By Christopher D. M. Fletcher, Philip H. McKee
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A,' . ,. ,. ,a ' ,,",' ~'. " . 12 Hepatic amyloid deposition. The liver parenchyma, originally rather waxy in appearance, has been stained with Congo Red to show extensive deposition of amyloid, particularly in the mid-zone of the lobules. Hepatic amyloidosis is most often secondary in type, being composed of serum amyloid A protein. Common' causes of secondary amyloidosis include chronic infection or chronic inflammatory disorders such as rheumatoid arthritis. While the liver may become enlarged and firm , functional impairment is rare despite a degree of parenchymal atrophy.
Malignant transformation is illdlf " , IIIH Fig. 4 Pharyngeal pouch. The pharynx has been opened posteriorly to show a diverticulum extend ing laterally. A pharyngeal pouch is a pulsion diver ticulum which occurs at Killian's dehiscence, due to neuromuscular in coordination of the pharyngeal con strictor muscles. Elderly males are predominantly affected and very occasionally post cricoid carcinoma may develop in such a pouch . 'i 1tllllll,hagu8 - peptic (Barrett's) ulcer. A sharply demar , II" ' I I,IIul norrh agic base is present in the lower third of I!
Currentl y fa voured aetiologic al agents are nitros amines, derived from ingested nitrates which are used in preserva tives and crop fertilisers. Known predisposing conditions include chronic atrophic gastritis and uncommonly, gastric adenomata. Macroscopically, ulcerating tumours are far more common than the fungating or polypoid forms. Fig. 21 Linitis plastica ('leather-bottle' stomaoh), has been dissected to show diffuse infiltration of II JlII I " curve by pale, rigid tumour, resulting in shrinka( JI' 01" " lumen .