Superpage - Images
Liver & intrahepatic bile ducts

Authors: Awab Abdalhai, M.B.B.S., Monica Abdelmalak, M.D., Maryam Aghighi, M.D., Diana Agostini-Vulaj, D.O., Nazire Ece Albayrak, M.D., Andrew Alexander, M.D., Manju Ambelil, M.D., Komal Arora, M.D., Naziheh Assarzadegan, M.D., Aurélie Beaufrère, M.D., Tamar C. Brandler, M.D., M.S., Chrystalle Katte Carreon, M.D., Lokman Cevik, M.D., Anthony W.H. Chan, M.B.Ch.B., Irene Y. Chen, M.D., Wei Chen, M.D., Ph.D., Shefali Chopra, M.D., Yevgen Chornenkyy, M.D., M.Sc., Maria Augusta Cipriano, M.D., Elaina Daniels, M.D., Simona De Michele, M.D., Paul DiDomenico, M.D., M.B.A., M.S., Mohamed El Hag, M.D., M.S., Reima El Naili, M.D., Daffolyn Rachael Fels Elliott, M.D., Ph.D., Kimberley J. Evason, M.D., Ph.D., Ladan Fazlollahi, M.D., M.P.H., Ryan M. Gill, M.D., Ph.D., Raul S. Gonzalez, M.D., Surbhi Goyal, M.D., Rondell P. Graham, M.B.B.S., Nathalie Guedj, M.D., Ph.D., Joshua A. Hanson, M.D., David Hernandez Gonzalo, M.D., Aaron R. Huber, D.O., Komal Ijaz, M.D., Yoshihiro Ikura, M.D. , Vladyslav Ilchenko, M.D., Shilpa Jain, M.D., Deepali Jain, M.D., Upasana Joneja, M.D., Shahbaz Khan, M.D., Nigar Anjuman Khurram, M.D., Stephen M. Lagana, M.D., Belinda Lategan, M.D., Nicole Leonard, M.D., Tom Liang, M.D., Xiaoyan Liao, M.D., Ph.D., Lawrence Hsu Lin, M.D., Ph.D., Bella Lingjia Liu, M.D., Zaid Mahdi, M.D., Ph.D., Patrick Maher, M.D., Rifat Mannan, M.B.B.S., M.D., Lidiane Vieira Marins, M.D., Ph.D., Michael McCarthy, M.D. , Hunter Monroe, B.S., ILKe Nalbantoglu, M.D., Arun R. Napit, M.B.B.S., Antonio Galvao Neto, M.D., Rui Caetano Oliveira, M.D., Ph.D., Mehmet Ozcan, M.D., Kalyani R. Patel, M.D., Krutika S. Patel, M.B.B.S., M.D., Avani Pendse, M.D., Ph.D. , Nat Pernick, M.D., Maryam Kherad Pezhouh, M.D., M.Sc., Juan Putra, M.D., Ryan Rebbe, M.D., Maitreyi Rohit, M.B.B.S., M.S., Olivia A. Sagan, M.D., Puja Sakhuja, M.D., Emine Turkmen Samdanci, M.D., Rashmi Samdani, M.D., Ruhani Sardana, M.B.B.S., Romil Saxena, M.B.B.S., Wai Szeto, M.D., M.S., Patricia Tsang, M.D., M.B.A., Caroline I.M. Underwood, M.D., Jennifer Vazzano, D.O., M.S., Josef G. Venable, M.D., Lynette Viruet-Guzmán, M.D., M.P.H., Monika Vyas, M.D., Stephen C. Ward, M.D., Ph.D., Annika L. Windon, M.D., Rong Xia, M.D., Ph.D., Feng Yin, M.D., Ph.D., Lizhi Zhang, M.D., Xuchen Zhang, M.D., Ph.D.
Deputy Editors-in-Chief: Jennifer A. Bennett, M.D., Raul S. Gonzalez, M.D., Catherine E. Hagen, M.D., Aaron R. Huber, D.O., Debra L. Zynger, M.D.
Editor-in-Chiefs: Raul S. Gonzalez, M.D., Debra L. Zynger, M.D.

Copyright: 2004-2024, PathologyOutlines.com, Inc.

GI related: Jobs, Fellowships, Conferences, Cases, CME, Board Review

Editorial Board oversight: Monika Vyas, M.D. (last reviewed February 2023)
Page views in 2024 to date: 8

Acute antibody mediated rejection including hyperacute rejection
Microscopic (histologic) images

Contributed by Mohamed El Hag, M.D., M.S.
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Dilated portal capillaries

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Capillaritis


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Intimal arteritis

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Diffuse C4d IHC

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Plasma cell rich rejection

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Plasma cell rich rejection


Acute hepatitis-general
Gross images

Contributed by Josef G. Venable, M.D. and Annika L. Windon, M.D.
Severe acute hepatitis Severe acute hepatitis

Severe acute hepatitis

Microscopic (histologic) images

Contributed by Josef G. Venable, M.D. and Annika L. Windon, M.D.
Hepatocyte damage

Hepatocyte damage

Granuloma

Granuloma

Interface activity

Interface activity

Confluent necrosis Confluent necrosis

Confluent necrosis


Bile ductular reaction

Bile ductular reaction

Parenchymal collapse Parenchymal collapse

Parenchymal collapse

Confluent necrosis Confluent necrosis

Confluent necrosis


Acute T cell mediated rejection
Microscopic (histologic) images

Contributed by Andrew Alexander, M.D. and Maryam Kherad Pezhouh, M.D., M.Sc.

Portal inflammation

Portal inflammation with endothelialitis

Central vein endothelialitis

Bile duct injury


Bile duct injury

Activated lymphocytes


Adenovirus hepatitis
Radiology images

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Liver hypodense areas

Liver hypodense areas

Gross images

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Areas of coagulative necrosis

Areas of coagulative necrosis

Microscopic (histologic) images

Contributed by Vladyslav Ilchenko, M.D. and Case #354
Coagulative necrosis

Coagulative necrosis

Adenovirus immunohistochemistry

Adenovirus IHC

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Large necrotic focus

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Nuclear inclusion bodies


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Nuclear and cytoplasmic viral inclusion bodies

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Adenovirus immunostain


Alagille syndrome
Microscopic (histologic) images

Contributed by Kalyani R. Patel, M.D.
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Liver biopsies


Alcoholic liver disease
Diagrams / tables

Images hosted on other servers:

Natural history of alcohol related liver disease

Gross images

Contributed by Anthony W.H. Chan, M.B.Ch.B. and @Andrew_Fltv on Twitter
Alcoholic cirrhosis Alcoholic cirrhosis

Alcoholic cirrhosis

Alcoholic liver disease

Alcoholic liver disease

Microscopic (histologic) images

Contributed by Anthony W.H. Chan, M.B.Ch.B.
Micronodular cirrhosis Micronodular cirrhosis Micronodular cirrhosis

Micronodular cirrhosis

Micronodular cirrhosis after abstinence

Micronodular cirrhosis after abstinence

Iron deposition

Iron deposition


Alpha-1 antitrypsin deficiency
Gross images

Contributed by Avani Pendse, M.D., Ph.D.

Cirrhotic liver

Microscopic (histologic) images

Contributed by Avani Pendse, M.D., Ph.D.

Nodular cirrhosis

Trichrome

Intracytoplasmic globules

PASD


AAT

Neonatal biopsy changes

Giant cell change


Anatomy
Diagrams / tables

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Embryonic hepatic bud formation

Anterior and posterior views

Blood supply

Intrahepatic biliary tree

Clinical images

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Accessory lobe with pedicle and adherent gallbladder

Microscopic (histologic) images

Contributed by Grigory Demyashkin, M.D.

Liver

Small intestine; esophagus; stomach; pancreas; liver

Liver, islets of hematopoiesis

Final kidney; liver; gonad and kidney primary; symphysis

Videos

Development of foregut related to the peritoneum


Angiomyolipoma
Radiology images

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Low echoic mass in segment 6 (arrow)

Hyperdense lesion

Hypervascular lesion

Clinical images

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Soft, dark red tumor

Soft, dark red tumor

Gross images

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Right posterior hepatic segmentectomy

Left lateral hepatic segmentectomy

Microscopic (histologic) images

Contributed by Kimberley J. Evason, M.D., Ph.D.

3 components

Pleomorphism and EMH

Epithelioid cells

Interface with normal

Fat, smooth muscle, vessels


HMB45

Arginase

MelanA

S100


Angiosarcoma
Gross images

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Vascular lesion with dense fibrosis

Microscopic (histologic) images

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Sinusoidal infiltration


Arterial disorders
Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.

Granulomatosis with polyangiitis

Hepatic artery dissection

Hyaline arteriolosclerosis


Ascending cholangitis
Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.

