Liver and Biliary Pathology Practice Questions

Q: A 23-year-old woman presents after a motor vehicle accident. An abdominal CT scan revealed a questionable mass in the right lobe of the liver. A subsequent fine-needle biopsy confirmed the presence of a liver adenoma. Which of the following is associated with the development of this lesion?

Oral contraceptives. **Explanation:** **Hepatic Adenoma** is a benign epithelial liver tumor that occurs most commonly in young women of childbearing age. **1. Why Oral Contraceptives (OCPs) are correct:** There is a strong, well-established causal relationship between the long-term use of **oral contraceptives** and the development of hepatic adenomas [1]. The risk increases with the duration of use and the potency of the estrogen component [1]. These tumors are often highly vascular and carry a significant risk of **spontaneous rupture and life-threatening intraperitoneal hemorrhage**, especially during pregnancy or menstruation. Regression may occur upon discontinuation of OCPs [1]. **2. Why other options are incorrect:** * **Hepatitis B & C (Options A & B):** These viral infections are primary risk factors for **Hepatocellular Carcinoma (HCC)** and cirrhosis, but they are not associated with benign hepatic adenomas. * **Polycythemia Vera (Option D):** This myeloproliferative disorder is a major risk factor for **Budd-Chiari Syndrome** (hepatic vein thrombosis) due to hypercoagulability, but it does not cause adenomas. **3. High-Yield Clinical Pearls for NEET-PG:** * **Risk Factors:** Besides OCPs, hepatic adenomas are associated with **Anabolic Steroids** and **Glycogen Storage Diseases** (especially Type I - von Gierke disease) [1]. * **Morphology:** Characterized by sheets of hepatocytes without portal tracts or bile ducts. * **Molecular Subtypes:** * *HNF1-α inactivated:* Low malignancy risk [1]. * *β-catenin activated:* High risk of malignant transformation to HCC. * *Inflammatory:* Associated with obesity and CRP elevation. * **Management:** Large adenomas (>5 cm) or those with β-catenin mutations are usually resected due to the risk of rupture or malignancy. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, p. 874.

Q: Torres bodies are seen in which of the following conditions?

Yellow fever. **Explanation:** **Yellow Fever (Correct Answer):** Torres bodies are characteristic **intranuclear eosinophilic inclusion bodies** found in the hepatocytes of patients with Yellow Fever. They represent viral nucleocapsids and are often seen alongside **Councilman bodies**, which are eosinophilic globules representing apoptotic hepatocytes (acidophilic degeneration). These findings are hallmark pathological features of the mid-zonal necrosis typically seen in the liver during Yellow Fever infection. **Analysis of Incorrect Options:** * **Kala-azar (Visceral Leishmaniasis):** Characterized by **LD bodies** (Leishman-Donovan bodies), which are amastigote forms of the parasite found within the macrophages of the reticuloendothelial system (spleen, liver, bone marrow). * **HSV (Herpes Simplex Virus):** Characterized by **Cowdry Type A** inclusions (intranuclear eosinophilic bodies surrounded by a clear halo) and "ground-glass" nuclei. * **EBV (Epstein-Barr Virus):** Associated with **atypical lymphocytes** [2] (Downey cells) in the peripheral blood smear. It does not produce Torres bodies. **High-Yield Clinical Pearls for NEET-PG:** * **Yellow Fever Triad:** Mid-zonal necrosis, Councilman bodies, and Torres bodies. * **Councilman bodies** are not pathognomonic for Yellow Fever; they can be seen in other forms of viral hepatitis [1], but **Torres bodies** are more specific. * **Negri bodies:** Seen in Rabies (intracytoplasmic, Hippocampus/Purkinje cells). * **Guarnieri bodies:** Seen in Smallpox (intracytoplasmic). * **Henderson-Paterson bodies:** Seen in Molluscum Contagiosum. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 390-391. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 369-370.

Question 1

A 23-year-old woman presents after a motor vehicle accident. An abdominal CT scan revealed a questionable mass in the right lobe of the liver. A subsequent fine-needle biopsy confirmed the presence of a liver adenoma. Which of the following is associated with the development of this lesion?

Accepted Answer

Oral contraceptives

Answer

Hepatitis B

Answer

Hepatitis C

Answer

Polycythemia vera

Question 2

Mallory hyaline is a characteristic feature of?

Accepted Answer

Alcoholic liver disease

Answer

Hepatocellular carcinoma

Answer

Primary biliary cirrhosis

Answer

Wilson's disease

Question 3

Increased deposition of fat in the liver in a patient with alcoholism is due to which of the following mechanisms?

Accepted Answer

Increased catabolism of fat peripherally

Answer

Decreased fatty acid oxidation

Answer

Increased triglyceride synthesis

Answer

Accumulation of triglycerides in the terminal hepatic venular zone

Question 4

What is the most common cause of Budd-Chiari syndrome?

Accepted Answer

Polycythemia vera

Answer

Hepatic vein valves

Answer

Hypercoagulable state in Nephrotic syndrome

Answer

Paroxysmal nocturnal hemoglobinuria (PNH)

Question 5

True regarding fibrolamellar carcinoma (FLC) of the liver are all the following EXCEPT?

Accepted Answer

Occurs in a pre-existing cirrhotic liver

Answer

Age group of occurrence is between 20-40 years

Answer

Extensive fibrosis

Answer

Favorable prognosis

Question 6

Torres bodies are seen in which of the following conditions?

Accepted Answer

Yellow fever

Answer

Kala azar

Answer

HSV

Answer

EBV

Question 7

A 54-year-old chronic alcoholic presents with progressively increasing abdominal distension over the past 3 months. Paracentesis reveals straw-colored, clear fluid with a protein content of 2.3 g/dL. Which of the following is a major contributor to the fluid accumulation in this patient?

Accepted Answer

Decreased oncotic pressure

Answer

Blockage of lymphatics

Answer

Decreased capillary permeability

Answer

Inflammatory exudate

Question 8

Which of the following statements regarding Hepatocellular carcinoma (HCC) is true?

Accepted Answer

NASH is a risk factor for HCC.

Answer

Oral contraceptive pills (OCPs) are implicated in HCC development.

Answer

Focal Nodular Hyperplasia is a premalignant lesion for HCC.

Answer

Chromosomal abnormalities are characteristically seen in HCC.

Question 9

A 40-year-old man with a history of intravenous drug use and positive serologic studies for HBsAg and anti-HCV develops hepatocellular carcinoma 15 years later. Physical examination shows needle tracks in his left antecubital fossa and mild scleral icterus. Which of the following viral characteristics best explains the development of hepatocellular carcinoma?

Accepted Answer

Viral inflammatory changes with genomic damage

Answer

Viral integration in the vicinity of proto-oncogenes

Answer

Viral capture of proto-oncogenes from host cellular DNA

Answer

Viral inactivation of RB and p53 gene expression

Question 10

All of the following statements are true regarding hepatoblastoma, except:

Accepted Answer

Activation of JAK-STAT pathway is involved in pathogenesis

Answer

A type of small round cell tumor

Answer

Most common liver tumor of early childhood

Answer

Associated with Beckwith-Wiedemann syndrome

Liver and Biliary Pathology — MCQs

Liver and Biliary Pathology — MCQs

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