Hepatic duct calculi and obstructive biliary cirrhosis - Erler Zimmer 3D anatomy Series MP2084

This dissection model highlighting Hepatic Duct Calculi and Obstructive Biliary Cirrhosis is part of the exclusive Monash 3D anatomy series, a comprehensive series of human dissections reproduced with ultra-high resolution color 3D printing.

Clinical history

of an 85-year-old man presented with urinary retention due to benign prostatic hypertrophy. On admission, it was noted that he was jaundiced with cholestatic derangement of his liver function tests. He underwent transurethral prostatic resection but died of pneumonia 5 days after surgery.

Pathology

The specimen is a liver slice mounted to visualize the cut surface. The capsule is slightly thickened and the liver substance has a finely nodular appearance. The intrahepatic bile ducts are dilated. When the posterior or lower surface is viewed, an irregular pigmented calculus, 10 mm in diameter, embedded in a dilated hepatic duct is seen. Another smaller calculus, 3 mm in diameter, is removed. This specimen represents an example of secondary biliary cirrhosis due to large duct obstruction by liver stones.

Additional Information.

Hepatolithiasis is characterized by the presence of intrahepatic gallstones. These stones can lead to cholangitis, progressive atrophy and destruction of hepatocytes, and an increased risk of cholangiocarcinoma. It is common in East Asia but rare in Western countries. There is no difference in incidence between the sexes. The stones most commonly consist of pigmented calcium bilirubinate stones.

These stones cause obstruction of the intrahepatic bile duct. Proximal to the obstructive stone, distention and dilatation of the bile ducts is evident. There is also bile duct proliferation at the portal-parenchymal interface with stromal edema and infiltrating neutrophils, indicating acute-chronic inflammation. If left untreated, this inflammation leads to periportal fibrosis and eventually obstructive biliary cirrhosis. The microscopic appearance would show feathery degeneration of the periportal hepatocytes, cytoplasmic swelling often with Mallory Denk bodies (i.e., an inclusion found in the cytoplasm of liver cells with a braided rope-like appearance caused by damaged intermediate filaments within the hepatocytes), and biliary infarcts from extravasated bile. Chronic inflammation can lead to biliary dysplasia that can develop into cholangiocarcinoma.

Patients may present with repeated cholangitis, intermittent abdominal pain, jaundice or often asymptomatic. Treatment is usually surgical removal of the stones.

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What advantages does the Monash University anatomical dissection collection offer over plastic models or plastinated human specimens?

• Each body replica has been carefully created from selected patient X-ray data or human cadaver specimens selected by a highly trained team of anatomists at the Monash University Center for Human Anatomy Education to illustrate a range of clinically important areas of anatomy with a quality and fidelity that cannot be achieved with conventional anatomical models-this is real anatomy, not stylized anatomy.
• Each body replica has been rigorously checked by a team of highly trained anatomists at the Center for Human Anatomy Education, Monash University, to ensure the anatomical accuracy of the final product.
• The body replicas are not real human tissue and therefore not subject to any barriers of transportation, import, or use in educational facilities that do not hold an anatomy license. The Monash 3D Anatomy dissection series avoids these and other ethical issues that are raised when dealing with plastinated human remains.