Neutrophilic infiltrate


Ascites
Clinical images

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Severe ascites due to cirrhosis

Cytology images

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Ascites fluid cytology

Various images in patients with ascites, all interpreted as negative


Autoimmune cholangitis
Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.

Portal tract inflammation

Bile duct injury

Focal cholestasis

Florid duct lesion


Autoimmune hepatitis
Microscopic (histologic) images

Contributed by Anthony W.H. Chan, M.B.Ch.B.

Rosettes

Perivenular necrosis

Interface hepatitis Interface hepatitis Interface hepatitis

Interface hepatitis


Lobular infiltration

Giant cell

Emperipolesis

Cholestasis

Bile duct injury


Benign recurrent intrahepatic cholestasis
Microscopic (histologic) images

Contributed by Pierre Russo, M.D.
Mild cholestasis

Mild cholestasis

Mild cholestasis (canalicular and intracytoplasmic)

Mild cholestasis (canalicular and intracytoplasmic)


Bile duct adenoma
Gross images

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Well circumscribed
nonencapsulated
subcapsular lesion

Microscopic (histologic) images

Contributed by Komal Ijaz, M.D. and Feng Yin, M.D., Ph.D.
Well circumscribed unencapsulated lesion

Well circumscribed unencapsulated lesion

Subcapsular well circumscribed lesion

Subcapsular well circumscribed lesion

Tubules with fibrous stroma

Tubules with fibrous stroma

Tubules with focal crowding

Tubules with focal crowding


Tubules with bland cytology Tubules with bland cytology

Tubules with bland cytology

Tubules with cytoplastic mucin

Tubules with cytoplastic mucin

Fine needle biopsy Fine needle biopsy

Fine needle biopsy


Biliary adenofibroma
Radiology images

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Multiple cysts

Abdominal CT scan

Multiple cysts

Ultrasound and MRI findings

Multiple cysts

MRI

Multiple cysts

Portal venography

Gross images

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Multiple cysts

Mixed solid cystic mass

Multiple cysts

Tumor and liver parenchyma

Microscopic (histologic) images

Contributed by Reima El Naili, M.D.

Mixed epithelial stromal lesion

Tubuloacinar glands

Bland epithelial cells

Cystically dilated gland

Fibrous stroma

Intraluminal material


Demarcation

CK7

CK20

Vimentin

SMA

Desmin


Budd-Chiari syndrome
Gross images

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Normal (left) versus occluded (right) + hepatic veins

Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.

Thrombus in hepatic vein

Sinusoidal dilation and congestion


Calcifying nested stromal epithelial tumor
Radiology images

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Large liver mass

Gross images

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Well demarcated liver mass

Microscopic (histologic) images

Contributed by Xuchen Zhang, M.D., Ph.D.
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Well demarcated border

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Cell nests and stroma

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Epithelioid nests with osteoid

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Spindle nests with osteoid

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Beta catenin

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WT1


Cardiac (congestive) hepatopathy and Fontan associated liver disease
Gross images

Contributed by Juan Putra, M.D.
Nutmeg liver

Nutmeg liver

Microscopic (histologic) images

Contributed by Juan Putra, M.D., Monika Vyas, M.D. and Wei Chen, M.D., Ph.D.
Sinusoidal dilatation and congestion

Sinusoidal dilatation and congestion

Centrilobular hepatocyte atrophy

Centrilobular hepatocyte atrophy

Hepatocyte dropout and atrophy

Hepatocyte dropout and atrophy

Perisinusoidal fibrosis

Perisinusoidal fibrosis


Perivenular fibrosis

Perivenular fibrosis

Space of Disse congestion

Space of Disse congestion

Alternate zones of compressed and normal hepatic cell plates

Zones of compressed and normal hepatic cell plates


Caroli disease
Gross images

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Dilated bile ducts

Microscopic (histologic) images

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Dilated portal bile ducts (trichrome stain), with inspissated bile, with congenital hepatic fibrosis


Checkpoint inhibitor associated hepatitis
Microscopic (histologic) images

Contributed by Yevgen Chornenkyy, M.D., M.Sc. and Maryam Kherad Pezhouh, M.D., M.Sc.

Nivolumab: lobular inflammation

Nivolumab: portal inflammation


Pembrolizumab: lobular inflammation

Pembrolizumab: portal inflammation


Cholangitis lenta / sepsis
Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.
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Ductular cholestasis in sepsis

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Ductular cholestasis in cirrhosis


Choledochal cyst
Diagrams / tables

Images hosted on other servers:

Choledochal cyst classification

Clinical images

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Intraoperative view of choledochal cyst


Cholestasis
Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.

Bland cholestasis

Cholestatic hepatitis

Ductular cholestasis

Cholate stasis


Chronic antibody mediated rejection
Gross images

Contributed by Mohamed El Hag, M.D., M.S.

Explanted liver allograft

Microscopic (histologic) images

Contributed by Mohamed El Hag, M.D., M.S.

Chronic hepatitis pattern

Portal venopathy

Arterial lesions


Fibrosis

Portal collagenization

C4d


Chronic hepatitis
Radiology images

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Nodular liver in patient with hepatitis B

Gross images

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Cirrhotic liver is diffusely nodular

Microscopic (histologic) images

Contributed by Kimberley J. Evason, M.D., Ph.D.
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Chronic hepatitis C

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Fibrosis in chronic hepatitis C

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Cirrhosis (end stage)

Chronic hepatitis B and AIH

Chronic hepatitis B and AIH


Bridging fibrosis

Bridging fibrosis

Hereditary hemochromatosis

Hereditary hemochromatosis

Alpha-1 antitrypsin deficiency

Alpha-1 antitrypsin deficiency

Periportal fibrosis in A1AT

Periportal fibrosis in A1AT


Chronic hepatitis-grading / staging
Diagrams / tables

Images hosted on other servers:
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METAVIR staging

Microscopic (histologic) images

Contributed by Kimberley J. Evason, M.D., Ph.D.
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Mild periportal activity

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Lobular activity

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Mild lobular activity


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Stage 1, Batts-Ludwig methodology

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Stage 2, Batts-Ludwig methodology

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Stage 3, Batts-Ludwig methodology

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Stage 4, Batts-Ludwig methodology


Chronic viral hepatitis
Radiology images

Images hosted on other servers:
MRI of cirrhotic liver

MRI of cirrhotic liver

Gross images

Images hosted on other servers:
Micronodular cirrhosis

Micronodular cirrhosis

Microscopic (histologic) images

Contributed by Wai Szeto, M.D., M.S.
Chronic HBV portal inflammation

Chronic HBV portal inflammation

HBV ground glass hepatocytes

HBV ground glass hepatocytes

Chronic hepatitis C

Chronic hepatitis C

HCV portal lymphoid aggregate

HCV portal lymphoid aggregate


Chronic HCV and HCC

Chronic HCV and HCC

Fibrosis in HCV

Fibrosis in HCV

HBsAg

HBsAg

HBcAg

HBcAg

Videos

Viral hepatitis

Chronic hepatitis histopathology


Cirrhosis
Radiology images

Images hosted on other servers:

Cirrhosis

Gross images

Contributed by Anthony W.H. Chan, M.B.Ch.B.
Cirrhotic liver Cirrhotic liver

Cirrhotic liver



Images hosted on other servers:
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Micronodular and
macronodular
cirrhosis

Microscopic (histologic) images

Contributed by Anthony W.H. Chan, M.B.Ch.B.
Biliary type cirrhosis

Biliary type cirrhosis

Cirrhosis, hepatitis B virus (HBV)

Cirrhosis, hepatitis B virus (HBV)

Cirrhosis HBV, Sirius red

Cirrhosis HBV, Sirius red

Cirrhosis HBV HBsAg

Cirrhosis HBV, HBsAg


Combined hepatocellular carcinoma-cholangiocarcinoma
Radiology images

Contributed by Elia Gigante, M.D.
Imaging features of cHCC-CC Imaging features of cHCC-CC

Example of mixed pattern on contrast enhanced computed tomography

Gross images

Contributed by Nathalie Guedj, M.D., Ph.D.
Well demarcated tumor developed in normal liver

Well demarcated tumor developed in normal liver

Microscopic (histologic) images

Contributed by Aurélie Beaufrère, M.D.
Classical cHCC-CC Classical cHCC-CC Classical cHCC-CC

Classical cHCC-CC

Intermediate cell carcinoma Intermediate cell carcinoma Intermediate cell carcinoma

Intermediate cell carcinoma


Cholangiolocellular carcinoma Cholangiolocellular carcinoma Cholangiolocellular carcinoma

Cholangiolocellular carcinoma


Congenital hepatic fibrosis
Diagrams / tables

Contributed by Xiaoyan Liao, M.D., Ph.D.
Embryogenesis of intrahepatic bile duct

Embryogenesis of intrahepatic bile duct

Radiology images

Contributed by Irene Y. Chen, M.D.
Intrahepatic biliary cysts

Intrahepatic biliary cysts

MR abdomen in a patient with Caroli syndrome MR abdomen in a patient with Caroli syndrome MR abdomen in a patient with Caroli syndrome

