A

gure l8.4 (A) Massive necrosis, cut section of liver. The liver is small
VO08), bile-stained, soft, and congested. (B) Hepatocellular necrosis
y acetaminophen overdose. Confluent necrosis is seen in the
PETvenular region (zone 3) (large arrow). Residual normal tissue is
Cated by an asterisk. (Courtesy Dr. Matthew Yeh, University of
Washington, Seattle, Wash.)
 16 I7 18 19
3 4 6 7 8 910 12 13 4 16

from chronic viral hepaticis. Note the

Figure 18.5 Cirrhosis resulting
nodules
depressed areas of dense scar separating bulging regenerative
over the liver surface
R1 Mar-a d ra
Figure 18.20 Alcoholic cirrhosis. (A) The characteristic diffuse
of the surface is induced by the underlying fibrous nodularity
nodule size is 3 in this
scarring.
The average
mm close-up view,
typical of the
cirrhosis of alcoholic liver disease. I he greenish tint is "micronodular"
cholestasis. (B) Microscopically, this cirrhosis is marked caused by
entrapped in blue-staining Tibrous uissue, tatty by small nodules
seen in this "burned-out" accumulation is no
stage (Masson trichrome stain), longer
 2 34 5 6 7 8 9 10 12 13 14 15 16 7 8 19

igure 18.30 Biliary cirrhosis. Sagittal section through the liver

monct
demons (A)
Saining of ne nodularity (most prominent at the right) and bile
staining of end-stage
nodules of iver
todules of Stage biliary cirrhosis. (B) Unlike other forms of cirrhosis,
kejgsawEr cells in biliary cirrhosis are often not round but irregular,
ke
jigsaw puzzle
shapes.
Figure 18.32 Hepatolithiasis.A resected, atrophic right hepatic lobe with
characteristic findings including markedly dilated and distorted bile ducts
containing large pigment stones and broad areas of collapsed liver
parenchyma. (Courtesy Dr. Wilson M.S. Tsui, Caritas Medical Centre, Hong
Kong.)
On,
are
ma-
tal
nes
ns.
ith
0).
ed

th
h

S
e

Figure 18.38 Congenital hepatic fibrosis with multiple biliary cysts.

 4 5 7B 9
2 3

Figure 18.41 Liver infarct. A thrombus is lodged in a

peripheral branch
of the hepatic artery (arrow) and compresses the adjacent portal vein; the
distal necrotic infarcted tissue has pale margins and multifocal areas of
hemorrhage.
 epati
of tne
Figure 18.43 Budd-Chiari syndrome. Thrombosis
veins has caused
hemorrhagic liver necrosis.
 B

Figure 18.45 Acute passive congestion ("nutmeg liver"). (A) The cut
surface of the liver has a variegated mottled red appearance,
congestion and hemorrhage in the centrilobular regions of the
representing
parenchyma. (B) On microscopic examination, the centrilobular
region is
suffused with red blood cells, and
seen. Portal tracts and the
atrophied hepatocytes are not easily
periportal parenchyma are intact.
 s s o n

Figure 18.46 Eclampsia. oma dissecting under

capsule in a fatal case. Subcapsular hematoma disseu Office o

fice ofthe

Medical Examiner, San (Courtesy Dr. Brian Blackbournc

Diego, Calif.)
A4 5 6 8 9 10 II 12 13 14

Figure 18.47 Focal nodular hyperplasia. (A) Resected

lobulated contours and central stellate scar.
a specimen showing
(B)
showing a broad fibrous scar with thick-walled Low-power micrograph
reaction, but no interlobular bile arteries and ductular
ducts.
Figure 18.49 Hepato
wel-define
l-define tanpatocellular
tan mas adenoma. (A) Resected specimen showing
of
a

epatocytes, with i
e liver.(B) Microscopic view showing thin co
arterial vascular
an arterial supply (arrow) and no portal tracts.
vascu
 autopsY
e18.52 Hepatocellular carcinoma. (A) Liver removed
at
lobe.
Unfocalneoplasm replacing most of the right hepatic
grant hepatocytes growing in distorted versions of normal
titecture,including
garge pseudoacinar spaces (malformed, dilated
bDile

l) and thickened
tocyte trabeculae.
Figure 18.54 (A) Hepatitis C-related cirrhosis with a distinctively large
nodule (arrows). Nodule-in-nodule growth suggests an evolving cancer. (B)
Histologically, the region with in the box in A shows a well-differentiated
hepatocellular carcinoma (HCC) (right side) and a subnodule of
moderately differentiated HCC within ic (center; left). (Courtesy Dr
Masamichi Kojiro, Kurume University, Kurume, Japan.)
 A

ving a
Figure 18.55 Fibrolamellar carcinoma. (A) Resected specimen
cords o
well-demarcated nodule. (B) Microscopic view showing nests
ai of
aignant-appearing, oncocytic hepatocytes separated by dense bu
collagen.
A Cm

44

in a
Multifocal cholangiocarcinoma
Cholangiocarcinoma. (A)
Figure 18.56 the liver fluke Clonorchis
sinensis.
with infestation by
liver from patient
a
stroma. (C) Perineural
glands in a reactive, sclerotic
(B) Invasive malignant wreathlike pattern around the
invasion by malignant glands, forming
a

Dr.Wilson M.S. Tsui, Caritas Medical

central, trapped nerve. (A, Courtes)y
Centre, Hong Kong.)
 the fundus is folded inward.
Figure 18.57 Phrygian cap of the gallbladder;
 18.58 Cholesterol gallstones. The wall of the gallbladder is
Figure
chronic cholecystitis.
thickened and fibrotic due to
Figure 8.60
Pigment
Present in this otherwisegallstones. Several faceted black Baga nt are

unremarkable gallbladder from

mechanical mitral valve prosthesis, a
with
hemolysis. Paar
leading to chronic intravas
e
S,
S
S
T

CENTIMETERS

Figure 18.62 Gallbladder adenocarcinoma. (A) The opened gallbladder

contains a large, exophytic tumor that virtually fills the lumen. (B)
Malignant glands are seen infiltrating a densely fibrotic gallbladder wall.