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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