MR abdomen in a patient with Caroli syndrome

Microscopic (histologic) images

Contributed by Xiaoyan Liao, M.D., Ph.D.
Abnormal duct profile

Abnormal duct profile

Aberrant bile duct profile

Aberrant bile duct profile

Congenital hepatic fibrosis

Congenital hepatic fibrosis

Fibrosis Fibrosis

Fibrosis


COVID-19
Diagrams / tables

Images hosted on other servers:

Liver injury in COVID-19

Microscopic (histologic) images

Contributed by Stephen M. Lagana, M.D.
Macrovesicular steatosis

Macrovesicular steatosis

Lobular necroinflammation

Lobular necroinflammation

Apoptotic hepatocytes

Apoptotic hepatocytes

Portal inflammation with interface hepatitis

Portal inflammation with interface hepatitis

Mild portal inflammation

Mild portal inflammation


Phlebosclerosis

Phlebosclerosis

Portal arteriolar hyalinosis

Portal arteriolar hyalinosis

Lobular mitoses

Lobular mitoses

Large megakaryocytes

Large megakaryocytes

Sinusoidal microthrombi

Sinusoidal microthrombi

Electron microscopy images

Images hosted on other servers:

Electron microscopy
evidence of SARS-CoV-2
infection in liver cells

Videos

Liver histopathological findings in COVID-19 autopsies

Clinical insights: COVID-19 and the liver


Cytomegalovirus hepatitis
Radiology images

Images hosted on other servers:

Decreased parenchymal attenuation and slight dilatation

Ultrasonography of acute viral hepatitis

Microscopic (histologic) images

Contributed by Emma Elizabeth Furth, M.D. and L. Walden Browne, M.D., Ph.D.
CMV inclusions CMV inclusions CMV inclusions

Cytomegalovirus inclusions

Cytomegalovirus IHC

Videos

Histopathology liver - congenital cytomegalovirus disease


Donor liver frozen section evaluation
Diagrams / tables

Contributed by Kimberley J. Evason, M.D., Ph.D.
Large droplet fat determination

Large droplet fat determination

Small droplet fat determination

Small droplet fat determination

Microscopic (histologic) images

Drug / toxin induced hepatitis (DILI)-general
Microscopic (histologic) images

Contributed by Anthony W.H. Chan, M.B.Ch.B. and @RaulSGonzalezMD on Twitter
Hathothane associated hepatocellular necrosis

Hathothane associated hepatocellular necrosis

Methotrexate associated steatohepatitis

Methotrexate associated steatohepatitis

Herb associated acute cholestatic hepatitis

Herb associated acute cholestatic hepatitis

Drug / toxin induced hepatitis Drug / toxin induced hepatitis

Drug / toxin induced hepatitis


Drug / toxin induced hepatitis-acetaminophen
Microscopic (histologic) images

Contributed by Anthony W.H. Chan, M.B.Ch.B.
Acetaminophen associated hepatocellular necrosis

Acetaminophen associated hepatocellular necrosis


Ductular reaction
Diagrams / tables

Images hosted on other servers:

Ductular reaction at the interface

Microscopic (histologic) images

Contributed by Shahbaz Khan, M.D.

Familial intrahepatic cholestasis

Staining with CK19

Biliary atresia

Prolonged TPN

Videos

Ductular reaction in liver disease


Echinococcal cyst
Radiology images

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Breast: well defined opacity

Breast: axial and longitudinal sections

Clinical images

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Breast cyst

Gross images

Contributed by Ladan Fazlollahi, M.D., M.P.H.
Gross section of hydatid cyst

Gross section of hydatid cyst



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Hydatid cyst with fluid and daughter cysts

Breast: excised cyst

Breast: excised cyst with endocysts

Microscopic (histologic) images

Contributed by Ladan Fazlollahi, M.D., M.P.H. and Bobbi Pritt, M.D.
Hydatid cyst wall Hydatid cyst wall

Hydatid cyst wall

Hydatid cyst Hydatid cyst

Hydatid cyst

Hydatid cyst

Hydatid cyst

Numerous free hooklets


Classic protoscoleces with an armed rostellum

Videos

Bird's eye view of Echinococcus


Entamoeba histolytica abscess
Diagrams / tables

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Diagram of life cycle

Radiology images

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CT scan

Microscopic (histologic) images

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Trophozoites

Cysts


Epithelioid hemangioendothelioma
Radiology images

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CT, multifocal EHE

CT, multifocal EHE

CT, peripheral enhancement

CT, peripheral enhancement

Gross images

Images hosted on other servers:
Multifocal EHE

Multifocal EHE

Unifocal EHE

Unifocal EHE

Microscopic (histologic) images

Contributed by Shefali Chopra, M.D. and @JMGardnerMD on Twitter
Myxohyaline stroma Myxohyaline stroma

Myxohyaline stroma

Increased cellularity at tumor edge

Increased cellularity at tumor edge

Cells in small nests and cords

Cells in small nests and cords

Intracytoplasmic vacuoles

Intracytoplasmic vacuoles

Poorly vasoformative cells

Poorly vasoformative cells


Epithelioid hemangioendothelioma Epithelioid hemangioendothelioma Epithelioid hemangioendothelioma Epithelioid hemangioendothelioma

Epithelioid hemangioendothelioma


CD31

CD31

ERG

ERG

CAMTA1

CAMTA1

Cytology images

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FNA smears (Pap & cell block) FNA smears (Pap & cell block) FNA smears (Pap & cell block)

FNA smears (Pap & cell block)

Electron microscopy images

Images hosted on other servers:
Endothelial cells, solid nests

Endothelial cells, solid nests

Luminal differentiation

Luminal differentiation

Desmosomes

Desmosomes

Weibel-Palade bodies

Weibel-Palade bodies

Intracytoplasmic vacuoles

Intracytoplasmic vacuoles

Molecular / cytogenetics images

Images hosted on other servers:
Identification of <i>WWTR1</i>-<i>CAMTA1</i> genes by FISH

Identification of WWTR1-CAMTA1 fusion by FISH

<i>YAP1</i>-<i>TFE3</i> fusion

YAP1-TFE3 fusion

Protein domains of <i>YAP1</i>, <i>TFE3</i>

Protein domains of YAP1, TFE3

Videos

Laparoscopic segment 6 liver resection for hepatic EHE

Overview of vascular tumors of the skin (by Dr. Jerad Gardner)


Epstein-Barr virus hepatitis
Microscopic (histologic) images

Images hosted on other servers:

Prominent
inflammation
without hepatocyte
necrosis

Hepatocyte
regeneration with
binucleated figures
and mitotic activity


Erythropoietic protoporphyria
Diagrams / tables

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Heme biosynthetic pathway

Gross images

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Explanted liver


Extrahepatic biliary atresia
Gross images

Contributed by Qian Wang, M.D., Ph.D.

Nodular liver



Images hosted on other servers:

Rock hard, dark green liver

Microscopic (histologic) images

Contributed by Manju Ambelil, M.D., Jialing Huang, M.D., Ph.D. and Albina Joldoshova, M.D.
Ductular reaction and portal inflammation

Ductular reaction and portal inflammation

Ductular reaction

Ductular reaction

Explanted liver

Explanted liver

Hilar plate

Hilar plate

Prominent hepatic artery

Prominent hepatic artery

Trichrome

Trichrome


Extramedullary hematopoiesis
Microscopic (histologic) images

Contributed by S. Rajendiran, M.D., Nikhil Sangle, M.D. and ARUP Laboratories

50 year old man with vague abdominal pain; CT abdomen showed a 2 cm mass; CT guided biopsy performed

Liver with extramedullary hematopoiesis



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H&E and CD68


Fasciola hepatica
Diagrams / tables

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Life cycle

Radiology images

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CT

PET scan

MRI

Clinical images

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Living fasciola

Endoscopic view

Gross images

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Formalin fixed tissue

Fresh tissue

Microscopic (histologic) images

Contributed by Emine Turkmen Samdanci, M.D. and Mehmet Ozcan, M.D.
Necrotic lesions (low power field) Necrotic lesions

Necrotic lesions

Tract shaped granulomas

Tract shaped granulomas

Charcot-Leyden crystals

Charcot-Leyden crystals

Crystals in necrotic debris

Crystals in necrotic debris

Masson trichrome stain

Masson trichrome stain

Videos

Fascioliasis caused by Fasciola hepatica


Focal fatty change
Radiology images

Images hosted on other servers:
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CT scan

Gross images

Contributed by Nazire Ece Albayrak, M.D. and Julia Braza, M.D., M.S. (Case #141)

