MICROSCOPIC DESCRIPTION:
Part 1 consists of an allograft hepatectomy demonstrating
extensive coagulative necrosis involving almost 100% of the
sampled parenchyma. No viable hepatocytes and only ghost cells
and debris are seen. Some smaller branches of the hepatic artery
and portal veins show thrombosis, probably as a secondary effect.
In section 1D (superficial hilum), the portal vein is almost
totally occluded by a fresh hemorrhagic thrombus. The bile duct
shows hemorrhage and the surrounding fibroadipose tissue
demonstrates fat necrosis and hemorrhage. Focal areas of
organizing granulation tissue with calcifications are seen. In
section 1E and 1F, the arterial branches contain fresh thrombi.
In part 2, sections through the pancreas show hemorrhage and fat
necrosis. Otherwise, the pancreatic parenchyma is minimally
fibrotic. A small islet cell tumor (0.2 cm in diameter) is
incidentally noted, and several enlarged islets are additionally
seen. In section 2B from the hilum, the splenic vein and the
splenic artery contain fresh hemorrhagic thrombi. The pancreatic
resection margin shows mild hemorrhage and necrosis, but it is
mostly viable.
Part 3, from the right lobe of the liver, consists of a needle
core of liver parenchyma. The hepatic architecture is intact and
approximately six to seven portal tracts are recognized, which
are unremarkable. The lobules demonstrate mild centrilobular
hepatocellular necrosis and minimal sinusoidal neutrophilia. No
viral inclusions are seen and no evidence of rejection is
appreciated.
In part 4, from the left lobe, there is a needle liver biopsy.
Coagulative necrosis involving approximately 50% of the sampled
parenchyma is present. The viable hepatocytes show mild
regenerative changes. Mild sinusoidal neutrophilia is seen.