肝臟病理講解培訓課件

肝臟疾病病理學診斷OutlineofGuidelines1肝臟病理講解1/20/2025Classificationofliverdiseases2肝臟病理講解1/20/2025LIVER3肝臟病理講解1/20/2025LiverBiopsy4肝臟病理講解1/20/2025LiverBiopsy

ConfirmthediagnosisSerologicalbloodtestsEstablishdegreeoffibrosisSerologyBiopsynotrepresentativeIdentifycirrhosisDetermineoptimumtherapy5肝臟病理講解1/20/2025Liverbiopsyadequacy“Mosthepatopathologistsaresatisfiedwithabiopsyspecimencontainingatleastsixtoeightportaltracts”.BravoAAetalNEJM344,495;2001.Weshouldnotbeprimarilyconcernedwiththesizeofbiopsythat“satisfies”thepathologist.Thecorrectquestionis:Whatsizeofbiopsywillprovideareliableassessmentforthepatient’smanagement6肝臟病理講解1/20/2025LiverbiopsyadequacyGuidoMandRuggeM.SeminLivDis24,89;2004.Inmostdiffuseliverdiseasesexaminationof12-15completeportaltractsisnecessary.~20mmofa1.4mmdiameter(17gauge)needlebiopsy.Progressivelylongersamplesofthinnerbiopsiesareneeded.7肝臟病理講解1/20/202536-1肝臟活檢標本的評價整體情況-低倍鏡匯管區(qū)–中、高倍鏡肝小葉–中、高倍鏡中央靜脈–中、高倍鏡8肝臟病理講解1/20/2025LOBULEVSACINUS9肝臟病理講解1/20/202510肝臟病理講解1/20/2025肝小葉11肝臟病理講解1/20/2025肝板、肝竇12肝臟病理講解1/20/2025肝臟,EM13肝臟病理講解1/20/2025肝臟,EM(cont.)14肝臟病理講解1/20/2025匯管區(qū)和中央靜脈15肝臟病理講解1/20/202536-2常用診斷名詞的定義嗜酸性小體氣球樣變性Ductule葉間膽管碎宵狀壞死灶狀壞死帶狀壞死融合性壞死大片壞死橋接壞死