Resection specimen

Well circumscribed subcapsular lesion

Microscopic (histologic) images

Contributed by Nazire Ece Albayrak, M.D. and Julia Braza, M.D., M.S. (Case #141)

Areas of diffuse steatosis

Preserved portal tracts

FFC spared hepatic parenchyma interface


Predominantly macrovesicular steatosis

FFC and spared hepatic parenchyma

Mixed (macrovesicular and microvesicular) pattern of steatosis

Cytology images

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Fine needle aspiration biopsy

Fine needle aspiration biopsy


Focal nodular hyperplasia
Radiology images

Images hosted on other servers:
Liver ultrasound

Liver ultrasound

Liver CT Liver CT

Liver CT

Liver MRI Liver MRI

Liver MRI

Liver MRI

Liver MRI

Gross images

Contributed by Aaron R. Huber, D.O.
Epithelial whorls Epithelial whorls

Liver mass



Images hosted on other servers:
Nodular liver lesions

Nodular liver lesions

Lesions with central scars

Lesions with central scars

Microscopic (histologic) images

Contributed by Aaron R. Huber, D.O.
Central scar

Central scar

Bile ductular reaction Bile ductular reaction

Bile ductular reaction

Inflammation

Inflammation


Abnormal vessels

Abnormal vessels

Inflammation

Inflammation

Hepatocellular nodules

Hepatocellular nodules

Map-like staining

Map-like staining

Cytology images

Images hosted on other servers:
Benign hepatocytes in clusters

Benign hepatocytes in clusters


Foregut cyst
Microscopic (histologic) images

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Ciliated foregut cyst


Gaucher disease
Diagrams / tables

Images hosted on other servers:

Glucosylceramide metabolic pathway

Radiology images

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Gaucher lytic lesions

Erlenmeyer flask deformity

Clinical images

Images hosted on other servers:

Perinatal collodion Gaucher (type 2)

Gross images

Images hosted on other servers:

Splenomegaly in Gaucher disease

Microscopic (histologic) images

Contributed by Patricia Tsang, M.D. and Mowafak Hamodat, M.B.Ch.B., M.Sc. (Case #164)
Gaucher in marrow biopsy

Gaucher in marrow biopsy

Fibrillary Gaucher cell cytoplasm

Fibrillary Gaucher cell cytoplasm

Gaucher cells marrow clot

Gaucher cells marrow clot

Liver biopsy

Liver biopsy

PASD positive Gaucher cells

PASD positive Gaucher cells

Marrow aspirate

Marrow aspirate

Electron microscopy images

Images hosted on other servers:

Gaucher cell cytoplasmic fibrils

Videos

Gaucher disease involving bone


Glycogenic hepatopathy
Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D. and Catherine E. Hagen, M.D.
Enlarged glycogen heavy hepatocytes Enlarged glycogen heavy hepatocytes Enlarged glycogen heavy hepatocytes

Enlarged glycogen heavy hepatocytes

Glycogenated hepatocytes

Glycogenated hepatocytes

PAS

PAS

PASD

PASD


Granulomatous hepatitis
Microscopic (histologic) images

Contributed by Anthony W.H. Chan, M.B.Ch.B.

Fibrin ring granuloma

Classical Hodgkin lymphoma

Trifluoperazine induced liver injury

PBC associated portal granuloma PBC associated portal granuloma

PBC associated portal granuloma


Hepatic granuloma in sarcoidosis

Hepatic granuloma in sarcoidosis

Lipogranuloma in NAFLD Lipogranuloma in NAFLD

Lipogranuloma in NAFLD


HCC - clear cell variant
Microscopic (histologic) images

Contributed by Jaime A. Mejía, M.D.

Clear cell hepatocellular carcinoma



Images hosted on other servers:

Various images


HCC - cytology
Radiology images

Contributed by Lawrence Hsu Lin, M.D., Ph.D. and Tamar C. Brandler, M.D., M.S.
Missing Image

Rounded mass (ultrasound)

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Lobulated mass (ultrasound)

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Heterogeneous echotexture (ultrasound)

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Hypodense mass (CT)

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Ill defined area (CT)


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Large hepatic mass (MRI)

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Poorly defined mass (MRI)

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Ultrasound guided biopsy

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CT guided biopsy

Cytology images

Contributed by Lawrence Hsu Lin, M.D., Ph.D. and Tamar C. Brandler, M.D., M.S.
Missing Image Missing Image

High cellularity with bare nuclei

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High cellularity and normal appearing hepatocytes

Missing Image Missing Image

Thickened trabeculae

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Pseudoglandular structures


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Endothelial wrapping

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Transgressing vessel

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Transversing vessel

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Enlarged nuclei and increased N/C ratio

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Enlarged nuclei and prominent nucleoli

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Multinucleated tumor cells


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Bile production

Missing Image

Cell block - well differentiated HCC

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Cell block - poorly differentiated HCC

Missing Image

Cell block - multinucleated tumor cells



Images hosted on other servers:

Well differentiated neoplasm

Moderately differentiated neoplasm

Poorly differentiated neoplasm (marked nuclear pleomorphism)


Trabecular and pseudoacinar patterns

Pseudoacinar pattern

Fatty change


Mallory hyaline

Fibrolamellar variant

Sarcomatoid change

HepPar1, CEA and CD31 IHC

Reticulin stain


HCC - fibrolamellar variant
Microscopic (histologic) images

Contributed by Rondell P. Graham, M.B.B.S. and @RaulSGonzalezMD on Twitter

Fibrolamellar

HCC - fibrolamellar variant HCC - fibrolamellar variant HCC - fibrolamellar variant

HCC - fibrolamellar variant



Case #161

Pale bodies

Trichrome

CK7

HepPar

Ki67



Images hosted on other servers:

Various images

Cytology images

Contributed by Rondell P. Graham, M.B.B.S.

Fibrolamellar



Images hosted on other servers:

Various images


HCC - lymphocyte rich
Radiology images

Images hosted on other servers:

CT scan

Microscopic (histologic) images

Contributed by Ryan M. Gill, M.D., Ph.D.

Lymphocyte rich HCC

Reticulin

Lymphoepithelioma-like HCC

Cytokeratin


HCC - macrotrabecular massive
Microscopic (histologic) images

Contributed by Xuchen Zhang, M.D., Ph.D.
Macrotrabeculae with anaplastic cells

Macrotrabeculae with anaplastic cells

Macrotrabecular pattern Macrotrabecular pattern

Macrotrabecular pattern

Macrotrabeculae with cytologic atypia

Macrotrabeculae with cytologic atypia



Contributed by @liverwei on Twitter
Macrotrabecular massive hepatocellular carcinoma Macrotrabecular massive hepatocellular carcinoma

Macrotrabecular massive hepatocellular carcinoma


Contributed by @RaulSGonzalezMD on Twitter
Macrotrabecular massive hepatocellular carcinoma Macrotrabecular massive hepatocellular carcinoma

Macrotrabecular massive hepatocellular carcinoma


HCC - sarcomatoid variant
Radiology images

Images hosted on other servers:

Multiphase abdominal CT scan

T1 weighted MRI

T2 weighted MRI

Gross images

Images hosted on other servers:

Well defined, pink-yellow mass

Whiteish tumor with hemorrhage and necrosis

Microscopic (histologic) images

Contributed by Ryan M. Gill, M.D., Ph.D.

Variable cellularity

Malignant spindle cells

Mitotic figures

Cytokeratin MNF

HepPar1


Mixed
sarcomatoid
HCC and
cholangiocarcinoma

Sarcomatoid area

Mitotic figures

Arginase


HCC - scirrhous type
Radiology images

Images hosted on other servers:

CT scans

Gross images

Images hosted on other servers:

Firm, whitish tumor

Microscopic (histologic) images

Contributed by Ryan M. Gill, M.D., Ph.D. and Maura F. O’Neil, M.D.

