Liver and Biliary Pathology Practice Questions

Q: Ground glass cells of Hadziyannis are seen in which organ?

Liver. **Explanation:** **Ground glass cells of Hadziyannis** are a classic histopathological hallmark of **Chronic Hepatitis B Virus (HBV) infection** [1]. These are found exclusively in the **Liver**. 1. **Why Liver is Correct:** In chronic HBV infection, there is a massive overproduction and accumulation of **Hepatitis B surface antigen (HBsAg)** within the smooth endoplasmic reticulum (SER) of the hepatocytes [1]. On H&E staining, this results in a finely granular, homogeneous, eosinophilic ("ground glass") appearance of the cytoplasm, which displaces the nucleus to the periphery [1]. These cells can be specifically highlighted using special stains like **Orcein, Shikata, or Aldehyde Fuchsin.** 2. **Why Other Options are Incorrect:** * **Bone:** Pathology here typically involves "ground glass" appearance on **radiology** (e.g., Fibrous Dysplasia), not cellular histology of Hadziyannis. * **Thyroid:** Associated with "Orphan Annie eye" nuclei (Papillary Thyroid Carcinoma), which are cleared-out nuclei, not cytoplasmic ground glass changes. * **Prostate:** Common findings include corpora amylacea or specific architectural changes in adenocarcinoma, but not Hadziyannis cells. **High-Yield Clinical Pearls for NEET-PG:** * **Hadziyannis Cells = HBsAg** (Surface antigen) [1]. * **Sanded Nuclei = HBcAg** (Core antigen accumulation in the nucleus). * **Differential Diagnosis:** Ground glass hepatocytes can also be seen in **Type IV Glycogenosis** (Lafora body disease) and due to certain drugs (e.g., Cytochrome P450 inducers like Phenobarbital), but the term "Hadziyannis" specifically refers to HBV. * **Stains for HBsAg:** Orcein (most common), Victoria Blue, and Immunohistochemistry (IHC) [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, pp. 843-845.

Q: Which of the following is a true statement about fibrolamellar carcinoma?

Common in young adults and children. **Fibrolamellar Carcinoma (FLC)** is a distinct variant of Hepatocellular Carcinoma (HCC) that differs significantly from conventional HCC in its epidemiology, clinical presentation, and prognosis. [1] ### **Explanation of Options** * **A. Common in young adults and children (Correct):** Unlike conventional HCC, which typically occurs in older adults with underlying liver disease, FLC characteristically affects **young adults (ages 20–40)** and children. There is no gender predilection (Male = Female). [1] * **B. More common in males (Incorrect):** Conventional HCC has a strong male predominance (3:1). FLC, however, affects males and females equally. [1] * **C. Related to OCP use (Incorrect):** FLC is **not** associated with oral contraceptive use (which is linked to Hepatic Adenoma), nor is it associated with HBV, HCV, or cirrhosis. It typically arises in a **non-cirrhotic liver**. [1] * **D. Associated with a poor prognosis (Incorrect):** FLC generally has a **better prognosis** than conventional HCC because it is often slow-growing and occurs in a healthy, non-cirrhotic liver, making surgical resection more successful. [1] ### **High-Yield Clinical Pearls for NEET-PG** * **Morphology:** Grossly, it presents as a single large hard mass with a **central stellate scar** (resembling Focal Nodular Hyperplasia). * **Histology:** Characterized by large, polygonal, **oncocytic cells** (rich in mitochondria) separated by parallel lamellae of dense **collagen bundles** (fibrolamellar pattern). * **Tumor Marker:** Serum **Alpha-fetoprotein (AFP) levels are usually normal**. [1] * **Molecular Hallmark:** A characteristic **DNAJB1-PRKACA gene fusion** is found in nearly all cases, which is a highly specific diagnostic marker. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 399-400.

Question 1

Ground glass cells of Hadziyannis are seen in which organ?

Accepted Answer

Liver

Answer

Bone

Answer

Thyroid

Answer

Prostate

Question 2

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

Question 3

Fatty liver is due to excessive accumulation of

Accepted Answer

Triacylglycerols

Answer

Phospholipids

Answer

Cholesterol

Answer

Free fatty acids

Question 4

Which of the following is not a predisposing factor for hepatocellular carcinoma?

Accepted Answer

Females

Answer

Hepatitis B

Answer

Hepatitis C

Answer

Aflatoxins

Question 5

Regarding the cause of fatty liver, which statement about its pathogenesis is true?

Accepted Answer

Decreased beta oxidation of fatty acids

Answer

Decreased triglycerides

Answer

Decreased fatty acid mobilization

Answer

Increased catabolism of fatty acids

Question 6

Which of the following most significantly increases the risk of Hepatocellular carcinoma?

Accepted Answer

Hepatitis B Virus (HBV)

Answer

Cytomegalovirus (CMV)

Answer

Epstein-Barr Virus (EBV)

Answer

Hepatitis A Virus (HAV)

Question 7

Oval cells are bipotential progenitors of which of the following?

Accepted Answer

Liver

Answer

Lung

Answer

Brain

Answer

Heart

Question 8

Which of the following is NOT true about hemangioendothelioma?

Accepted Answer

The adult variant is benign.

Answer

It is more common in females.

Answer

It can be multiple and involve bilateral lobes.

Answer

It is an indication for liver transplant.

Question 9

A 26-year-old woman presents with fever, malaise, signs of jaundice, clay-colored stool, and dark urine. A liver biopsy reveals liver cell drop-out along with focal inflammation and ballooning degeneration of hepatocytes. A few intensely eosinophilic oval bodies are found. What are these microscopic bodies called?

Accepted Answer

Councilman bodies

Answer

Mallory bodies

Answer

Cowdry A bodies

Answer

Russell bodies

Question 10

Which of the following is a true statement about fibrolamellar carcinoma?

Accepted Answer

Common in young adults and children

Answer

More common in males

Answer

Related to oral contraceptive pill (OCP) use

Answer

Associated with a poor prognosis

Liver and Biliary Pathology — MCQs

Liver and Biliary Pathology — MCQs

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