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Vascular Disorders

Vascular diseases of the liver are less common than other liver diseases, such as hepatitides, cholestatic diseases and alcoholic/nonalcoholic fatty liver diseases, but are gaining increasing recognition because of the improved diagnosis of these other diseases, as well as the secondary involvement of vessels in the course of almost all liver diseases. The dramatic decrease in chronic viral hepatitis C due to effective antiviral regimens in…

Diseases of the Gallbladder

CHAPTER CONTENTS Normal gallbladder 644 Macroanatomy 644 Microanatomy 645 Immunohistochemistry 646 Embryology 646 Physiology 647 Routine specimen processing 647 Congenital anomalies 647 Gallstones 648 Epidemiology 648 Cholesterol gallstones 648 Pigmented gallstones 648 Clinical features and treatment 649 Complications 650 Hydrops and mucocele 650 Cholecystitis 650 Acute cholecystitis 650 Chronic cholecystitis and variants 652 Other inflammatory diseases of the gallbladder 655 Infections 655 Vasculitis 655 Diverticular disease…

Bile Duct Diseases

. This chapter covers the different diseases in which there is injury to the intrahepatic and/or extrahepatic bile ducts ( Box 9.1 ). The disorders are varied; some, although selectively affecting the bile ducts, are discussed in more detail elsewhere in this volume, and appropriate chapter cross-references are given. In this chapter we emphasize the histological features that characterize the early stages of the disease in…

Autoimmune Hepatitis

CHAPTER CONTENTS Definition 527 Epidemiology 527 Demographic features 528 Elderly patients 528 Pathogenesis 528 Genetic predisposition 529 Triggering factors 529 Humoral immune response 529 Cellular immune response 530 Immune regulation and dysregulation 531 Clinical features 532 Asymptomatic presentation 532 Acute and fulminant presentation 532 Diagnosis 532 Serum autoantibodies 533 Scoring systems 533 Classification 535 Histopathology 535 Grading and staging 538 Histopathological features of remission and relapse…

Non-Hepatotropic Viral, Bacterial and Parasitic Infections of the Liver

## Within the past century, pandemic infections, including the 1918 influenza pandemic, human immunodeficiency virus (HIV)-acquired immunodeficiency syndrome (AIDS), H1N1 ‘swine’ influenza, Zika virus and, at the time of writing, SARS-CoV-2, remind us how the ease and frequency of worldwide travel to both remote and urban areas facilitate the potential for infections to arrive in almost any part of the world within their incubation period. ,…

Hepatitis Due to Hepatotropic Viruses

CHAPTER CONTENTS Acute viral hepatitis 402 Clinical features 402 Pathological features 403 Evolution of the lesion 409 Differential diagnosis of acute hepatitis 409 Sequelae of acute hepatitis 411 Chronic viral hepatitis 411 Clinical features 411 Multiple chronic viral infections 412 Pathological features 413 Differential diagnosis of chronic hepatitis 418 Semiquantitative scoring in chronic hepatitis 419 Assessment of concomitant disease processes 424 Premalignant and malignancy-associated changes 424…

Fatty Liver Disease

Spectrum of fatty liver disease Thomas Addison, known for his description of the eponymous disease, was the first to use the term ‘fatty liver’ in the English medical literature in 1836, most likely referring to alcohol-related liver disease (ALD). Three years later, Karl Rokitansky from Vienna observed that fat accumulation in the liver may be aetiologically related to cirrhosis. It was subsequently recognized that ALD comprises…

Disorders of Iron Overload

CHAPTER CONTENTS Iron metabolism and homeostasis 295 Iron absorption and transport 295 Regulation of iron homeostasis 296 Hereditary iron overload 299 Hereditary haemochromatosis 299 Ferroportin disease 306 Hereditary hyperferritinaemia 307 Atransferrinaemia/hypotransferrinaemia 307 Acaeruloplasminaemia 308 Miscellaneous iron overload 308 Neonatal haemochromatosis 308 African iron overload 309 Acquired/secondary iron overload 310 Thalassaemia 310 Sideroblastic anaemias 311 Porphyria cutanea tarda 311 Parenteral iron overload 312 Anaemia of inflammation 313…

Developmental and Inherited Liver Disease

. Developmental and inherited disorders affecting the liver typically present in childhood but may affect individuals of any age. The effect of inherited metabolic disorders on the liver may be considered primary , caused by the accumulation of a metabolite resulting from an enzyme defect (e.g. sphingomyelin in Niemann–Pick [NP] disease), or secondary , when the major changes in the liver are the result of a…

