Description
Clinical History
An 85-year old male 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 a transurethral prostate resection but died from pneumonia 5 days post-operative.
Pathology
The specimen is a slice of liver mounted to display the cut surface. The capsule is slightly thickened and the liver substance has a finely nodular appearance. Intrahepatic bile ducts are dilated. When the posterior or inferior surface is viewed an irregular pigmented calculus, 10 mm in diameter, is seen impacted in a distended hepatic duct. Another smaller calculus 3 mm in diameter has been dislodged. This specimen represents an example of secondary biliary cirrhosis due to large duct obstruction from hepatic calculi.
Further Information
Hepatolithiasis is characterized by the presence of intrahepatic gallstones. These calculi can lead to cholangitis, progressive hepatocyte atrophy and destruction, and an increased risk of cholangiocarcinoma. It is common in East Asia but rare in Western countries. There is no difference in incidence between genders. The stones are most commonly made up of pigmented calcium bilirubinate stones.
These stones cause intrahepatic bile duct obstruction. Proximal to the obstructing stone distension and dilation of the bile ducts is evident. There is also bile duct proliferation at the portal-parenchymal interface with stromal oedema and infiltrating neutrophils, indicating an acute-chronic inflammation. If untreated this inflammation leads to periportal fibrosis and eventually obstructive biliary cirrhosis. Microscopic appearance would show feathery degeneration of periportal hepatocytes, cytoplasmic swelling often with Mallory Denk bodies (i.e. an inclusion found in the cytoplasm of liver cells with twisted-rope appearance caused by damaged intermediate filaments within the hepatocytes) and bile infarcts from extravasated bile. Chronic inflammation can lead to biliary dysplasia which may develop into cholangiocarcinoma.
Patients may present with repeated cholangitis, intermittent abdominal pain, jaundice or frequently no symptoms. Treatment is usually surgical removal of the calculi.
Advantages
- Anatomically accurate and identical to real specimen
- No ethical issues - not real human body parts
- Reasonably priced
- Available within a short lead time
- Reproducible, several identical prints can be used as a classroom set
- Can be produced in different sizes to cater for the needs of the teacher
Human Cadavers
- Access to cadavers can be problematic. Many countries cannot access cadavers for cultural and religious reasons
- Cadavers cost a lot money
- High cost for establishing your own plastination suite
- Wet specimens cannot be used in uncertified labs
- Dissection of cadavers is a lot of staff time and that is a cost
- Storage of cadaver material needs special refrigeration etc. which has coast
- If you want another specimen you have to start all over again
Plastinates
- Costs
- Ethical issues
- Timeframe for plastination process
- Many countries do not allow their importation
- One of a kind
Superior 3D print results compared with conventional methods
- Vibrant color offering with 10 million colors
- UV-curable inkjet printing
- High quality 3D printing that can create products that are delicate, extremely precise and incredibly realistic
Clear Support Material
- To avoid breakage of fragile, thin, and delicate arteries, veins or vessels, a clear support material is printed on such spots. This makes the models robust and can be handled by students easily.