16肝臟病理講解1/20/2025Acidophilbody17肝臟病理講解1/20/2025BallooningDegeneration18肝臟病理講解1/20/2025FattyDegeneration–Alcoholicliverdisease19肝臟病理講解1/20/2025Ductule20肝臟病理講解1/20/2025Interlobularbileduct21肝臟病理講解1/20/2025Necrosis,piecemeal22肝臟病理講解1/20/2025Necrosis,focal23肝臟病理講解1/20/2025Necrosis,Zonal24肝臟病理講解1/20/2025Necrosis,Confluent25肝臟病理講解1/20/2025Necrosis,Massive26肝臟病理講解1/20/2025Necrosis,Bridging27肝臟病理講解1/20/2025DrugandToxin-InducedLiverDisease28肝臟病理講解1/20/202536-3肝小葉淋巴細胞浸潤伴有或不伴有肝細胞變性或壞死急性醫(yī)源性急性病毒性(HAV,HBVB,HCV,CMV,EBVetc)自身免疫性癌髓外造血白血病/淋巴瘤原發(fā)性膽管性肝硬化29肝臟病理講解1/20/202536-4肝小葉多形核細胞浸潤伴有或不伴有肝細胞變性或壞死酒精性肝炎細菌/真菌感染醫(yī)源性反應敗血癥“手術性”肝炎病毒感染（CMV)30肝臟病理講解1/20/2025AutoimmuneHepatitis31肝臟病理講解1/20/202536-5肝細胞壞死伴輕微炎癥反應急性病毒感染纖維化性膽汁淤積性肝炎肝靜脈血液外溢缺血嗜肝病毒引起的大片壞死醫(yī)源或毒素反應創(chuàng)傷腫瘤32肝臟病理講解1/20/202536-6匯管區(qū)淋巴細胞或和漿細胞浸潤急性病毒性肝炎自身免疫性肝炎膽管阻塞移植物抗宿主反應淋巴瘤/白血病肝小葉炎癥或變性或壞死輕微肉芽腫或腫瘤原發(fā)性膽汁性肝硬化原發(fā)性硬化性膽管炎排斥反應病毒性肝炎Wilson病33肝臟病理講解1/20/2025Primarybiliarycirrhosis34肝臟病理講解1/20/2025Antimitochondrialantibody35肝臟病理講解1/20/202536-7匯管區(qū)多形核細胞浸潤-肝小葉炎癥或變性或壞死輕微順行性膽管炎膽道阻塞高營養(yǎng)醫(yī)源性病毒性肝炎,“膽管溶解性”36肝臟病理講解1/20/202536-8匯管區(qū)嗜酸性粒細胞浸潤自身免疫性肝炎髓外造血醫(yī)源反應寄生蟲感染原發(fā)性膽汁性肝硬化原發(fā)性硬化性膽管炎排斥反應37肝臟病理講解1/20/2025Liverbiopsyfroma25y-oLaotianshowingagranulomatousreactionagainsttheovum(HE).38肝臟病理講解1/20/202536-9肉芽腫性炎癥兒童慢性肉芽腫病克隆氏病異物反應原發(fā)性肝臟肉芽腫病免疫性膽管炎細菌、真菌、立克次氏體、病毒感染脂肪性肉芽腫惡性腫瘤醫(yī)源性反應原發(fā)性膽汁性肝硬化肉瘤樣病39肝臟病理講解1/20/202536-10肝纖維化淀粉樣橋接性纖維化中央透明變性纖維化先天性肝纖維化先天性梅毒囊性纖維化灶性結節(jié)狀增生肝臟門脈區(qū)纖維化肝臟靜脈性血液外溢，慢性阻塞性代謝性疾病中央靜脈周圍纖維化腫瘤40肝臟病理講解1/20/2025肝纖維化41肝臟病理講解1/20/2025肝硬化=肝細胞再生+纖維化42肝臟病理講解1/20/202536-11膽汁淤積良性家族性膽汁淤積妊娠性膽汁淤積醫(yī)源性手術后性膽汁淤積敗血癥43肝臟病理講解1/20/2025細胞內淤膽44肝臟病理講解1/20/2025IntrahepapticCholestasis45肝臟病理講解1/20/2025ExtrahepapticCholestasis46肝臟病理講解1/20/202536-12淤血或出血伴有肝竇擴張肝靜脈血外溢靜脈阻塞性疾病心力衰竭醫(yī)源反應腫瘤壓迫結節(jié)性再生性增生和回管區(qū)硬化門脈阻塞47肝臟病理講解1/20/2025肝淤血48肝臟病理講解1/20/2025肝出血49肝臟病理講解1/20/202536-13色素沉積膽色素鐵脂褐素其它外源性色素福爾馬林色素50肝臟病理講解1/20/2025膽色素–bilepigment51肝臟病理講解1/20/2025Hemochromatosis52肝臟病理講解1/20/2025Prussianblueironstain53肝臟病理講解1/20/2025Lipofuscin54肝臟病理講解1/20/202536-14細胞內包含體腺病毒抗胰靡蛋白酶缺乏支鏈淀粉血癥大泡脂肪變微泡脂肪變“糖原性”胞核巨線粒體“毛玻璃”細胞HSVMalloryhyaline55肝臟病理講解1/20/2025ALPHA-1-ANTITRYPSINSTORAGEMEGAMITOCHONDRIA

