1tumor sistem alimentari
TRANSCRIPT
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TUMOR SISTEM TUMOR SISTEM ALIMENTARIALIMENTARI
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Reparative lesion:
EPULIS
Excessive reparative process-Granulomatous epulis-Fibromatous epulis-Giant cell epulis-Haemangioform epulis-Pregnancy epulis
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LEUKOPLAKIA- white patches of keratosis- premalignant lesion- hyperkeratosis, hyperplasia of the squamous epithelium- dysplastic changes
SQUAMOUS CELL CARCINOMA
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Pleomorphic adenoma (parotid)Pleomorphic adenoma (parotid)
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Pleomorphic adenoma (parotid)Pleomorphic adenoma (parotid)
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Pleomorphic adenoma (gross)Pleomorphic adenoma (gross)
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Pleomorphic adenoma Pleomorphic adenoma
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Pleomorphic adenomaPleomorphic adenoma
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Warthin tumorWarthin tumor
Benign tumor mostly occur in parotid gland
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Warthin tumorWarthin tumor
Cystic spaces lined by double-layered eosinophilic epithelium, and all embedded in lymphoid stroma
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OncocytomaOncocytoma
Mostly in parotid gland
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OncocytomaOncocytoma
Large granular appearing, eosinophilic-staining epithelial cells
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Adenoid cystic carcinomaAdenoid cystic carcinoma
Minor salivary gland
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Adenoid cystic carcinomaAdenoid cystic carcinoma
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Adenoid cystic carcinomaAdenoid cystic carcinoma
Most characteristic appearance consists of cribriform pattern with masses of small, dark-staining cells arrayed arround
cystic spaces
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Adenoid cystic carcinomaAdenoid cystic carcinoma
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Mucoepidermoid tumorMucoepidermoid tumor(Palatal gland)(Palatal gland)
Mostly in parotid gland
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Mucoepidermoid tumorMucoepidermoid tumor(Low grade)(Low grade)
Comprised of mucus-producing and epidermoid omponents and cells intermediate between the two
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Mucoepidermoid tumorMucoepidermoid tumor(moderate grade)(moderate grade)
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Mucoepidermoid tumorMucoepidermoid tumor(High grade)(High grade)
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Perforation of the cheek: cancer of the tongue
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III. Diseases of the Esophagus
F.2. BARRET’S ESOPHAGUS
Columnar metaplasia (often of intestinal type with prominent goblet cells) ofesophageal squamous epithelium.Complication of long-standing gastroesophageal reflux, to be a well-known precursor of esophageal adenocarcinoma
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III. Diseases of the EsophagusIII. Diseases of the Esophagus
G.1. Squamous Cell CarcinomaG.1. Squamous Cell Carcinoma
Arises most frequently in the upper and middle thirds of the esophagus
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III. Diseases of the EsophagusIII. Diseases of the Esophagus
G2. AdenocarcinomaG2. Adenocarcinoma
Arises most frequently in the lower third, and mostly from aberrant gastric mucosa or Barret’s esophagus
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STOMACH
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ATROPHICGASTRITIS
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H.pylori
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Helicobacter pylori (gastric mucosa)(silver stain) x 300
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H. PYLORY AND CHRONIC GASTRITIS
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Intestinal metaplasia: stomach(alkaline phosphatase) x 50
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OTHER GASTRITISOTHER GASTRITIS
Eosinophyillic gastritis:Eosinophyillic gastritis: food allergy ? food allergy ? Granulomatus gastritis:Granulomatus gastritis: tuberculosis, tuberculosis,
syphilis, sarcoidosis, fungi, Crohn syphilis, sarcoidosis, fungi, Crohn diseasedisease
Reflux gastritis:Reflux gastritis: duodenal and bile duodenal and bile refluxreflux
Menetrier disease (giant hypertrophic Menetrier disease (giant hypertrophic gastritis)gastritis)
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Menetrier diseaseMenetrier disease (HYPERTROPHIC GASTROPATHY)(HYPERTROPHIC GASTROPATHY)
Severe hyperplasia of mucosal layer Severe hyperplasia of mucosal layer cells + glandular atrophy cells + glandular atrophy extreme extreme enlargement of gastric rugaeenlargement of gastric rugae
Hypertrophic gastropathy + hyper-Hypertrophic gastropathy + hyper-secretion: mucosal cells, parietal and secretion: mucosal cells, parietal and chief cells hyperplasia.chief cells hyperplasia.
