Ansari
Deptt
. Of Pathology
JNMC,AMU
Slide2Fatty liver
Gross Description
Fatty liver is caused by the excessive deposition of fats, especially triglycerides, in the cells of the liver.
The liver appears enlarged and pale/yellowish in
colour
Weight is increased
Soft and greasy to touch due to excess fat deposition
Slide3Causes
Obesity
Diabetes and metabolic syndrome
Polycystic
ovary
disease
Alcohol intake
Non alcoholic
steatohepatitis
Hypothyroidism
Total
parenteral
nutrition
Kwashiorkar
Certain medications like antidepressants, steroids,
diltiazem
Methotrexate
,
Griseofulvin
and
tamoxifen
Acute fatty liver in pregnancy
Lipid disorders.
Slide4Microscopic examination
Histological architecture of liver is maintained
In early lesions, fat droplets(
microvesicles
)are seen within cytoplasm of
hepatocytes
as clear spaces (
microvesicular
steatosis
)
As disease progresses, the vesicles coalesce to form a larger
macrovesicle
which compresses the nucleus to the periphery and filling the cytoplasm as large empty space (
macrovesicular
steatosis
)
The cells may rupture and extracellular fatty cysts may be created in severe cases.
Slide5Special stains to identify fat – these are applied on frozen sections and include
osmic
acid, Oil red O, Sudan Black B.
Differential diagnosis on microscopy– clear spaces can be due to water retention or glycogen.
Glycogen—P.A.S
stainpositive
Water - not stainable.
Slide6Diagrammatic Representation -10x
Slide7Diagrammatic Representation—40x
Nuleus
Slide8Slide9Slide10Fatty change –scanner view
Fatty area
Normal area of liver
Portal triad
Slide11Fat vacuoles within
hepatocytes
with nuclear compression
Slide12Slide13Black fat droplets using
osmic
acid
Slide14Fatty change using a
trichrome
stain to highlight the connective tissue
Slide15Cirrhosis Liver
Slide16Gross Desciption
Cirrhosis is defined as the degeneration and death of liver cells due to chronic injury, and their replacement by fibrosis, along with loss of normal liver architecture and regeneration of hepatic tissue in the form of
disorganised
nodules
seperated
by fibrous tissue.
It is an end stage phenomenon in many chronic liver diseases.
Slide17Liver may be shrunken,
indurated
, yellow/tan in appearance or may have pale areas due to alcoholic
steatosis
.
Liver biopsies can be fragmented due to fibrosis
Cirrhosis can be of the following morphologic types
a)
micronodula
r
---diffuse involvement with regenerative nodules <3mm in size.
B)
macronodular
– nodules >3mm in size, irregular distribution, usually visible on
gros
examination
The surface of liver appears irregular/nodular and cut surface can show nodular areas on close inspection.
Slide18Microscopic Appearance
Distortion of normal hepatic architecture
Formation of nodular aggregates of
hepatocytes
in an irregular distribution and of varying size (<3mm or >3mm or mixed).
Nodules are surrounded by bands of fibrous tissue of variable thickness.
There are areas of necrosis and loss of
hepatocytes
. Bridging fibrosis can be present .
Inflammation may be evident also.
Slide19Special stains-
Fibrosis can be highlighted by special connective tissue stains like Van-
Gieson
(red areas) or Masson’s
trichrome
.
Complications
– liver failure, portal hypertension and
ascites
, risk of
hepatocellular
carcinoma.
Slide20Diagrammatic representation-low power
Slide21Diagrammatic representation-high power
Slide22Slide23Micronodular
pattern- small nodules <3mm diffusely present over liver surface
Slide24Macronodular
pattern with irregular
nodularity
on liver surface
Slide25Microscopic appearance—scanner view shows nodules of
hepatocytes
seperated
by fibrous bands
Slide26Biopsy showing fibrosis around aggregates of liver cells
fibrosis
inflammation
nodule
Slide27High power showing part of a nodule with inflamed fibrous band at the periphery
nodule
Fibrosis with inflammation
Slide28Trichrome
stain highlights the fibrous bands
Slide29Helpful links
http://www.virtualpathology.leeds.ac.uk/
https://www.webpathology.com/
https://www.pathpedia.com/
Slide30