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Ulcerative and inflammatory conditions

Recurrent aphthous ulcers Most cases of recurrent aphthous ulcers are idiopathic and occur in 15% to 25% of the population, usually children, teenagers, and young adults. Trauma and stress, both physical and emotional, bring on episodes in susceptible individuals. However, aphthous-like lesions are seen in many systemic diseases and oral hypersensitivity reactions but unlike idiopathic aphthous ulcers that are episodic for a few decades of the…

Vascular, neural, adipocytic, muscle, and myofibroblastic tumors

Only the most common soft tissue tumors that one encounters with regularity in the oral cavity will be discussed here. The landscape of these tumors has changed tremendously over the last 10 years because of advances in molecular diagnostics and development of surrogate markers for genetic alterations ( Table 6.1 ). Beyond benign and malignant tumors are tumors of intermediate potential as well as benign tumors…

Fibrous and gingival nodules

Fibrous lesions Fibroma (“bite” or “irritation” fibroma, fibroepithelial or fibrovascular polyp), and giant cell fibroma Clinical findings Fibroma: This occurs at any age group without sex predilection and consists of a dome-shaped nodule or papule that may be white/keratotic, mucosa-colored, or ulcerated. It is located in areas readily traumatized by biting (i.e., buccal mucosa, lateral tongue, and lower lip mucosa) or on the gingiva where plaque…

Bacterial, viral, fungal, and other infectious conditions

Besides the common bacterial, fungal, and viral infections of the oral cavity, any infection that occurs in any part of the body may manifest in the mouth, including mycobacterial, treponemal, and protozoal infections, although they are uncommon and rarely occur initially in the mouth. However, in many parts of the world, syphilitic and protozoal infections are on the rise. Polymicrobial bacterial infections in the mouth are…

Noninfectious papillary lesions

Giant cell fibroma This lesion may occur as a smooth-surfaced nodule or have a bossellated, multinodular, or papillary appearance and is discussed in Chapter 5 . Inflammatory papillary hyperplasia of the palatal mucosa Clinical findings This occurs in adults wearing maxillary dentures (usually in the sixth decade upwards) and is occasionally seen in patients with high-arched palates and mouth-breathing habit. Patients may report sensitivity, especially if…

Developmental and congenital conditions

Definitions Choristoma : An overgrowth of tissues that is mature and found in an area where such tissue is not usually present, such as an osseous or cartilaginous choristoma of the tongue. Hamartoma : An overgrowth of tissue that is mature and normally found in that area, such as a leiomyomatous hamartoma. Nevus : An overgrowth of tissue that is normally found in the skin or…

Benign and Malignant Tumors of the Liver

Processing Techniques Specimen analysis should include information important for tumor staging, and mandatory cancer synoptic features should be noted in the gross description. This includes tumor size (size and location of the five largest nodules in cases with multiple tumors, and range of size for others), extent of necrosis of each nodule, local extrahepatic extension, gross vascular invasion of portal/hepatic veins, and distance from resection margin(s).…

Inherited Metabolic and Developmental Disorders of the Pediatric and Adult Liver

Introduction Jaundice, which is observed in almost every newborn, is termed physiological because it clears within a few days, after hepatic activation of bilirubin conjugation. This phenomenon reflects a unique feature of prenatal life: Many functions of the liver that are required after birth for nutrition, metabolic balance, and detoxification and excretion of endogenous chemicals are provided to the developing fetus by the placenta and the…

Liver Pathology in Pregnancy

Acknowledgment We appreciate the contributions of Dr. Jacqueline Wolf to the previous editions of this chapter. Introduction Pregnancy is an altered physiological state designed to support the developing fetus, and gastrointestinal complaints are common during pregnancy. Although de novo abnormalities of the liver occur infrequently, they require prompt diagnosis and treatment to avoid the potentially high rates of maternal and fetal morbidity and mortality associated with…

Pathology of Liver and Hematopoietic Stem Cell Transplantation

Introduction Liver transplantation is used worldwide to treat a broad spectrum of end-stage liver diseases. Nonalcoholic fatty liver disease–induced cirrhosis, alcohol-induced liver disease, and hepatitis C virus (HCV) infection are the leading indications in North America, Europe, and South America. In Asia, hepatitis B virus (HBV)–induced cirrhosis is responsible for most liver transplantation, followed by the previously listed causes. Recurrence of the original disease is common…