GROUNDGLASSCELLS

56肝臟病理講解1/20/2025Alpha-1-antitrypsindeficiency57肝臟病理講解1/20/2025CMVhepatitis58肝臟病理講解1/20/2025GlycogenNuclei59肝臟病理講解1/20/2025A30-year-oldwomaninthe30thweekofpregnancywithFulminanthepaticfailure60肝臟病理講解1/20/2025herpessimplexvirus61肝臟病理講解1/20/2025Malloryhyaline62肝臟病理講解1/20/202536-15脂肪變顯著不伴有或輕微壞死酒精性脂肪性肝炎妊娠脂肪肝灶性脂肪變肝細胞腺瘤、癌醫(yī)源、毒素反應代謝性疾病非酒精性脂肪性肝炎非特異性脂肪變Wilson病63肝臟病理講解1/20/202536-16組織中出現不常見細胞髓外造血巨核細胞轉移瘤儲備細胞（肝、Kupffer或Ito)64肝臟病理講解1/20/2025髓外造血65肝臟病理講解1/20/202536-17“幾乎正常”的肝活檢肝匯管區(qū)纖維化醫(yī)源性反應Missedlesion結節(jié)狀再生或增生蓄積或代謝性疾病66肝臟病理講解1/20/202536-18缺少(觀察不到)正常結構膽管中央靜脈肝細胞匯管區(qū)匯管靜脈肝竇67肝臟病理講解1/20/202536-19肝臟代謝性疾病的光鏡診斷類型診斷性LM診斷性EMa-抗胰糜蛋白酶缺乏匯管區(qū)周肝細胞內PAS陽性球滴擴張內質網內出現顆粒狀物囊性纖維化灶性膽管性纖維化膽管纖維狀物Gaucher病Kupffer增大，匯管區(qū)巨噬細胞，“Crinkledpaper”胞漿溶酶體內管狀包含體糖原沉積癥IV嗜堿性細胞內包含物,PSA+絲狀物粘多糖貯積癥肝細胞,Kuppfer膠體鐵染色溶酶體內“羊毛”狀物遲發(fā)性皮膚卟啉癥肝細胞內針狀包含物肝細胞內針狀包含物紅細胞生成性原卟啉癥膽素色(毛細核小膽管)“Starburst”狀排列的結晶68肝臟病理講解1/20/202536-20肝臟代謝性疾病的電鏡和非特異性光鏡診斷類型LMEM糖原沉積,II細胞內糖原增加結合溶酶體,糖原GM2神經節(jié)苷脂沉積癥正常膜性層狀包含體Niemann-Pick病泡沫狀肝、Kupffer細胞溶酶體內“myelin”樣包含體Wolman病泡沫狀肝、Kupffer細胞肝、Kupffer細胞內脂滴Zellweger綜合癥非特異性肝細胞改變缺乏過氧化小體(peroxisomes)69肝臟病理講解1/20/202536-21肝臟代謝性疾病非診斷的光鏡和電鏡特點類型LMEM半乳糖血癥Galactosemia

同高酪氨酸血癥同高酪氨酸血癥糖原沉積(I,III)Glycogenstorage

肝細胞大,竇受壓,鋪轉排列,脂肪變,高糖原核仁糖原分隔細胞器,脂滴,高糖原核仁遺傳性果糖不耐癥Hereditaryfructoseintolerance

同高酪氨酸血癥“fructoseholes”同心排列內質網,糖原顆粒高酪氨酸血癥Tyrosinemia肝細胞變性伴脂肪變(灶性),淤膽,纖維化,肝硬化淤膽,脂滴,內質網增加,異常線粒體70肝臟病理講解1/20/2025高酪氨酸血癥肝臟71肝臟病理講解1/20/2025Glycogenstorage,Liver,LM72肝臟病理講解1/20/2025Glycogenstorage,Liver,EM73肝臟病理講解1/20/2025肝臟疾病診斷病因學形態(tài)（LM&EM)組化和免疫組化血清學、酶學檢查臨床表現74肝臟病理講解1/20/2025AlcoholicFattyLiver75肝臟病理講解1/20/2025AlcoholicFattyLiver76肝臟病理講解1/20/2025CirrhosisFibrosisRegeneratingNodule77肝臟病理講解1/20/2025Micronodularcirrhosis78肝臟病理講解1/20/2025Micronodularcirrhosis:79肝臟病理講解1/20/2025HepaticAdenoma80肝臟病理講解1/20/2025HepatocellularCarcinoma81肝臟病理講解1/20/2025Hepaticmetastasis:82肝臟病理講解1/20/2025Hepaticmetastasis:83肝臟病理講解1/20/2025AmoebicLiverAbscess:84肝臟病理講解1/20/2025HeparLobatum(cong.Syphilis):85肝臟病理講解1/20/2025HCC-TheGlobalPerspectiveTheBigFiveCancers86肝臟病理講解1/20/2025TheMajorEtiologicalFactorsChronichepatitis-typesBorCCirrhosis/chronicliverdiseaseofanytypeAflatoxinexposureMales,increasingage87肝臟病理講解1/20/2025

8%-High

2-7%-Intermediate

<2%-LowDatafromCDC

ChronicHBVInfection-GeographicDistribution88肝臟病理講解1/20/2025

ProspectiveStudyofHCCDevelopment

inHBsAgSeropositiveMaleChinese

HCCDEVELOPMENT

19,223(HBsAg-ve)

9

22,707

Meanfollow-up=8.9years

MaleChinese

3,454(HBsAg+ve)

152