Hepatic Pathology

For each of the following clinical histories, match the most characteristic, diagnostic hepatic morphologic finding:

1. A 48-year-old woman who has never smoked has experienced increasing dyspnea for several years. Spirometry reveals findings characteristic for an obstructive lung disease, and a pulmonary ventilation-perfusion scan reveals decreased areas of perfusion in all lung fields, while a chest radiograph reveals increased areas of lucency in all lung fields. Her cardiac function is still normal. She has a firm liver edge on physical examination:

2. A 45-year-old woman is obese and has a history of diabetes mellitus. She uses alcohol rarely. On abdominal CT scan, the liver is slightly enlarged and shows uniform decreased attenuation. Laboratory findings show: serum total protein 7.0 g/dL, albumin 3.8 g/dL, alkaline phosphatase 62 U/L, AST 87 U/L, ALT 84 U/L, total bilirubin 1.2 mg/dL, and direct bilirubin 0.8 mg/dL:

3. A 38-year-old woman has had nausea for the past week. On examination she has scleral icterus and a slightly increased liver span. Laboratory studies show total protein 5.5 g/dL, albumin 3.1 g/dL, total bilirubin 6 mg/dL, AST 109 U/L, ALT 122 U/L, and alkaline phosphatase 62 U/L. Serologic studies show HBsAg positive and HBeAg positive:

4. A 48-year-old man has sudden severe hematemesis. Upper GI endoscopy shows ruptured esophageal varices:

5. A 66-year-old man has weight loss of 4 kg and malaise for 4 months. One examination his liver span is increased. Laboratory studies show AST 30 U/L, ALT 25 U/L, total bilirubin 1 mg/dL, and alkaline phosphatase 199 U/L. CT imaging of his abdomen shows a solitary irregular 11 cm mass in the right lobe of his liver:

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A. Apoptosis B. Central venular sclerosis C. Centrilobular congestion D. Cholangiocarcinoma
E. Cholangitis F. Cholestasis G. Granulomatous bile duct destruction H. Hemosiderin deposition
I. Hepatocellular carcinoma J. Macrovesicular steatosis K. Mallory bodies L. Metastatic adenocarcinoma
M. Neutrophilic infiltration N. Periportal PAS-positive globules O. Interface hepatitis P. Portal fibrosis
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