Cellular and Molecular Techniques

CHAPTER CONTENTS Liver biopsy 96 Evolving role 96 Different types 97 Limitations of and requirements forinterpretation 99 Competitors and alternatives to liver biopsy 100 Routine handling, fixation and staining of liver specimens 103 Handling and fixation 103 Staining 104 Immunohistochemistry 106 Principles and main applications 106 Multiplex approach 107 Tissue microarray 107 Molecular techniques 107 In situ molecular techniques 108 Harvesting material for ex situ molecularanalysis…

Structure, Function and Responses to Injury

. The practice of hepatopathology requires a clear understanding of liver anatomy and physiology, as a prelude to understanding the expression of pathological processes in the liver. As an anatomical entity, the liver is deceptively simple. It is large, representing about 2% of the total body mass of an adult human and occupying most of the right upper quadrant of the abdomen. It has a roughly…

Intraoperative Consultation Quality Assurance

Quality assurance of intraoperative consultation (IOC) is typically part of a larger quality assurance (QA) plan for anatomic pathology or surgical pathology (Nakhleh and Fitzgibbons, 2005; Lester, 2006). Even though IOC is an integral part of surgical pathology, in most departments the IOC service operates as a unique subunit. The frozen section room often has a unique and separate physical location, specialized equipment, and possible additional…

Biospecimen Collection During Intraoperative Consultation

Infrastructure for Biospecimen Collection Intraoperative Consultation as A Site for Collection In this chapter we evaluate opportunities for the collection of biospecimens during intraoperative consultation (IOC). Because the majority of consultations occur in the context of cancer surgeries, we will focus here on the collection of biospecimens from patients with cancer and on the benefits and opportunities of these specimens for cancer research. We argue that…

Intraoperative Consultation During Orthopedic Surgery

Tumors of bone and soft tissue invariably require clinical history and radiologic evaluation for definitive diagnosis. Increasingly, core needle biopsy (CNB) is the primary method for obtaining tissue for diagnosis due to advancement of intraprocedural imaging techniques, safety, and cost effectiveness. The major role of intraoperative frozen section is to determine adequacy of tissue for diagnosis in those cases in which core needle biopsy is not…

Frozen Section Diagnosis in Transplantation Pathology

Introduction Frozen section performance in the transplant setting is dominated by evaluation of donor organs to assess suitability for transplantation. Knowledge regarding certain clinical aspects of the donor is valuable, and this will be addressed first. We will then focus on frozen section work flow and analysis in relation to kidney and liver transplantation. Discussion emphasizes these organs because their assessment comprises the overwhelming majority of…

Intraoperative Consultation During Gynecologic Pathology (Vagina, Vulva, Uterine Cervix, and Corpus)

In this chapter we review a practical approach to intraoperative frozen section and highlight the role of the pathologist in guiding intraoperative decision making. For convenience sake, we use the term “frozen section,” but at the onset we wish to point out that the pathologist’s role extends beyond looking at slides to, obviously, careful gross inspection which dictates not only areas to be selected for evaluation…

Frozen Section in Gynecologic Pathology (Ovary, Fallopian Tube, and Peritoneum)

Pelvic lesions are submitted for frozen-section intraoperative determination of the nature of an ovarian, fallopian tube, or peritoneal mass or lesion. Those frozen sections usually have very important implication for management because most are submitted for evaluation with clinical suspicion of malignancy. When malignancy is confirmed, the gynecologic surgeon usually performs a staging procedure, which generally includes omentectomy, pelvic and paraortic lymphadenectomy, and peritoneal biopsies if…

Intraoperative Consultation During Urologic Surgery

Intraoperative and frozen section analyses are relatively uncommon for genitourologic surgery with about 5.4% of all urologist-generated specimens at our institution being submitted for intraoperative consultation (IOC). General indications include: 1) evaluation of resection margins, 2) diagnosis or classification of lesions, and 3) ruling out metastasis in a lymph node or tumor. Diagnostic issues related to the first two topics are specific for each genitourinary (GU)…

Intraoperative Consultation During Breast Surgery

Incorporation of routine intraoperative assessment of axillary sentinel lymph node and breast tissue is feasible at most breast surgery centers and may result in significant clinical benefit to the patient. The use of intraoperative frozen section is reported to reduce the number of operations and therefore the cost of treating patients with breast cancer (Sabel et al, 2012). Sabel et al reported that intraoperative frozen section…

Intraoperative Consultation During Liver Surgery

Introduction Liver frozen sections, like frozen sections in general, are required when the results stand to alter the course of the surgical procedure. Indications for frozen section examination can be divided into four major categories: 1. Evaluation for possible metastatic disease—typically involving the sampling of surface lesions identified during staging procedures or during other abdominal procedures. These may be single or multiple lesions. 2. Liver resection—evaluation…