Unencapsulated

Fibrous stroma

Cytologic features


Core biopsy

CK7

Glypican 3

HepPar1


HCC - steatohepatitic
Gross images

Contributed by Stephen C. Ward, M.D., Ph.D.
Yellow cut surface

Yellow cut surface

Microscopic (histologic) images

Contributed by Stephen C. Ward, M.D., Ph.D.
Steatosis

Steatosis in tumor

Ballooning degeneration

Ballooning degeneration

Mallory-Denk bodies

Mallory-Denk bodies

Chronic inflammatory infiltrate

Chronic inflammatory infiltrate

Pericellular fibrosis

Pericellular fibrosis


Masson trichrome

Masson trichrome

Ubiquitin

Ubiquitin

Arginase1

Arginase1

HepPar1

HepPar1

Cytology images

Images hosted on other servers:

Atypical hepatocytes with steatototic vacuoles


HCC - undifferentiated variant
Microscopic (histologic) images

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Scattered multinucleated hyperchromatic cells, necrosis


Hemangioma
Radiology images

Contributed by Lizhi Zhang, M.D.
CT scan: arterial phase

CT scan: arterial phase

CT scan: venous phase

Gross images

Contributed by Lizhi Zhang, M.D.
Cavernous hemangioma

Cavernous hemangioma

Microscopic (histologic) images

Contributed by Lizhi Zhang, M.D.
Cavernous hemangioma Cavernous hemangioma Cavernous hemangioma

Cavernous hemangioma

CD31 immunostain

CD31 immunostain

ERG immunostain

ERG immunostain

Sclerosing hemangioma

Sclerosing hemangioma


Sclerosing hemangioma

Sclerosing hemangioma

Capillary hemangioma

Capillary hemangioma

Anastomosing hemangioma Anastomosing hemangioma

Anastomosing hemangioma

Hepatic small vessel neoplasm Hepatic small vessel neoplasm

Hepatic small vessel neoplasm


Hemochromatosis
Diagrams / tables

Images hosted on other servers:

Hemochromatosis diagnostic algorithm

Iron metabolism

Hepcidin regulation

Scheuer iron scoring system

Radiology images

Images hosted on other servers:

MRI findings in hemochromatosis

Iron quantification by MRI

Clinical images

Images hosted on other servers:

Skin
hyperpigmentation
(bronze diabetes)

Gross images

Images hosted on other servers:

Dark brown discoloration of the liver

Dark brown discoloration of the myocardial muscle

Liver, pancreas, lymph nodes

Microscopic (histologic) images

Contributed by Kimberley J. Evason, M.D., Ph.D.

Liver with hepatocellular iron

Liver, iron stain

Periportal hepatocytes, iron stain


Canalicular pattern, iron stain

Bile duct epithelium iron

Trichrome

Pancreas, iron stain

Molecular / cytogenetics images

Contributed by Pinar Bayrak-Toydemir, Ph.D.

Melting curve: wild type



Images hosted on other servers:

Compound heterozygote sequence analysis


Hepatic failure
Gross images

Contributed by Anthony W.H. Chan, M.B.Ch.B.

Acute hepatic failure



Images hosted on other servers:

Explanted liver with large areas of hemorrhage and necrosis

Microscopic (histologic) images

Contributed by Anthony W.H. Chan, M.B.Ch.B.

Panacinar hemorrhagic necrosis

Prominent ductular reaction

Collapse of reticulin framework



Images hosted on other servers:

Post isoflurane anesthesia

Explanted liver
demonstrating
massive necrosis and
architectural collapse


Hepatic failure
Diagrams / tables
N/A
Radiology images
N/A
Clinical images
N/A
Gross images

Contributed by Anthony W.H. Chan, M.B.Ch.B.
Acute hepatic failure

Acute hepatic failure



HTML NOTE: Keep this image?
Images hosted on other servers:
Explanted liver with large areas of hemorrhage and necrosis

Explanted liver with large areas of hemorrhage and necrosis

Microscopic (histologic) images

Contributed by Anthony W.H. Chan, M.B.Ch.B.
Panacinar hemorrhagic necrosis Panacinar hemorrhagic necrosis

Panacinar hemorrhagic necrosis

Prominent ductular reaction

Prominent ductular reaction

Extensive zone 3 hemorrhagic necrosis

Extensive zone 3 hemorrhagic necrosis

Absence of significant fibrosis

Absence of significant fibrosis

Collapse of reticulin framework

Collapse of reticulin framework

Cytology images
N/A
Electron microscopy images
N/A
Molecular / cytogenetics images
N/A
Videos
N/A

Hepatic infantile hemangioma
Diagrams / tables

Images hosted on other servers:
Clinical presentation

Clinical presentation

Pathophysiology

Pathophysiology

Radiology images

Images hosted on other servers:
Multifocal and diffuse HIH Multifocal and diffuse HIH

Multifocal and diffuse HIH

Clinical images
Not available
Gross images

Contributed by Xuchen Zhang, M.D., Ph.D.
Focal hemorrhagic and fibrotic changes

Focal hemorrhagic and fibrotic changes

Microscopic (histologic) images

Contributed by Xuchen Zhang, M.D., Ph.D. and Deepali Jain, M.D.
Vascular channels Vascular channels

Vascular channels

Periphery of the tumor Periphery of the tumor

Periphery of the tumor

Center of the tumor Center of the tumor

Center of the tumor


Unencapsulated vascular tumor

Unencapsulated vascular tumor

Junction between liver and tumor

Junction between liver and tumor

Small and capillary vascular channels

Small and capillary vascular channels

CD34 IHC stain CD34 IHC stain

CD34 IHC stain

CD34 IHC stain

CD34 IHC stain

Cytology images

Images hosted on other servers:
Tumoral endothelial cells Tumoral endothelial cells

Tumoral endothelial cells

Electron microscopy images
Not applicable
Molecular / cytogenetics images
Not applicable
Videos
Not available

Hepatic small vessel neoplasm
Radiology images

Contributed by Carlo M. Cicala, M.D.

Abdominal CT

Abdominal MRI

Gross images

Contributed by Ryan M. Gill, M.D.

Tan-brown, unencapsulated, mottled tumor

Microscopic (histologic) images

Contributed by Ryan M. Gill, M.D.

Infiltrating small vessels

Extramedullary hematopoiesis (megakaryocyte)

Densely packed infiltrative vessels

Reticulin stain

CD31 IHC stain


ERG IHC stain

CD34 IHC stain

Ki67

Ki67 in hepatic angiosarcoma


Hepatitis (acute and chronic)-general
Radiology images

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Acute viral hepatitis with gallbladder wall thickening

Hepatic cirrhosis with portal hypertension

Gross images

Images hosted on other servers:

Viral hepatitis with necrosis and lobular collapse

Macronodular cirrhosis of liver

Micronodular cirrhosis of liver with fatty change

Microscopic (histologic) images

Contributed by Rifat Mannan, M.B.B.S., M.D., Alexander Boyd, M.B.Ch.B., Owen Cain, M.B.Ch.B.,
Abhishek Chauhan, Ph.D. and Gwilym J. Webb, M.B.Ch.B., M.A.

Lymphoid aggregate: hepatitis C

Acute hepatitis histopathology

Chronic hepatitis B

Interface hepatitis

Nonalcoholic fatty liver disease

Alpha-1 antitrypsin deficiency

Videos

Histopathology of liver in viral hepatitis

Histopathology of liver in chronic hepatitis


Hepatitis A virus (HAV)
Diagrams / tables

Images hosted on other servers:

Drawing of virion

Microscopic (histologic) images

Images hosted on other servers:

Portal and periportal
inflammation with
some ballooning
degeneration

Lobular inflammation

Confluent necrosis (PAS)

Acidophil bodies and hydropic degeneration

With marked cholestasis


Hepatitis B virus (HBV)
Diagrams / tables

Images hosted on other servers:
Worldwide all age prevalence for HBsAg in 2019

Worldwide all age prevalence for HBsAg in 2019

Interpretation of HBV immunologic markers

Interpretation of HBV immunologic markers

Radiology images
Not relevant
Clinical images
Not relevant
Gross images
Not relevant
Microscopic (histologic) images

Contributed by Monika Vyas, M.D.
Liver parenchymal collapse

Liver parenchymal collapse

Reticulin stain

Reticulin stain

Trichrome stain

Trichrome stain

Hepatocyte dropout

Hepatocyte dropout

Acidophil (councilman) body

Acidophil (councilman) body


Liver cirrhosis

Liver cirrhosis

Ground glass HBsAg inclusion

Ground glass HBsAg inclusion

HBsAg immunohistochemical stain

HBsAg IHC stain

Hepatocellular carcinoma

Hepatocellular carcinoma

Cytology images
Not relevant
Electron microscopy images
Not relevant
Molecular / cytogenetics images
Not relevant
Videos
Not relevant

Hepatitis B virus (HBV)
Diagrams / tables

Images hosted on other servers:

Drawing of virion

Gross images

Images hosted on other servers:

Atrophic liver due to fulminant hepatitis

Microscopic (histologic) images

Images hosted on other servers:

Lobular disarray

Acidophil bodies

Submassive necrosis


Ground glass hepatocytes in asymptomatic carrier

Moderate portal inflammation

Portal
inflammation
with minimal
interface hepatitis

Portal fibrosis with minimal inflammation (trichrome)


Severe with marked portal inflammation and piecemeal necrosis

Immunostain for surface antigen

Immunostain for core antigen (in nuclei)


Hepatitis C virus (HCV)
Microscopic (histologic) images

Images hosted on other servers:

Portal lymphocytosis

Bile duct involvement

Portal - portal fibrosis

Immunostain


Hepatoblastoma
Radiology images

Contributed by Rui Caetano Oliveira, M.D. and Maria Augusta Cipriano, M.D.

