Canine and Feline Liver Cytology

About the Author ix

Foreword xi

Preface xiii

Acknowledgments xv

1 Before the Analysis: Rules for Interpretation of Hepatic Cytology 1

1.1 The Rules for Cytological Diagnosis of Hepatic Diseases 2

1.1.1 Rule 1 2

1.1.2 Rule 2 2

1.1.3 Rule 3 2

1.1.4 Rule 4 3

1.1.5 Rule 5 3

1.1.6 Rule 6 3

1.1.7 Rule 7 4

1.1.8 Rule 8 4

1.2 Diagnostic Approach to Liver Disease 4

1.2.1 Clinical and Anamnestic Signs 5

1.2.2 Hematochemical Investigation 5

1.2.2.1 Pathological Bases of Liver Damage 5

1.2.2.2 Diagnosis of Liver Damage 8

1.2.2.3 Useful Enzymes for Recognition of Damage to Hepatocytes and Cholangiocytes 9

1.2.2.4 Liver Failure Diagnosis 11

1.2.2.5 Parameters of Liver Failure 12

1.2.3 Ultrasonographic Investigation 14

1.2.4 Cytological and Histopathological Investigation 15

1.2.4.1 Sample Collection 15

1.2.4.2 Cytological Approach to Hepatic Diseases 16

1.3 Key Points 16

References 17

2 Normal Histology and Cytology of the Liver 19

2.1 Normal Histology of the Liver 19

2.2 Normal Cytology of the Liver 27

2.2.1 Hepatocytes 28

2.2.2 Kupffer Cells 30

2.2.3 Stellate Cells (Ito Cells) 31

2.2.4 Cholangiocytes (Biliary Cells) 32

2.2.5 Hepatic Lymphocytes 33

2.2.6 Hepatic Mast Cells 34

2.2.7 Hematopoietic Cells 34

2.2.8 Mesothelial Cells 36

2.3 Key Points 38

References 39

3 Nonspecific and Reversible Hepatocellular Damage 41

3.1 Accumulation of Water 42

3.2 Accumulation of Glycogen 43

3.3 Accumulation of Lipids 46

3.4 Accumulation of Bilirubin and Bile Salts 57

3.5 Hyperplasia of Stellate Cells 57

3.6 Regenerative Changes 59

3.7 Key Points 64

References 64

4 Intracytoplasmic and Extracytoplasmic Pathological Accumulation 67

4.1 Pathological Intracytoplasmic Accumulation 67

4.1.1 Lipofuscin 67

4.1.2 Copper 73

4.1.3 Iron and Hemosiderin 76

4.1.4 Protein Droplets 82

4.1.5 Cytoplasmic Granular Eosinophilic Material 82

4.1.6 Hepatic Lysosomal Storage Disorders 85

4.2 Pathological Extracytoplasmic Accumulation 86

4.2.1 Bile 86

4.2.2 Amyloid 90

4.3 Key Points 96

References 96

5 Irreversible Hepatocellular Damage 101

5.1 Necrosis 101

5.2 Apoptosis 107

5.3 Key Points 110

References 110

6 Inflammation 113

6.1 Presence of Neutrophilic Granulocytes 115

6.2 Presence of Eosinophilic Granulocytes 123

6.3 Presence of Lymphocytes and Plasma Cells 125

6.4 Presence of Macrophages 130

6.5 Presence of Mast Cells 137

6.6 Key Points 139

References 139

7 Nuclear Inclusions 143

7.1 “Brick” Inclusions 143

7.2 Glycogen Pseudo-inclusions 144

7.3 Lead Inclusions 146

7.4 Viral Inclusions 146

7.5 Key Points 147

References 147

8 Cytological Features of Liver Fibrosis 149

8.1 Cytological Features of Liver Fibrosis 150

8.2 Key Points 159

References 160

9 Cytological Features of Biliary Diseases 163

9.1 General Features of Biliary Diseases 165

9.2 Cytological Features of Specific Biliary Diseases 167

9.2.1 Acute and Chronic Cholestasis 167

9.2.2 Acute Cholangitis 170

9.2.3 Chronic Cholangitis 170

9.2.4 Lymphocytic Cholangitis 170

9.3 Key Points 175

References 175

10 Bile and Gallbladder Diseases 177

10.1 Bactibilia and Septic Cholecystitis 179

10.2 Epithelial Hyperplasia 181

10.3 Gallbladder Mucocele 181

10.4 Limy Bile Syndrome 183

10.5 Biliary Sludge 183

10.6 Neoplastic Diseases of Gallbladder 183

10.7 Other Gallbladder Diseases 184

10.8 Key Points 184

References 184

11 Etiological Agents 187

11.1 Viruses 188

11.2 Bacteria 189

11.3 Protozoa 193

11.4 Fungi 194

11.5 Parasites 194

11.6 Key Points 197

References 197

12 Neoplastic Lesions of the Hepatic Parenchyma 199

12.1 Epithelial Neoplasia 200

12.1.1 Nodular Hyperplasia 200

12.1.2 Hepatocellular Adenoma 204

12.1.3 Hepatocellular Carcinoma 206

12.1.4 Cholangioma 215

12.1.5 Cholangiocellular Carcinoma 217

12.1.6 Other Nodular Lesions of Biliary Origin 222

12.1.7 Hepatic Carcinoid 223

12.1.8 Hepatoblastoma 227

12.2 Mesenchymal Neoplasia 227

12.2.1 Malignant Mesenchymal Neoplasms 227

12.3 Hematopoietic Neoplasia 229

12.3.1 Myelolipoma 231

12.3.2 Large Cell Hepatic Lymphoma 232

12.3.3 Small Cell Lymphoma 234

12.3.4 Large Granular Lymphocyte (LGL) Lymphoma 236

12.3.5 Epitheliotropic Lymphoma 239

12.3.6 Other Types of Hepatic Lymphoma 240

12.3.7 Malignant Histiocytic Neoplasms 242

12.3.8 Mast Cell Tumor 245

12.3.9 Hepatic Splenosis 247

12.4 Metastatic Neoplasia 247

12.5 Criteria for Selection of Sampling Methods for Liver Nodular Lesions 248

12.6 Key Points 250

References 250

Index 255