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Manual Laboratory Activity Pathology Anatomy For MANUAL LABORATORY ACTIVITY PATHOLOGY ANATOMY FOR STUDENT Resource Person : Ismet M. Nur., dr., SpPA(K)., MM. Module Author : Meta Maulida D., drg., M.Kes. Subject : Cell Injury, Inflammation, Neoplasm Department : Anatomic Pathology Date : January, 2020 A Sequent : I Introduction : 30 min II Pre-test : 5 min III Laboratory activity : 80 min IV Post-test : 5 min B Learning Objectives : After performing laboratory activity, the students should be able to : Describe the macroscopic and microscopic feature of: ballooning degeneration, acute hepatitis, chronic active hepatitis, chronic persistent hepatitis, cirrhosis hepatic, and hepatocellular carcinoma. C Topic : 1. Cell injury. 2. Inflammation 3. Neoplasm. D Venue : Biomedical Laboratory, Faculty of Medicine, UNISBA, Taman Sari 22, Bandung 40116 E Equipment : Poster, atlas, light microscope and preparates of : Ballooning degeneration Chronic active hepatitis Chronic persistent hepatitis Cirrhosis hepatic Hepatocellular carcinoma F Pre-requisite/ Pre-test and Task : Note: If the pre-test score less than 50, the student won't be allowed to follow laboratory activity G Implementation 1. Students are divided into 20 groups 2. Each group is supervised by one tutor Manual Laboratory Department of Anatomic Pathology Page 1 Structure of Liver Microscopic architecture of the liver parenchyma. Both a lobule and an acinus are represented. The idealized classic lobule is represented as hexagonal centered on a central vein (CV), also known as terminal hepatic venule, and has portal tracts at three of its apices. The portal tracts contain branches of the portal vein (PV), hepatic artery (HA), and the bile duct (BD) system. Regions of the lobule generally are referred to as periportal, midzonal, and centrilobular, according to their proximity to portal spaces and central vein. Another useful way to sub-divide the liver architecture is to use the blood supply as a point of reference. Using this approach, triangular acini can be recognized. Acini have at their base branches of portal vessels that penetrate the parenchyma (“penetrating vessels”). On the basis of the distance from the blood supply, the acinus is divided into zones 1 (closest to blood source), 2, and 3 (farthest from blood source). Identify : 1. Lobule, acinus, sinusoid, hepatosit, kupffer cell 2. central vena, portal triad : bile duct, hepatic portal vein, hepatic artery 3. Periportal zone, midzonal, centrilobular zone Manual Laboratory Department of Anatomic Pathology Page 2 BALOONING DEGENERATION Tissue source: Liver Macroscopic The liver is usually enlarged and reddened. features: Microscopic Ballooning degeneration may the result of damage from toxic or features : immunology insult that caused swelling of the hepatocytes. Moderate cells swelling are reversible. More severe damage, swollen hepatocytes have irregularly clumped cytoplasm organelles and large clear spaced. 40X 400X Identify : 1. Hepatosit (ballooning degeneration), kupffer cell hyperplasia, inflammatory cell. 2. Central vena (hepatosit venule), portal triad : bile duct, hepatic portal vein, hepatic artery. Schematic Drawing : Manual Laboratory Department of Anatomic Pathology Page 3 CHRONIC ACTIVE HEPATITIS Tissue source: Liver Macroscopic The liver is slightly enlarged and appears as a red brownish tissue. features: Microscopic The portal tracts are usually infiltrated with lymphocytes, features : macrophages, occasional plasma, and rare neutrophils. The inflammatory infiltrate may spill over into the adjacent parenchyma to cause necrosis of periportal hepatocytes (piecemeal necrosis) and bridging necrosis. 400X 100X Identify : 1. Infiltrate of inflammatory cell (Piecemeal necrosis, bridging necrosis) 2. central vena, portal triad: proliferation of bile duct, hepatic portal vein, hepatic artery Schematic Drawing: Manual Laboratory Department of Anatomic Pathology Page 4 CHRONIC PERSISTENT HEPATITIS Tissue source: Liver Macroscopic The liver is mildly enlarged, areas of necrosis and collapse of liver features: lobules are seen as ill define areas that are pale yellow. Microscopic Inflammatory restricted in portal tracts, consists of mononuclear cells features : with mild fibrosis. There is no piecemeal or bridging necrosis. Liver architecture is usually well preserved. 100X 400X Identify : 1. Portal tracts inflammatory cell 2. Mild bridging fibrosis 3. There is no piecemeal necrosis and bridging necrosis Schematic Drawing: Manual Laboratory Department of Anatomic Pathology Page 5 CIRROSIS HEPATIS Tissue source: Liver Macroscopic At first, the cirrhosis liver is yellow-tan, fatty, and enlarged, usually features: weighing over 2 kg. Over years, it is transformed into brown, shrunken, no fatty organ, sometimes less than 1 kg in weight. The characteristic feature is diffuse nodularity on the surface Microscopic Cirrhosis as the end-stage of chronic liver disease is defined by three features : characteristics: bridging fibrous septa, parenchyma nodules and disruption of the architecture of entire liver. 40X 400X Identify: 1. Inflammatory cells 2. Fibrous septa, bridging fibrous septa, parenchyma nodule 3. Hyperplasia of bile duct Schematic Drawing: Manual Laboratory Department of Anatomic Pathology Page 6 HEPATOCELLULAR CARCINOMA Tissue source: Liver Macroscopic The entire surfaces of the left lobe and most of the right lobe have an features: irregular nodular appearance. Cut section shown several satellites tumor nodules are present as well in the liver away from the large mass. Microscopic Hepatitis B virus playing a great part in its etiology. The great features : majority of tumors arise in cirrhosis liver. It consists of broaded trabeculae (2-8 cells thick) of large polyhedral cells (malignant hepatocytes). Malignant hepatocytes are uniform in the field but spindle shaped or giant form with large eosinophilic multivacuolated cytoplasm and large roud vesicular nuclei and prominent central nucleoli can be seen. 100X 400X Identify: 1. Pleomorphism hepatocytes 2. Trabeculae form Schematic Drawning: Manual Laboratory Department of Anatomic Pathology Page 7 G Reference : 1. Kumar, V., Abbas, A. K., & Aster, J. C. Robbins and Cotran pathologic basis of disease. 9ed. Philadelphia, PA: Elsevier/Saunders. 2015. 2. C. Simon Herrrington. Muir’s Textbook of Pathology. 15 ed. CRC PRESS- TAYLOR & FRANCIS GROUP. 2014. 3. Harsh Mohan. Textbook of pathology. Sixth editon. 2010. 4. Junquiera Basic histology text and atlas. 12e H Home work : To be collected to your tutor at the day of lab activity! 1. Bagaimana gambaran mikrostruktur hepar? 2. Jelaskan gambaran makrostruktur dan mikrostruktur (gambar dan beri keterangan) dari ballooning degeneration, chronic active hepatitis, chronic persistent hepatitis, cirrhosis hepatic, hepatocellular carcinoma. Manual Laboratory Department of Anatomic Pathology Page 8 .
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