Hepatic ultrasonography

Hepatic CT

Gross images

Contributed by Rui Caetano Oliveira, M.D. and Maria Augusta Cipriano, M.D.

Gross examination

Microscopic (histologic) images

Contributed by Rui Caetano Oliveira, M.D. and Maria Augusta Cipriano, M.D.

Hepatoblastoma patterns

Small cell undifferentiated pattern

Fetal component

Small nests


Therapy changes

Keratin staining

Polyclonal CEA

CK19 staining

Beta catenin staining


Hepatocellular adenoma
Diagrams / tables

Contributed by Avani Pendse, M.D., Ph.D.

Subtypes

Radiology images

Images hosted on other servers:

HA-H MRI

HA-B MRI

Gross images

Contributed by Avani Pendse, M.D., Ph.D.
HA-I

HA-I



Images hosted on other servers:

HA-H, HA-I, HA-B

Malignant transformation

Microscopic (histologic) images

Contributed by Monica Abdelmalak, M.D., Avani Pendse, M.D., Ph.D. and Raul S. Gonzalez, M.D.
HA-H: well defined border

HA-H: well defined border

HA-H: marked steatosis

HA-H: marked steatosis

HA-H: reticulin

HA-H: reticulin

HA-H: HSP70

HA-H: HSP70

HA-H: CD34

HA-H: CD34

HA-H: glypican 3

HA-H: glypican 3


HA-H: beta catenin

HA-H: beta catenin

HA-H: glutamine synthetase

HA-H: glutamine synthetase

HA-H: SAA

HA-H: SAA

HA-I: sinusoidal dilatation

HA-I: sinusoidal dilatation

HA-I: inflammation

HA-I: inflammation

HA-I: SAA

HA-I: SAA


HA-I: beta catenin

HA-I: beta catenin

HA-I: glutamine synthetase

HA-I: glutamine synthetase

HA-I: glypican 3

HA-I: glypican 3

HA-B: focal pseudoacinar architecture

HA-B: focal pseudoacinar architecture


Hepatocellular carcinoma overview
Diagrams / tables

Images hosted on other servers:

Diagnostic
algorithm of liver
nodule workup in
cirrhotic patients

Barcelona Clinic Liver
Cancer algorithm
for patient
management

Radiology images

Contributed by Irene Y. Chen, M.D.
Abdominal CT Abdominal CT

Abdominal CT

MR abdomen (T1) without contrast

MR abdomen (T1) without contrast

MR abdomen (T1) with contrast

MR abdomen (T1) with contrast

Gross images

Contributed by Irene Y. Chen, M.D.
Right hepatic lobectomy

Right hepatic lobectomy

Hepatectomy for transplant

Hepatectomy for transplant

Partial hepatectomy

Partial hepatectomy for transplant

Microscopic (histologic) images

Contributed by Irene Y. Chen, M.D.
Trabecular pattern Trabecular pattern

Trabecular pattern

Pseudoacinar pattern

Pseudoacinar pattern

Hyaline eosinophilic inclusions

Hyaline eosinophilic inclusions

Arginase-1

Arginase-1
(ARG1)

Hepatocyte Paraffin 1 (HepPar1)

Hepatocyte Paraffin 1 (HepPar1)


Contributed by @liverwei on Twitter
Hepatocellular carcinoma overview

Hepatocellular carcinoma

Cytology images

Images hosted on other servers:

Clusters of malignant cells at low power

Peripheral
endothelial wrapping
and thickened
trabeculae


Hepatoportal sclerosis
Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.
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Portal vein radicles

Missing Image

Portal vein herniation



Images hosted on other servers:
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Portal tract abnormalities 1

Missing Image

Portal tract abnormalities 2


Hereditary hemorrhagic telangiectasia
Radiology images

Images hosted on other servers:
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CT manifestations of Osler-Weber-Rendu syndrome in liver


Missing Image

Biliary type of HHT

Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.
Missing Image

Portal tract in HHT



Images hosted on other servers:
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Vascular abnormalities


Herpes simplex virus hepatitis
Radiology images

Images hosted on other servers:
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No liver abnormalities

Missing Image

Lesions mimicking abscess

Gross images

Images hosted on other servers:
Missing Image

Random lobular geographic necrosis

Missing Image

Soft nodules

Microscopic (histologic) images

Contributed by Yubo "Mike" Wu, D.O.
Missing Image

Low-power necrosis

Missing Image Missing Image

Necrosis

Missing Image Missing Image

Viral cytopathic effect

Missing Image

HSV immunostain


High grade dysplastic nodule
Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.

High grade dysplastic nodule


Contributed by @liverwei on Twitter
High grade dysplastic nodule High grade dysplastic nodule

High grade dysplastic nodule



Images hosted on other servers:

Increased cellularity and unpaired arteries


Histology
Diagrams / tables

Images hosted on other servers:

Lobule and portal triad

Anatomy and functional segments

Gross images

Contributed by Michelle Wilkinson, B.S., P.A. (ASCP)
Red-brown cut surface

Red-brown cut surface

Microscopic (histologic) images

Contributed by Kimberley J. Evason, M.D., Ph.D.
Lobule

Lobule

Trichrome

Trichrome

Portal tract

Portal tract

PASD

PASD

Trichrome large portal tract

Trichrome large portal tract

Hepatocytes and sinusoids

Hepatocytes and sinusoids


Central vein

Central vein

Canaliculi

Canaliculi

Reticulin

Reticulin

Kupffer cells

Kupffer cells

Iron

Iron

Cytology images

Contributed by Kimberley J. Evason, M.D., Ph.D.
Benign hepatocytes, Diff-Quik

Benign hepatocytes, Diff-Quik

Benign hepatocytes, Pap

Benign hepatocytes, Pap

Electron microscopy images

Images hosted on other servers:

Endothelium, tangential cut

Bile canaliculus


Infantile hemangioendothelioma / hemangioma
Microscopic (histologic) images

Case #432

4x

10x

20x

20x

40x


CD34 2x

CD34 20x


Intraductal papillary neoplasm of the bile ducts
Radiology images

Images hosted on other servers:
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Dilated duct

Missing Image

Papillary projections

Gross images

Images hosted on other servers:
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Friable, villiform projections

Microscopic (histologic) images

Contributed by Zachary Dong, M.D.
Missing Image

Friable papillary projections

Missing Image

Papillary lesion

Missing Image

Pancreaticobiliary
type epithelium


Intrahepatic biliary atresia
Microscopic (histologic) images

Images hosted on other servers:

Liver biopsy


Intrahepatic cholangiocarcinoma (small and large duct types)
Diagrams / tables

Images hosted on other servers:

Classifications of
cholangiocarcinoma

Radiology images

Images hosted on other servers:

CT scan

Ultrasound

MRI

Gross images

Images hosted on other servers:

Mass forming
cholangiocarcinoma

Microscopic (histologic) images

Contributed by Wei Chen, M.D., Ph.D., Omid Savari, M.D. and @RaulSGonzalezMD on Twitter

Large duct type iCCA

Small duct type iCCA

Anastomosing glands

Ductal plate malformation pattern

With necrosis


With sclerotic stroma

Irregular nuclear features

Irregular nuclear features

Infiltrating hepatic parenchyma

Poorly differentiated


Intrahepatic cholangiocarcinoma Intrahepatic cholangiocarcinoma Intrahepatic cholangiocarcinoma

Intrahepatic cholangiocarcinoma

Cytology images

Images hosted on other servers:

Cholangiocarcinoma
on FNA


Lafora disease
Microscopic (histologic) images

Case #361

H&E images


PAS+ stain



Images hosted on other servers:
Periportal hepatocytes

Periportal hepatocytes

PASD

PASD


Large duct obstruction
Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.
Missing Image Missing Image Missing Image

Acute large duct obstruction

Missing Image

Chronic large duct obstruction


Large regenerative nodule
Microscopic (histologic) images

Contributed by Naziheh Assarzadegan, M.D.

