STATION 10 ANSWERS

1.    Name the organ and describe the morphological features.

The organ shown here is the liver. The prominent features are multiple (nearly) spherical nodules of varying sizes (from 0.5 to 3cm in diameter) scattered throughout the liver parenchyma, compressing the intervening parenchyma. The liver capsule is intact. There are no signs of fatty change or presence of other space-occupying lesion in the liver. The nodules are not bile-stained. This specimen is a cirrhotic liver.

2.    What are the likely histological features?

In cirrhosis, the normal architecture of the liver is diffusely replaced by nodules of regenerated liver cells, separated by bands of collagenous fibrosis. It has three characteristics, namely long-standing destruction of liver cells, associated chronic inflammation that stimulates fibrosis, and regeneration of hepatocytes to cause nodules. Bridging fibrous septa in the form of delicate bands and broad scars replace multiple adjacent lobules.

3.    What are the other sites involved?

a.    Spleen.

b.    Gastro-esophageal junction: varices.

c.    Brain: hepatic encephalopathy.

4.    What are the clinical manifestations?

a.    Portal hypertension: varices, splenomegaly and caput medusae.

b.    Petechiae and ecchymoses: failure to synthesize clotting factors.

c.    Impaired metabolism of endogenous estrogens: testicular atrophy, spider nevi and gynecomastia.

d.    Low serum albumin: ascites and edema.

e.    Conjugated hyperbilirubinaemia due to hepatic failure to secrete bile: jaundice, scratch marks and pruritus.

Copyright � Joseph Ong 2003