Gastrinoma Gastrinoma excessive gastrin excessive gastrin excretion excretion gastric glandular gastric glandular hyperplasia (Zollinger-Ellison hyperplasia (Zollinger-Ellison syndrome)syndrome)
Sometimes with severe loss of plasma Sometimes with severe loss of plasma proteins from the altered mucosaproteins from the altered mucosa
Risk of peptic ulcerRisk of peptic ulcer
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TRIGER FACTORS OF PEPTIC ULCER
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PEPTIC ULCER
Cylindric epithelia
Necrotic debris
Granulation tissue with lymphocytic infiltration
Glands hyperplasia
Edema
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POLYPPOLYP- - Polypoid massPolypoid mass– >90% non neoplasm (inflammatory/ >90% non neoplasm (inflammatory/
hyperplasia)hyperplasia)– Sessile / pedunculatedSessile / pedunculated– 20-25% multiple20-25% multiple– Mostly occur in chronic gastritisMostly occur in chronic gastritis– No malignant potentialNo malignant potential
ADENOMAADENOMA– neoplasm neoplasm 5-10% of gastric polyp 5-10% of gastric polyp– Sessile / pedunculatedSessile / pedunculated– distal – antrum predominant distal – antrum predominant – Six decade, Male: female = 2:1Six decade, Male: female = 2:1– Some cases origin from chronic gastritis with Some cases origin from chronic gastritis with
intestinal metaplasiaintestinal metaplasia
I. Diseases of the stomach
D. Tumors of the stomach (benign)
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I. Diseases of the stomachI. Diseases of the stomach
D. Tumors of the stomach (malignant)D. Tumors of the stomach (malignant)
90-95% of gastric malignancy90-95% of gastric malignancy High incidence: japan, Chili, Costa Rica, China High incidence: japan, Chili, Costa Rica, China Location: Location: - 40-50% pylorus/anthrum; 25% cardia- 40-50% pylorus/anthrum; 25% cardia
- 40% minor curvature; 12% c. major40% minor curvature; 12% c. major- Etiology:Etiology:
- DietDiet- Chronic atrophic gastritisChronic atrophic gastritis- H. pylori H. pylori infectioninfection- partial gastrectomypartial gastrectomy- Gastric Adenoma Gastric Adenoma - Genetic : A blood group, family factorGenetic : A blood group, family factor
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GASTRIC CANCERGASTRIC CANCER– InvasionInvasion
Early ( mucosa and sub- mucosa)Early ( mucosa and sub- mucosa)Advanced (invade the sub- mucosa)Advanced (invade the sub- mucosa)
– Macroscopic growthMacroscopic growthExophyticExophyticflat/ depressedflat/ depressedExcavationExcavation
Linitis plastica –Linitis plastica – tumor cells diffusely infiltrate tumor cells diffusely infiltrate gastric wall gastric wall leather bottle appearance leather bottle appearance
– HistologyHistology intestinal gland typeintestinal gland typeDiffuse: Diffuse: signet-ring cellsignet-ring cell
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The differences between a The differences between a benign and a malignant ulcerbenign and a malignant ulcer
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Benign or malignant? Benign or malignant?
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Answer :Answer :
Benign. Benign. Clear, sharp, punched out borders. Clear, sharp, punched out borders.
No neoplastic mass present. Benign No neoplastic mass present. Benign peptic ulcer.peptic ulcer.
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Benign or malignant? Benign or malignant?
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Malignant. Malignant. Large ulcer. The margins are Large ulcer. The margins are
irregular and you can see the mass irregular and you can see the mass under the ulcer. under the ulcer.