Vascular Disorders of the Liver

Acknowledgment We are indebted to Ian R. Wanless, MD, FRCPC, for his extensive work on this chapter in prior editions of this book. Introduction Vascular diseases of the liver are less common than many other conditions, but they have assumed increasing importance in the differential diagnosis of liver disorders: in part because of improved ability to diagnose the more common chronic hepatitic and biliary liver diseases…

Cirrhosis

Introduction Worldwide, cirrhosis leads to more than 1.3 million deaths per year and is the 14th leading cause of death. Cirrhosis results from chronic liver injury and typically takes decades to develop and can be caused by numerous etiologies including metabolic disease, chronic viral hepatitis, autoimmune hepatitis, biliary disease, and fatty liver disease. The term cirrhosis derives from the Greek word κίρρoς, meaning “tawny,” and was…

Fatty Liver Disease

Introduction Definitions Steatosis, defined as the accumulation of triacylglycerides in hepatocytes, is a frequent finding in most liver biopsies. Based on magnetic resonance measures of lipid signal in European normal-weight healthy adult volunteers, the normal liver contains approximately 3% to 5% lipid, with men having slightly more lipid than women. By convention, histologically evident steatosis that occupies more than 5% of hepatocytes is considered pathological. Macrovesicular…

Toxin- and Drug-Induced Disorders of the Liver

Introduction Because the liver is the major site of drug metabolism, it is also the major target of drug-induced injury. Despite rigorous preclinical and clinical toxicological studies and safety analyses in clinical trials, the frequency of drug hepatotoxicity has remained relatively unchanged during the years, and drug-induced liver injury (DILI) is still the main reason for removal of a drug from the market. Furthermore, adverse chemical…

Autoimmune and Chronic Cholestatic Disorders of the Liver

Introduction The three most common liver syndromes with a putative autoimmune cause are autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC). Overlap syndromes involve various combinations of these disorders. Other chronic cholestatic disorders discussed in this chapter include hepatobiliary involvement by immunoglobulin G4 (IgG4)-related disease. Some uncommon noncongenital chronic biliary diseases that can mimic PBC and PSC are reviewed as well as…

Acute and Chronic Infectious Hepatitis

Introduction A wide variety of infectious agents can involve the liver. The most common are the “hepatotropic” viruses—those that preferentially involve the liver—including hepatitis A, B, C, D, and E. Many other viruses, such as cytomegalovirus (CMV) and Epstein-Barr virus (EBV), may produce hepatic injury as part of systemic infection. Although some infectious agents produce characteristic morphological patterns of injury, in many cases, the findings are…

Diagnostic Cytology of the Liver

Introduction As the role of fine-needle aspiration biopsy (FNAB) in the evaluation of focal liver lesions has evolved, it has presented new challenges. , Advances in dynamic imaging modalities have obviated the need for tissue confirmation in clinically classic cases of hepatocellular carcinoma (HCC). Ultrasound surveillance and serum α-fetoprotein (AFP) assessment of high-risk patients have improved the detection of small nodules (≤2 cm in diameter). Accurate…

Molecular Pathogenesis and Diagnostics of Hepatocellular Tumors

Introduction Identification of the molecular pathways altered in benign and malignant hepatocellular tumors has significantly increased our understanding of hepatocellular tumorigenesis. The immunohistochemical markers derived from these molecular alterations have been useful in clinical pathology practice, contributing to accurate diagnosis and classification of these tumors in resection and biopsy specimens. Benign Hepatocellular Tumors Hepatocellular adenoma (HCA) and focal nodular hyperplasia (FNH) are benign hepatocellular tumors. HCA…

Liver Tissue Processing and Normal Histology

Liver Biopsy Specimens Histopathological examination of liver tissue by needle biopsy remains an integral part of the management of liver diseases, as morphology is of critical importance for synthesizing clinical and laboratory testing findings into cogent understanding of a patient’s liver disease. Liver biopsies were documented in the late 19th century, when Ehrlich and then Lucatello performed liver puncture through a laparoscope, primarily for chemical studies.…

Algorithmic Approach to Diagnosis of Medical Liver Disorders

Introduction The goal of this chapter is to provide a structured and efficacious approach to evaluation of nontargeted liver biopsy specimens (i.e., “medical” liver biopsies). The process begins with recognizing the predominant pattern of injury and then, by careful correlation with clinical and laboratory findings, identifying a disease process and/or providing a reliable prioritized differential diagnosis. There is considerable overlap in morphological patterns of injury among…