28
Liver and Pancreas
Fig. 28.8 Hydatid cyst of the liver. Fragments of laminated layer of the
cyst wall in a dirty background with debris. FNA smear (Romanowsky x LP).
Fig. 28.9 Hydatid cyst of the liver. Detached hooklets and calcareous
corpuscles embedded in the debris. FNA smear (Papanicolaou x OI).
identified. They have small, vesicular nuclei and vacuolated cyto-
plasm that usually contains some phagocytosed red blood cells.
The cytologic findings of the aspirate from an abscess plus the
gross appearance of the aspirated material are certainly consist-
ent with an amebic abscess. In the diagnosis of amebic abscess,
the indirect hemagglutination test is highly sensitive and can be
used to confirm the cytologic diagnosis.
Pyogenic Abscess
Most abscesses of the liver are of a bacterial, pyogenic origin. The
symptoms may be rather subtle. Pyogenic abscesses are caused
by bacterial infections through ascension of the biliary tract (in
cases of acute cholangitis), through the portal vein (in cases
of pylephlebitis, often a complication of acute appendicitis),
by means of a hepatic artery (in cases of septicemia), by direct
Fig. 28.10 Hydatid cyst of the liver. A scolex that has many hooklets. FNA
smear (Papanicolaou x OI).
extension (in cases of subphrenic abscess), or by trauma. They
may be single or multiple. Suppurative abdominal disease with
or without pylephlebitis may result in septic emboli, giving
rise to liver abscesses. These most often occur in the right lobe
when the suppurative disorder is drained by the right superior
mesenteric vein, whereas disease in the left side of the abdomen
may cause suppuration in one or both sides. Abscesses of the
liver are occasionally caused by
Actinomyces israelii.
Cytology
Fine-needle aspiration smears from a pyogenic abscess con-
tain a heavy neutrophilic inflammatory exudate and nuclear
debris. Necrotic hepatocytes are usually not seen. The aspirate
is purulent-looking and foul-smelling. Material aspirated from
an actinomycotic abscess contains numerous neutrophils and
phagocytic macrophages. Reactive fibroblasts are abundant. The
organisms in the lesions occur as colonies (granules) composed
of delicate, branching, intertwined, gram-positive filaments with
granular, basophilic centers.
Granulomas
The causes of granulomas of the liver include infectious diseases
(e.g. tuberculosis, schistosomiasis, brucellosis, and histoplas-
mosis), drug sensitivity, foreign body reaction (e.g. intravenous
talc granulomatosis), and sarcoidosis. Tuberculous and sarcoid
granulomas are the most common. Intravenous talc granulo-
matosis occurs in narcotic addicts and is caused by intravenous
injection of drugs that contain talc. Narcotic addicts may inad-
vertently inject talc into their body in two ways.
1. H e ro in b o u g h t fro m a "s tre e t p u s h e r" m a y be d ilu te d
w ith a substance th a t appears s im ila r to th e drug. Talc is
o fte n used.
2. In tra v e n o u s in je c tio n o f crushed tab lets th a t are in te n d e d
o n ly fo r o ra l a d m in is tra tio n is n o t an u n c o m m o n prac-
tice a m o n g n a rc o tic addicts. Talc m a y be used as a fille r
substance. T h e ta lc crystals lod g e in th e p a re n ch ym a o f
th e lun g s a nd liv e r and cause g ra n u lo m a to sis .
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