Answer :Answer :
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The Growth of Gastric CancerThe Growth of Gastric Cancer
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Sessile adenoma
Dysplasia: characterized by a flat lesion
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Other gastric tumorsOther gastric tumors
MALIGNANT LYMPHOMAMALIGNANT LYMPHOMA– 40% malignant lymphoma of GIT40% malignant lymphoma of GIT– 5% of gastric malignancy5% of gastric malignancy– B cell type predominant, MALT originB cell type predominant, MALT origin
CARCINOID TUMORCARCINOID TUMOR Carcinoid syndromeCarcinoid syndrome– Low grade malignancyLow grade malignancy– Metastasis to the liverMetastasis to the liver– Multiple lesionsMultiple lesions
LEIOMYOMALEIOMYOMA SECONDARY TUMORS (METASTASIS)SECONDARY TUMORS (METASTASIS)
– rarerare– Mostly from leukemia or general Mostly from leukemia or general
lymphoma lymphoma – From breast / lung cancer From breast / lung cancer diffuse diffuse
linitis plasticalinitis plastica
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Early Gastric CarcinomaEarly Gastric Carcinoma
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Early Gastric CarcinomaEarly Gastric Carcinoma
Scanning power view of histologic section
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Early Gastric CarcinomaEarly Gastric Carcinoma
Scanning power view of histologic section
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Gastric Gastric CarcinomaCarcinoma
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Gastric Gastric CarcinomaCarcinoma
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Gastric Gastric CarcinomaCarcinoma
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Gastric Gastric CarcinomaCarcinoma
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Gastric Gastric CarcinomaCarcinoma
Signet ring cells
Signet ring cells (PAS +)
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Gastric Carcinoid TumorGastric Carcinoid Tumor
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Gastric Carcinoid TumorGastric Carcinoid Tumor
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Gastric Carcinoid TumorGastric Carcinoid Tumor
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Gastric Carcinoid TumorGastric Carcinoid Tumor
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Gastric Carcinoid TumorGastric Carcinoid Tumor
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Gastric Carcinoid TumorGastric Carcinoid Tumor
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Gastro-Duodenal junctionGastro-Duodenal junction
Circular muscle
Longitudinal muscle
Stomach: Glandular arrangement
Pyloric sphincter
Duodenum: villous arrangement
Brunner’s gland
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Duodenum Duodenum
Mucosa
Villi
Submucosa
Muscularis mucosae
Circular layer
Longitudinal layer Brunner’s gland
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DuodenumDuodenum
Glands
Submucous
Muscularis mucosa
Lamina propria
Villi
Crypt of Lieberkuhn
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DuodenumDuodenum(PAS staining) (PAS staining)
Goblet cells
Brunner’s gland
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DuodenumDuodenum
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Small IntestineSmall Intestine
Mucosa
Villi
Muscularis mucosae
Circular muscle layer
Longitudinal muscle
Peyer’s patches
Plicae circulares
Vascular submucosa
Serosa
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Small IntestineSmall IntestineVilli
Lamina propria
Crypt of Lieberkuhn
Muscularis mucosae
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Ileocecal JunctionIleocecal Junction
Lymphoid tissue
Small intestine Muscularis propria Large intestine
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II. Diseases of the Small IntestineII. Diseases of the Small Intestine
A. Peptic UlcerA. Peptic Ulcer
B. Crohn DiseaseB. Crohn Disease
C. Meckel DiverticulumC. Meckel Diverticulum
D. Malabsorption syndromeD. Malabsorption syndrome
E. E. Tumors of the Small IntestineTumors of the Small Intestine
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Colon Colon
Lymphoid aggregates
Circular layer
Longitudinal layer
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ColonColon
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ColonColon
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ColonColon
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Recto-anal JunctionRecto-anal Junction
The junction
Squamous epithelia
Rectal mucosa
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Adenomatous polypAdenomatous polyp
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Colon adenomaColon adenoma
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What kind of polyp is this? What kind of polyp is this?
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The answer :The answer :
tubulovillous adenomatubulovillous adenoma
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This is a gross morphologic term and does This is a gross morphologic term and does not describe the histopathologic features of not describe the histopathologic features of the lesion.the lesion.
It could be It could be adenomatousadenomatous or a simple type of or a simple type of polyp. polyp.
A correct diagnosis of a polyp can only be A correct diagnosis of a polyp can only be given after a histologic examination.given after a histologic examination.
What kind of polyp is this? What kind of polyp is this?
