Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
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        Liver Histology
      
[liver diseases]

  • Glisson's capsule: contains the organ
  • hepatocyte generation: proceeds from portal bile ducts as stem cells, then transitional cells & head toward central vein as maturing parenchyma & then terminally differentiated pericentral hepatocytes; hepatocyte "plates" form the lobule which is zonally tripartited in ascending number from portal to central (direction of blood flow) as zones 1 (periportal), 2, & 3 (pericentral).
  • space of Disse: between intralobular hepatocytes & sinusoidal lining endothelial cells
  • space of Mall: in continuity with space of Disse but is between periportal "limiting plate" hepatocytes and portal stroma (hepato-portal interface)
  • portal blood flow: portal vein enters liver hilum and successively branches smaller and smaller until become conducting venules which distribute blood into the hepatic sinusoids to percolate through lobule to central vein.
  • sinusoidal "membrane":
    • Kupffer cells: hepatic macrophages in lumen of sinusoids & most numerous periportal
    • endothelial cells: form a highly fenestrated sinusoidal conduit membrane, creating the sinusoidal lumen
    • hepatic stellate lipocytic cells of Ito: reside in space of Disse & are desmin-positive contactile4 cells; as prominent single vacuoles in PBC3; as prominent single vacuoles in hypervitaminosis A1 [LMC-02-2879] and, with appropriate history and elevated serum retinol levels, a diagnosis of hypervitaminosis can be made2 . They normally4 store lipid (and lipid soluble vitamin A); they can become4 activated myofibroblasts that secrete extracellular matrix proteins & proinflammatory cytokines. Ito produces ADAMTS13, the deficit of which is involved in TTP.
    • liver-associated lymphocytes: greater periportal concentration and 65% are natural killer T cells.
  • hepatic arterial flow: arterial branches accompany the portal vein branches
    • periportal plexus: around portal vein branches & terminally drain into sinusoids (rarely forming arterioportal anastamoses), thence to central vein.
    • peribiliary plexus: subdivides into capillaries which then drain into sinusoids, thence to central vein.
  • bile flow: intrahepatocytic flow through interconnected cannaliculi from pericentral hepatocytes progressively toward the portal zones, entering the canals of Hering (composed of a mix of hepatocytes & cholangiocytes), then into cholangioles, then through the "limiting plate" into terminal portal units into interlobular bile bile ducts
  • lymph flow: liver is largest source of lymph in the body; arise as a fine plexus of endothelial tubes associated with terminal ends of hepatic arterioles and thereafter follow the hepatic artery in retrograde fashion and sometimes partly also associated with the portal vein branches.
  • hepatic venous outflow: central veins empty into collecting venules which merge increasingly to become the hepatic vein exiting into the vena cava
  • the "portal triad":
    • portal vein
    • hepatic artery
    • bile duct
    • lymphatics 
    • nerves: terminal fibers even go into lobule
    • stroma
      • fixed fibrous cells
      • a few lymphocytes
      • a few macrophages

References:

  1. Scheuer PJ, et. al. Pathology of the Liver, 4th Ed. [text], 2002. (EBS)

  2. Ludwig & Batts, Practical Liver Biopsy interp, 2nd Ed, 1998 (EBS)

  3. Frank Mitros' on-line liver atlas 

  4. Zhou W, et. al., ADAMTS13 is Expressed in Hepatic Stellate Cells, Lab. Invest. 85:780-788, June 2005 (noted in June 2005 Modern Pathology).

(posted 2003; latest addition 27 May 2005)
 
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