Small cell change

Large cell change

Large cell change with adjacent cirrhotic nodule



Images hosted on other servers:

Large regenerative
nodule in a patient with
Budd-Chiari syndrome


Late T cell mediated (cellular) rejection
Diagrams / tables

Grading descriptors of late onset T cell mediated rejection presenting as isolated central perivenulitis (Hepatology 2006;44:489)
Description Biopsy findings
Minimal or indeterminate Perivenular inflammation involving a minority of terminal hepatic veins, with patchy perivenular hepatocyte loss but without confluent perivenular necrosis
Mild As above but involving most terminal hepatic veins
Moderate As above, with focal confluent perivenular hepatocyte dropout and mild or moderate inflammation but without bridging necrosis
Severe As above, with confluent perivenular hepatocyte dropout and inflammation involving most hepatic venules and with central to central bridging necrosis


Banff working group proposed scoring of late TCMR for further development (Banff Foundation: Banff Liver Group 2022 [Accessed 3 January 2024])
Subscore Component Contribution Criteria
Alloimmune activity grade Portal inflammation 0 - 3 Existing Banff criteria
Bile duct damage 0 - 3 Existing Banff criteria
More severe lesion:
subendothelial inflammation or central perivenulitis
0 - 4 Banff rejection activity index (RAI) "v" score or Banff 2006 isolated CP score
Interface hepatitis 0 - 4 Proposed criteria
Fibrosis stage Periportal 0 - 3 Venturi: LAFS
Subsinusoidal 0 - 3
Perivenular 0 - 3
Radiology images
N/A
Clinical images
N/A
Gross images
N/A
Microscopic (histologic) images

Contributed by Nigar Anjuman Khurram, M.D.
Mild mixed portal inflammation

Mild mixed portal inflammation

Bile duct damage

Bile duct damage

Prominent central perivenulitis

Prominent central perivenulitis

Prominent foci of central perivenulitis

Prominent foci of central perivenulitis

Portal tract

Portal tract

Cytology images
N/A
Electron microscopy images
N/A
Molecular / cytogenetics images
N/A
Videos
N/A

Liver cell dysplasia
Microscopic (histologic) images

Contributed by Naziheh Assarzadegan, M.D.

Small cell change

Large cell change

Large cell change with adjacent cirrhotic nodule


Low grade dysplastic nodule
Microscopic (histologic) images

Contributed by Naziheh Assarzadegan, M.D.

Mild increase in
cellularity compared
to surrounding
cirrhotic liver



Images hosted on other servers:

Low grade dysplastic nodules


Macroregenerative nodule
Gross images

Images hosted on other servers:
Missing Image

Macroregenerative nodules in explanted liver

Missing Image

Macroregenerative nodule with atypical features

Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.

Macroregenerative nodule



Images hosted on other servers:
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Macroregenerative nodule with thickened hepatic plates

Missing Image

Atypical macroregenerative nodule


Malnutrition (total parenteral nutrition)
Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D. and Anthony W.H. Chan, M.B.Ch.B.
Missing Image

Cholestasis

Missing Image

Macrovesicular steatosis

Missing Image Missing Image

Canalicular cholestasis


Mesenchymal hamartoma
Radiology images

Images hosted on other servers:

CT scans

Gross images

Contributed by Bella Lingjia Liu, M.D.

Cut surface of the tumor



Images hosted on other servers:

Cut surface of the tumor

Microscopic (histologic) images

Contributed by Bella Lingjia Liu, M.D. and Ankur R. Sangoi, M.D. (Case #61)
Solid area

Solid area

Entrapped benign hepatocytes

Entrapped benign hepatocytes

Bile ducts

Bile ducts

Cystic area Cystic area

Cystic area


Branching bile ducts

Branching bile ducts

Disorganized hepatic architecture Disorganized hepatic architecture

Disorganized hepatic architecture

Dilated and branching bile ducts

Dilated and branching bile ducts

Hepatocytes in myxoid stroma

Hepatocytes in myxoid stroma


Bland bile duct structures

Bland bile duct structures

CK7

CK7

Vimentin

Vimentin

Cytology images

Images hosted on other servers:
Cytology

Hepatic mesenchymal hamartoma


Metastases
Gross images

Images hosted on other servers:

Multiple metastases

Colonic adenocarcinoma metastases

Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D. and Semir Vranic, M.D., Ph.D.

Ocular melanoma metastatic to liver: 70 year old woman with liver mass

Melanoma metastatic to liver: uveal melanoma



Contributed by @liverwei on Twitter
Metastases Metastases Metastases Metastases

Metastases


Metastases Metastases Metastases Metastases

Metastases



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Metastatic breast carcinoma to liver

Gastric hepatoid adenocarcinoma metastatic to liver


Methotrexate
Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.

Macrovesicular steatosis

Liver fibrosis


Mucinous cystic neoplasm
Radiology images

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CT with cystic mass

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CT with large lesion

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Cholangiogram

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Ultrasound

Gross images

Contributed by Justin Smith, M.H.S., PA (ASCP)

Multiloculated cyst



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Right hepatectomy specimen

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Cystic lesion

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Thin walled cystic mass

Microscopic (histologic) images

Contributed by Kimberley J. Evason, M.D., Ph.D.
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Cystic lesion

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Ovarian stroma

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Columnar epithelium

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ER / PR

Cytology images

Contributed by Kimberley J. Evason, M.D., Ph.D.
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Pap stain of cyst fluid

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Diff-Quik stain of cyst fluid

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Cell block


Navajo hepatopathy
Diagrams / tables

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Proteins involved in mtDNA replication

Microscopic (histologic) images

Contributed by Joshua A. Hanson, M.D.
Steatohepatitis

Steatohepatitis

Macrovesicular steatosis

Macrovesicular steatosis

Megamitochondria

Megamitochondria

Mixed steatosis and megamitochondria

Mixed steatosis and megamitochondria

Juxtaposed cirrhotic nodules

Juxtaposed cirrhotic nodules

Canalicular cholestasis

Canalicular cholestasis


Cirrhosis

Cirrhosis

Copper stain

Copper stain


Neonatal hepatitis
Microscopic (histologic) images

Contributed by Anthony W.H. Chan, M.B.Ch.B.

Neonatal hepatitis


Niemann-Pick disease
Microscopic (histologic) images

AFIP images

Foamy, vacuolated appearance


Nodular regenerative hyperplasia
Diagrams / tables

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Liver adaptive reactions overview

Liver adaptive reactions overview

Proposed diagnostic criteria

Proposed diagnostic criteria

Radiology images

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Atoll lesion on ultrasound

Atoll lesion on ultrasound

CT scan demonstrating NRH

CT scan demonstrating NRH

Gross images

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Postmortem liver

Postmortem liver

Microscopic (histologic) images

Contributed by David Hernandez Gonzalo, M.D.
Nodules without fibrous septa Nodules without fibrous septa Nodules without fibrous septa

Nodules without fibrous septa

Reversed lobulation

Reversed lobulation


Reticulin stain Reticulin stain

Reticulin stain

Trichrome stain

Absence of fibrosis


Nonalcoholic fatty liver disease / nonalcoholic steatohepatitis (NASH)
Diagrams / tables

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Diagnostic algorithm

Radiology images

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Bright liver

Hypodensity on CT

Increased signal on T1 weighted MRI

MRI based fat content evaluation

Gross images

Contributed by Yoshihiro Ikura, M.D.

NAFLD liver

Microscopic (histologic) images

Contributed by Yoshihiro Ikura, M.D.

Zone 3 steatosis

Lobular inflammation

Hepatocellular ballooning and Mallory-Denk bodies

Mallory-Denk bodies (ubiquitin)

Hepatocellular ballooning (CK18)


Perivenular fibrosis (trichrome)

Glycogenated nuclei

Giant mitochondria

Lipogranuloma

NAFLD associated cirrhosis (trichrome)


Peliosis hepatis
Clinical images

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Blood filled spaces on CT

Microscopic (histologic) images

Contributed by @RaulSGonzalezMD on Twitter
Contributed by @RaulSGonzalezMD on Twitter (see original post here)"> Peliosis hepatisContributed by @RaulSGonzalezMD on Twitter (see original post here)"> Peliosis hepatis

Peliosis hepatis



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Peliosis 1

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Peliosis 2


Polycystic liver disease / duct plate malformation
Gross images

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Massive hepatomegaly and numerous cysts

Microscopic (histologic) images

Contributed by Debra Zynger, M.D.

Low power

Cysts

von Meyenberg complex

Liver parenchyma


Portal hypertension
Microscopic (histologic) images

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Idiopathic noncirrhotic portal hypertension


Portal vein obstruction
Radiology images

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Pancreatic mass and portal vein thrombosis

Gross images

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Tumor thrombus causing portal vein obstruction


Primary biliary cholangitis
Gross images

Contributed by Raul Gonzalez, M.D.

Cirrhotic liver

Microscopic (histologic) images

Contributed by Raul Gonzalez, M.D.

Portal and duct inflammation

Florid duct lesion

Lobular cholestasis

Lobular macrophages

Ductular reaction

Duct loss


Primary hyperoxaluria
Diagrams / tables

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Diagnosis and treatment of primary hyperoxalurias

Radiology images

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Oxalate osteopathy

Abdomen Xray and renal ultrasonography

Systemic involvement ("oxalosis")

Gross images

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Calcium oxalate stones

Microscopic (histologic) images

Case #436

Liver with portal birefringent oxalate crystals

Molecular / cytogenetics images

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GRHPR mutation


Primary sclerosing cholangitis
Diagrams / tables

Images hosted on other servers:

Algorithm for the management of suspected PSC

Radiology images

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Diffuse intrahepatic bile duct stricture

Prominent irregular hepatic ducts

Gross images

Contributed by Raul S. Gonzalez, M.D.