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Ulcerative ColitisUlcerative Colitis
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Familial Adenomatous PolyposisFamilial Adenomatous Polyposis
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Polyposis of the colon
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ULCUS CARCINOMATOSAULCUS CARCINOMATOSA
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Ulcerating carcinoma of the colon
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Adenocarcinoma of the colon
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Colon CarcinomaColon Carcinoma
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Adenocarcinoma of the colon(PAS) x 100
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Mucinous carcinoma of the colon
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Signet-ring cell carcinoma of the colon(HE) x 100
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Adenocarcinoma, NOS
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CEA: carcinoma of the colon(IH) x 50
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Peritoneal carcinosis: metastatic rectal carcinoma
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Dukes’ StageDukes’ Stage
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ASTLER - ASTLER - COLLERCOLLER
Five-year survival rateFive-year survival rateA – tumor terbatas di mukosa A – tumor terbatas di mukosa 100%100% B1 – sampai dengan muskularis propria, B1 – sampai dengan muskularis propria, belum sampai ke limfonodibelum sampai ke limfonodi 67%67%B2 – menembus muskularis propria, B2 – menembus muskularis propria, belum sampai ke limfonodi belum sampai ke limfonodi 54%54%C1 – sampai dengan muskularis propria,C1 – sampai dengan muskularis propria, sudah sampai limfonodi sudah sampai limfonodi 43%43%C2 – menembus muskularis propria,C2 – menembus muskularis propria, sudah sampai limfonodi sudah sampai limfonodi 22%22%D – metastasis jauh D – metastasis jauh sangat rendah sangat rendah
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SINDROM CARCINOID DIARRHOEA FLUSHING --------- > CYANOSIS HYPOTENSION DYSPNEU EDEMA / ASCITES STENOSIS OF TRICUSPID OF PULMONARY VALVES
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Carcinoid of the appendix(HE) x 75
(IH; chromogranin) x 75
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Practical Work:
Hepatobiliary & Pancreas
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Normal liverNormal hepatic lobe (EvG)
Normal hepatocytes
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Diagram of the liver lobule
(Vena centralis)
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Simple hepatic acinus
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Acinar agglomerate
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Hepatic Lobule
Collagenous tissue
Central vein Portal tract
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Hepatic Lobule
Central veinPortal tract
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Hepatic Lobule
Central vein
Portal tract
Collagenous tissue
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Portal Tract
Hepatic artery
Lymphatics
Hepatocytes (anatomosing plates)
Hepatic portal vein
Bile ductules
Hepatic sinusoid
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Liver parenchyme
Glycogen granulesBinucleate cells
Sinusoid lining cells
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Sinusoid lining cells
Kupffer cells
Endothelial cells
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Bile canaliculi
Canals of Hering
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Bile canaliculi
Binucleate cells
Walls of the canaliculi
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Fetal Liver
Erythroid
Myeloid precursorsMegakaryocytes
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Chronic Hepatitis
Piecemeal necrosis, irregular interface between parenchyma and connective tissue
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Chronic Hepatitis
The outlines of the enlarged and inflamed portal tract are blurred by iecemeal necrosis
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Chronic Hepatitis
Spikes of inflammation extent from portal connective tissue into the parenchyma
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Chronic Hepatitis
Reticulin staining: fibrosis is more clearly seen
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Chronic Hepatitis
Bridging necrosis
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Chronic Hepatitis (C)
Lymphoid tissue with germinal center
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Cirrhosis Hepatis
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Cirrhosis Hepatis
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liver cirrhosis
Micronodular Macronodular
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Cirrhosis Hepatis
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Cirrhosis Hepatis
Hepatocellular regenration
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Cirrhosis Hepatis
Recently formed bridging necrosis
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Cirrhosis Hepatis
Micronodular pattern
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Liver cirrhosis
active septum passive septum
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Cirrhosis Hepatis
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Steatosis
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Microcystic Steatosis
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Periportal Steatosis
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Hepatocellular Carcinoma
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Hepatocellular Carcinoma
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Hepatocellular Carcinoma
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Hepatocellular Carcinoma
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Hepatocellular carcinoma
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Hepatocellular Carcinoma
Bile productionLeft: moderately diff. (abundant); right: poorly diff.(hardto find)
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Hepatocellular Carcinoma
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Hepatocellular Carcinoma
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Cholangiocarcinoma
The large tumor has an irregular, infiltrative margin. The central white area is calcified. No cirrhosis in non-neoplastic liver.
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Intrahepatic Cholangiocarcinoma
The yellow foci of necrosis in the large mass
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Intrahepatic Cholangiocarcinoma
Moderately diff. glandular lumina are present (left), but not well-formed; on the right there are glandular lumna as well
as solid areas.
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Intrahepatic Cholangiocarcinoma
Vascular spread is shown in sinusoid (left), and in portal vein branches (right)
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Intrahepatic Cholangiocarcinoma
Hepatocyte antigen positive in normal liver cell (left), while the
tumor on the right is negative
Cytokeratin 7, cytoplasmic staining
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Gall Bladder
Muscular layer
Collagenous adventitial coat (serosa)Submucosa
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Gall Bladder
Spiral valve of Heister: the wall of cystic duct which is formed into a twisted mucosa-covered fold.
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Pancreas Intralobular duct Septa
Islet of LangerhansFat cells
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Pancreas
Glandular acini
Supporting tissue
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Pancreas
Intercalated ducts
Centroacinar cells
Interlobular ducts
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Pancreas Ectopic