These presentations are to help you identify basic histopathological features. They donot contain the additional factual information that you need to learn about these

topics, or all the images from resource sessions.Before viewing this presentation you are advised to review relevant histology, relevant

sections in a pathology textbook (acute and chronic viral hepatitis, hepaticsteatosis, non-alcoholic steatohepatitis, alcohol related liver disease, cirrhosis,

haemochromatosis and heart failure), relevant lecture notes, relevant sections of ahistopathology atlas and the histopathology power point presentations on necrosis

and intracellular accumulations and chronic inflammation.Copyright University of Adelaide 2011

Histopathology: liver pathology

Normal liver, low power view. Red star: central veinBlack stars: portal tracts

Normal liver, medium power view. Red star: terminal portal venule in portal tractBlue arrow: terminal branch of hepatic artery in portal tractYellow arrows: bile ductules (note cuboidal epithelium) in portal tractRed arrows: sinusoidsBlack arrows: lipofuscin pigment (yellow-brown) in hepatocytes

Normal liver, high power view.Red arrows: sinusoids (containing rbcs)Black arrows: lipofuscin pigment (yellow-brown) in hepatocytesBlue arrows: nuclei (endothelial or Kupffer cells) in sinusoids

Acute viral hepatitis. Disorganised lobular architecture with infiltrate of predominantly mononuclear inflammatorycells (lymphocytes and macrophages).Red arrow: apoptotic hepatocyte(Image from Robbins Pathologic Basis of Disease, 6th ed. W. B Saunders Co. 1999.)

Ground glass hepatocytes. In chronic hepatitis due to hepatitis B infection, liver cells accumulate HBsAgin the cytoplasm, which appears homogeneous, pale and glassy (arrows). (Image from RobbinsPathologic Basis of Disease, 6th ed. W. B Saunders Co. 1999.)

Chronic viral hepatitis. Yellow star: predominantly lymphocytic infiltrate in portal tract.Red arrows: the lymphocytic infiltrate extends out amongst periportal hepatocytesGreen arrow: bile ductule in portal tract

Chronic viral hepatitis, edge of a portal tract showing interface hepatitis.Predominantly lymphocytic infiltrate in portal tract.Red arrows: the lymphocytic infiltrate extends out amongst periportal hepatocytes.Black arrow: apoptotic periportal hepatocyteYellow arrow: bile ductule in portal tract

Chronic viral hepatitis, lobular inflammation. Focal predominantly lymphocytic infiltrate (red arrows) amongst hepatocytes in lobule.Yellow arrow: apoptotic hepatocyte

Percutaneous core liver biopsy, low power. In this special stain, collagen is stained red. There isincreased fibrous tissue in the portal tracts with fibrous bands extending outwards from portal tracts andcentral veins. However, this is not yet cirrhosis.

Cirrhosis, low power view.Yellow stars: nodules of hepatocytesRed stars: fibrous bands

Genetic/hereditary haemochromatosis. Excessive deposition of hemosiderin (brown pigment) inhepatocytes.

Genetic/hereditary haemochromatosis. Perl’s stain showing excessive iron (blue) in hepatocytes.

Alpha-1-antitrypsin deficiency. Periodic acid-Schiff stain of the liver, highlighting the characteristic red cytoplasmicgranules. PAS and PASD stains are widely used in histopathology, not just in liver biopsies. PAS is useful fordemonstrating glycogen and PASD for outlining basement membranes and highlighting fungal organisms. (Imagefrom Robbins Pathologic Basis of Disease, 6th ed. W. B Saunders Co. 1999.)

Liver - special stains (a) Reticulin method ×150(b) Reticulin method ×600; H hepatocyte plate, Ssinusoidal lining cell, T portal tract V terminalbranch of hepatic vein.(Image from Young et al. Wheater’s FunctionalHistology 5th ed, Elsevier).Reticulin stains demonstrate the fine supportingconnective tissue framework (black) that forms ascaffold for hepatocytes.

Liver congestion, low power. Impaired venous outflow from the liver, usually in congestive or right heart failure,leads to stasis of blood in sinusoids around central veins (yellow arrow). Note how the sinusoids around the portaltracts (red arrows) are not congested. The macroscopic changes of passive venous congestion of the liver arereferred to as nutmeg liver (inset). If there is also severe hypotension, centrilobular hepatocytes i.e. those furthestfrom the hepatic arterial supply entering via portal tracts, may also undergo ischaemic necrosis.

Macrovesicular steatosis, low power view. Many hepatocytes aredistended by large lipid vacuoles.

Steatohepatitis, high power view.Yellow stars: lipid vacuolesRed arrows: neutrophilsBlack arrows: ballooning degeneration of hepatocytes

A: Steatohepatitis, high power view. Black arrow: cluster of inflammatory cells (lymphocytes and deadfragmented neutrophils) surrounding a necrotic hepatocyte.B: Yellow arrows: Mallory’s hyaline. Eosinophilic cytoplasmic inclusions in hepatocytes formed fromintermediate cytoskeletal filaments.(Image from Robbins Pathologic Basis of Disease, 6th ed. W. B Saunders Co. 1999.)