QUESTION 13
A pathologist is examining a section of liver from the autopsy of a 43-year-old non-alcoholic male under the microscope and identifies that many of the hepatocytes around the central vein have one or more large well-defined circular clear spaces in the cytoplasm. Of the following, what other feature is most likely present in these hepatocytes?
A. Pale nucleus
B. Fragmented nucleus
C. Amyloid
D. Mallory’s hyaline
E. Swollen hepatocytes
Answer for Question 13
Answer: E (swollen hepatocytes)
Explanation: the well-defined circular clear spaces are vacuoles, containing triglyceride (i.e., steatosis). Fat accumulation is a sign of reversible injury. For example, microscopic examination of a person who binge drinks one weekend would reveal steatosis in the hepatocytes; however, days later, the steatosis would clear, unless they drank heavily again. Cytoplasmic swelling is also a feature of reversible cell injury. A pale nucleus (karyolysis) and a fragmented nucleus (karyorrhexis) are signs of irreversible injury. Amyloid deposition in the liver would be rare, and would not necessarily accompany steatosis. Mallory’s hyaline is best associated with alcoholic liver disease; both Mallory’s hyaline and steatosis can be seen in the same liver; however, most livers with steatosis will not have Mallory’s hyaline.
QUESTION 14
At autopsy a pathologist identifies a lesion in an organ. The lesion is white-yellow, wedge-shaped, and, although softer than the surrounding parenchyma, still relatively firm to the touch. Of the following, which organ was this pathologist most likely examining?
A. A lung
B. The liver
C. The brain
D. The colon
E. A kidney
Answer for Question 14
Answer: E (a kidney).
Explanation: The description fits that of an infarct (i.e., an area of coagulative necrosis). In organs with a single blood supply, such as a kidney (but also the spleen and the heart), the infarct will be yellow-white, yellow-tan, or otherwise pale. As infarcts are due to ischemia most commonly, no blood is passing to the dead tissue and therefore, it will be more pale, and not hemorrhagic, such as when an infarct occurs in an organ with dual blood supply (e.g., the liver, the lungs, or the colon). An infarct in the brain will always have markedly soft tissue, as, on a gross level, the brain undergoes liquefactive necrosis, with dissolution of architecture, and not coagulative necrosis, in which tissue architecture is preserved for some time after the infarct occurs.