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Chapter 11: Pathology of the Liver, Gallbladder, and Extrahepatic Biliary Tract

A 64-year-old man presents with abdominal distention. A CT scan of the abdomen shows a cirrhotic-appearing liver that contains a 4 cm dominant mass. A CT-guided transabdominal core biopsy of the mass is obtained and is diagnosed as moderately differentiated HCC. Which of the following microscopic findings would be most supportive of this diagnosis?

A. The presence of “dirty necrosis”

B. Reticulin stain showing thickened hepatic plates

C. The presence of bile canalicular plugs

D. The presence of a central fibrous scar

E. Mild variation in nuclear size and shape

Answer: B

Explanation: Thickened hepatic plates are a characteristic feature of HCC. Central fibrous scars are typically associated with focal nodular hyperplasia. “Dirty necrosis” is classically associated with colorectal adenocarcinoma. Mild variation in nuclear size and shape is nonspecific and can be seen in benign liver tissue. Bile plugs within canaliculi can be seen in HCC, but can also be seen in a variety of benign conditions.

A 35-year-old woman with a history of “breathing problems” presents with signs and symptoms of new onset liver dysfunction. A liver biopsy is performed. Which abnormality is most likely to be present in this biopsy?

A. Increased iron accumulation within hepatocytes

B. Numerous copper deposits highlighted by rhodanine stain

C. Mallory-Denk bodies within ballooned hepatocytes

D. Globular PAS-positive cytoplasmic inclusions

E. Prominent lipofuscin pigment within centrilobular hepatocytes

Answer: D

Explanation: The combination of lung and liver disease is most characteristic of α 1-antitrypsin deficiency. Globular PAS-positive cytoplasmic inclusions represent the accumulation of misfolded α 1-antitrypsin within hepatocytes. Mallory-Denk bodies and hepatocellular ballooning degeneration can be seen in steatohepatitis. Increased iron accumulation is seen in hemochromatosis, whereas increased copper accumulation is seen in Wilson disease. Lipofuscin is a “wear and tear” pigment that is seen in normal livers, particularly in older persons.

Which of the following findings is most likely to be seen in cholangiocarcinoma?

A. Tumor growth along intrahepatic bile ducts

B. Endothelium-lined spaces supported by a fibrous stroma

C. Cirrhosis within the background liver tissue

D. Abnormal thick-walled arteries

E. Bile production by tumor cells

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