Periductal fibrosis

Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.

"Onion skin" fibrosis

Scar replacing duct

Large duct rupture

Ductular reaction


Duct injury

Biliary type cirrhosis

PSC autoimmune hepatitis overlap

PSC with
cholangiocarcinoma


Progressive familial intrahepatic cholestasis
Diagrams / tables

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Types of PFIC

Microscopic (histologic) images

Contributed by Puja Sakhuja, M.D., Surbhi Goyal, M.D. and Lavleen Singh, M.D.

Bland cholestasis with hepatocytic pseudorosettes

Giant cell
transformation
with pseudoacinar
rosettes

Extensive portal fibrosis with ductular proliferation

Cholestasis with ductular proliferation


Reduced canalicular expression of CD10

Loss of BSEP immunoexpression

Canalicular BSEP expression

Loss of MDR3 immunoexpression

Canalicular MDR3 expression

Electron microscopy images

Contributed by Puja Sakhuja, M.D.

Amorphous, fine filamentous bile



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Distended bile canaliculi with coarse and granular bile


Q fever
Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.
Low power image of liver with Q fever

Liver with Q fever

Fibrin ring granulomas

Fibrin ring granulomas

Q fever granulomas Q fever granulomas

Q fever granulomas

Videos

A summary of Q fever


Recurrent disease
Diagrams / tables

Contributed by Lidiane Vieira Marins, M.D., Ph.D.
Basic liver injury patterns

Basic liver injury patterns

Image key

Image key

Normal appearance

Normal appearance

Acute recurrent HBV / HCV / AIH

Acute recurrent HBV / HCV / AIH

Chronic recurrent HBV / HCV

Chronic recurrent HBV / HCV


Chronic recurrent AIH

Chronic recurrent AIH

Recurrent PSC

Recurrent PSC

Recurrent PBC

Recurrent PBC

Recurrent ALD / MASLD

Recurrent ALD / MASLD

Recurrent HCC

Recurrent HCC

Radiology images
Not relevant to this topic
Clinical images
Not relevant to this topic
Gross images
Not relevant to this topic
Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.
Acute R-HCV Acute R-HCV

Acute R-HCV

Fibrosing cholestatic hepatitis

Fibrosing cholestatic hepatitis

R-PSC R-PSC

R-PSC


R-PBC R-PBC

R-PBC

Cytology images
Not relevant to this topic
Electron microscopy images
Not relevant to this topic
Molecular / cytogenetics images
Not relevant to this topic
Videos

Recurrent disease post-liver transplantation


Recurrent pyogenic cholangitis
Radiology images

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Cholangiogram
 with stones

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CT with stones

Clinical images

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Intrahepatic stone

Gross images

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Duct dilatation and stones

Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.
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Hepatolithiasis

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Periductal fibrosis

Missing Image

Duct inflammation


Schistosomiasis
Microscopic (histologic) images

Contributed by Dr. Keloth Pradeep

82 year old woman with liver biopsy for presumed liver metastases, based on CT / MRI findings: schistosomial ova and metastatic adenocarcinoma in liver



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Eggs in intestinal mucosa

Dense periportal fibrosis



Secondary biliary cirrhosis
Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.

Biliary type cirrhosis


Segmental atrophy
Diagrams / tables

Contributed by Naziheh Assarzadegan, M.D.

Segmental atrophy stages

Radiology images

Contributed by Naziheh Assarzadegan, M.D.

Mass,
concerning for
cholangiocarcinoma

Microscopic (histologic) images

Contributed by Naziheh Assarzadegan, M.D.

Subcapsular lesion

Abnormal thick walled blood vessels

Biliary cyst


Simple biliary cyst
Radiology images

Contributed by Lokman Cevik, M.D.
Large cyst in the liver

Large cyst in the liver

Multiple cysts in the liver

Multiple cysts in the liver

Clinical images

Images hosted on other servers:
Intraoperative view of the ruptured cyst

Ruptured cyst

Intraoperative view of perforated lesion of hepatic cyst

Perforated lesion of hepatic cyst

Microscopic (histologic) images

Contributed by Lokman Cevik, M.D. and Wei Chen, M.D., Ph.D.
Simple biliary cyst wall

Simple biliary cyst wall

Focal denuded epithelium

Focal denuded epithelium

Hemorrhage in cyst wall

Hemorrhage in cyst wall

Cyst lining epithelium

Cyst lining epithelium


Multilobular biliary cyst Multilobular biliary cyst

Multilobular biliary cyst

Hemangioma-like area

Hemangioma-like area


Sinusoidal obstruction syndrome / venoocclusive disease (SOS / VOD)
Diagrams / tables

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Hepatic acinus

Radiology images

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Sinusoidal obstruction syndrome

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Patchy liver enhancement

Missing Image Missing Image

Hepatic sinusoidal obstruction syndrome after ingestion of Gynura segetum

Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.

Acute disease, with sinusoidal hemorrhage

Chronic disease, with shrunken central vein



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Fibrous occlusion
of centrilobular
venule (silver stain)


Transplantation - surgical / vascular complications
Radiology images

Contributed by Ricardo Martins, M.D.

Portal vein thrombosis

Hepatic artery thrombosis

Acute portal vein thrombosis

Nonanastomotic strictures

Gross images

Contributed by Rui Caetano Oliveira, M.D., Ph.D.
Bile casts in ischemic cholangiopathy

Bile casts in ischemic cholangiopathy

Liver necrosis

Liver necrosis

Liver necrosis cut section

Liver necrosis cut section

Liver necrosis cut section

Liver necrosis cut section

Liver thrombosis

Liver thrombosis

Microscopic (histologic) images

Contributed by Rui Caetano Oliveira, M.D., Ph.D. and @RaulSGonzalezMD on Twitter

Ischemic cholangiopathy

Sinusoidal dilation

Hemorrhage

Foci of necrosis

Severe necrosis

Extensive necrosis


Extensive liver necrosis

Venous portal tract thrombosis

Major portal branch thrombosis

Bile duct ulceration

Extensive ulceration

Bile duct necrosis


Lipopeliosis following liver transplantation

Lipopeliosis following liver transplantation

Biliary cirrhosis

Ductular reaction and biliary metaplasia

Copper accumulation


Undifferentiated embryonal sarcoma
Clinical images

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Adult with 16 cm tumor

Gross images

Case #134

10 year old girl with 15 cm tumor

Microscopic (histologic) images

Case #134
Various images Various images Various images Various images Various images

Various images


PAS diastase

PAS diastase

Alpha-1-antitrypsin

Alpha-1-antitrypsin



Contributed by @liverwei on Twitter
Undifferentiated embryonal sarcoma Undifferentiated embryonal sarcoma Undifferentiated embryonal sarcoma Undifferentiated embryonal sarcoma

Undifferentiated embryonal sarcoma



Contributed by @RaulSGonzalezMD on Twitter
Undifferentiated embryonal sarcoma Undifferentiated embryonal sarcoma Undifferentiated embryonal sarcoma

Undifferentiated embryonal sarcoma


Vascular disorders-general
Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.

Ischemic necrosis

Sinusoidal dilatation


Von Meyenburg complex
Radiology images

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MRI

MRI

Ultrasound and CT

Ultrasound
and CT

Gross images

Images hosted on other servers:
Subcapsular lesion with smooth borders

Subcapsular lesion
with smooth borders

Microscopic (histologic) images

Contributed by Upasana Joneja, M.D.
Distinct lesion borders

Distinct lesion borders

Dilated glands with bile

Dilated glands with bile

Bland glandular cytology

Bland glandular cytology

CK7

CK7

Trichrome special stain

Trichrome special stain

Cytology images

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Fine needle aspiration findings of VMC

Fine needle aspiration of VMC


Well differentiated neuroendocrine tumor
Gross images

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62 year old woman
with tan gray tumor
that has soft, fish
flesh cut surface

Microscopic (histologic) images

Images hosted on other servers:

62 year old woman with primary hepatic carcinoid tumor

Primary liver tumor in patient with Zollinger-Ellison syndrome

Liver metastases from colon primary


Wilson disease
Diagrams / tables

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Normal copper and iron metabolism

Impaired copper and iron metabolism

Gross images

Images hosted on other servers:

Liver with cirrhosis

Liver with necrosis and parenchymal collapse

Microscopic (histologic) images

Contributed by ILKe Nalbantoglu, M.D. and Zafar Ali, M.D. (Case #388)

Normal architecture, patchy steatosis

Steatosis and glycogenated nuclei

Acute hepatitis


Fulminant hepatitis

Hepatitis

Cirrhosis

Copper stain (rhodamine)

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