Cirrhosis: Difference between revisions

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Cirrhosis of the [[liver]]:
Cirrhosis of the [[liver]]:
==Gross processing==
==Gross processing==
In [[autopsy]], make consecutive liver slices, such as in the sagittal or coronal plane.
In [[autopsy]], make consecutive liver slices, such as in the sagittal or coronal plane.
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*'''Diagnosing''' cirrhosis. The diagnosis of cirrhosis by biopsy requires the presence of fibrosis and nodules.
*'''Diagnosing''' cirrhosis. The diagnosis of cirrhosis by biopsy requires the presence of fibrosis and nodules.
*Assessing the degree of '''inflammation''' (grade) and '''fibrosis''' (stage) of the disease.  
*Assessing the degree of '''inflammation''' (grade) and '''fibrosis''' (stage) of the disease.  
 
*Finding the most probable differential diagnoses that '''cause''' the cirrhosis (or correlating with a previously established diagnosis).
:Correlate by information in the referral/requisition form, and preferably look in medical records as well.
<gallery mode=packed heights=180>
<gallery mode=packed heights=180>
File:Histopathology of mild zone 3 steatosis without fibrosis (van Gieson).jpg|'''No fibrosis''', but mild zone 3 steatosis, in which collagen fibres (pink–red, arrow) are confined to portal tracts (P) (van Gieson's stain)<ref name="BoydCain2020">{{cite journal|last1=Boyd|first1=Alexander|last2=Cain|first2=Owen|last3=Chauhan|first3=Abhishek|last4=Webb|first4=Gwilym James|title=Medical liver biopsy: background, indications, procedure and histopathology|journal=Frontline Gastroenterology|volume=11|issue=1|year=2020|pages=40–47|issn=2041-4137|doi=10.1136/flgastro-2018-101139}}<br>-"This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license"</ref>
File:Histopathology of mild zone 3 steatosis without fibrosis (van Gieson).jpg|'''No fibrosis''', but mild zone 3 steatosis, in which collagen fibres (pink–red, arrow) are confined to portal tracts (P) (van Gieson's stain)<ref name="BoydCain2020">{{cite journal|last1=Boyd|first1=Alexander|last2=Cain|first2=Owen|last3=Chauhan|first3=Abhishek|last4=Webb|first4=Gwilym James|title=Medical liver biopsy: background, indications, procedure and histopathology|journal=Frontline Gastroenterology|volume=11|issue=1|year=2020|pages=40–47|issn=2041-4137|doi=10.1136/flgastro-2018-101139}}<br>-"This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license"</ref>
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File:Cirrhosis of the liver (trichrome stain) (5690946257).jpg|[[Trichrome stain]], showing cirrhosis as a nodular texture surrounded by fibrosis (wherein collagen is stained blue).
File:Cirrhosis of the liver (trichrome stain) (5690946257).jpg|[[Trichrome stain]], showing cirrhosis as a nodular texture surrounded by fibrosis (wherein collagen is stained blue).
</gallery>
</gallery>
==Example report==
<gallery mode=packed>
File:Histopathology of chronic alcoholic cirrhosis.jpg|H&E stain
File:Trichrome stain of chronic alcoholic cirrhosis.jpg|Trichrome stain
File:Prussian blue stain of chronic alcoholic cirrhosis without iron overload.jpg|Iron (Prussian blue) stain
</gallery>
*'''Histologic features consistent with liver cirrhosis.'''
*'''See comment.'''
;Comment
Sections show core needle biopsy of liver parenchyma with distortion of the normal lobular architecture. There is prominent periportal fibrosis and bridging fibrosis with secondary formation of small regenerative nodules as highlighted by trichrome stain. The portal triads demonstrate chronic inflammatory cell infiltration mainly composed of lymphocytes.  Spillage of lymphocytes beyond the limiting plate is also noted, focally.  Iron stain demonstrates no increased iron deposits within hepatocytes. There is no histologic evidence of neoplastic disease. The histologic changes in this biopsy are consistent with the established micronodular liver cirrhosis,, consistent with clinically known alcoholic liver cirrhosis.  Clinical correlation is advised.
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Latest revision as of 17:52, 5 April 2023

Author: Mikael Häggström [note 1]
Cirrhosis of the liver:

Gross processing

In autopsy, make consecutive liver slices, such as in the sagittal or coronal plane.

Gross examination

Cirrhosis is characterized by pale areas. Categorize into either of the following: (1) micronodular, (2) macronodular, or (3) mixed:[1]

File:Gross pathology of alcoholic liver cirrhosis.jpg
Micronodular cirrhosis, with diffuse areas of pallor.
  • Micronodular or diffuse cirrhosis (uniform nodules less than 3 mm in diameter).[notes 1]
  • Macronodular cirrhosis (irregular nodules with a variation greater than 3 mm in diameter).
  • Mixed cirrhosis (when features of both micronodular and macronodular cirrhosis are present): Usually micronodular cirrhosis progresses into macronodular cirrhosis over time.

Microscopic evaluation

Components:[1]

  • Diagnosing cirrhosis. The diagnosis of cirrhosis by biopsy requires the presence of fibrosis and nodules.
  • Assessing the degree of inflammation (grade) and fibrosis (stage) of the disease.
  • Finding the most probable differential diagnoses that cause the cirrhosis (or correlating with a previously established diagnosis).
Correlate by information in the referral/requisition form, and preferably look in medical records as well.

Example report

  • Histologic features consistent with liver cirrhosis.
  • See comment.
Comment

Sections show core needle biopsy of liver parenchyma with distortion of the normal lobular architecture. There is prominent periportal fibrosis and bridging fibrosis with secondary formation of small regenerative nodules as highlighted by trichrome stain. The portal triads demonstrate chronic inflammatory cell infiltration mainly composed of lymphocytes. Spillage of lymphocytes beyond the limiting plate is also noted, focally. Iron stain demonstrates no increased iron deposits within hepatocytes. There is no histologic evidence of neoplastic disease. The histologic changes in this biopsy are consistent with the established micronodular liver cirrhosis,, consistent with clinically known alcoholic liver cirrhosis. Clinical correlation is advised.

Notes

  1. ↑ Micronodular or diffuse cirrhosis can be due to alcohol, hemochromatosis, hepatic venous outflow obstruction, chronic biliary obstruction, jejunoileal bypass, and Indian childhood cirrhosis.
  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. ↑ 1.0 1.1 Bashar Sharma; Savio John.. Hepatic Cirrhosis. StatPearls at the National Center for Biotechnology Information. Last Update: June 3, 2019.
  2. ↑ 2.0 2.1 2.2 2.3 Boyd, Alexander; Cain, Owen; Chauhan, Abhishek; Webb, Gwilym James (2020). "Medical liver biopsy: background, indications, procedure and histopathology ". Frontline Gastroenterology 11 (1): 40–47. doi:10.1136/flgastro-2018-101139. ISSN 2041-4137. 
    -"This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license"

Image sources


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