Talk:Liver pathology

Waffle on PSC

Microscopic

The specimen has an adequate length but contains only six complete portal tracts. There is mild periductal fibrosis (with a suggestion of an onion skin-like arrangement in one portal tract), mild periportal intrahepatocyte copper deposition, focal bile ductular proliferation, focal bile duct lymphocytic infiltration, and bile duct cell anisonucleosis. There is disruption of the hepatocyte plates and hepatocyte anisonucleosis, suggestive of a hepatocellular injury; however, there is no frank hepatocyte necrosis and the plate thickness is within normal limits.

There is no cholestasis, interface hepatitis, or portal or lobular inflammatory infiltrate. The PAS, PAS-D and Shikata stains are non-contributory. There is no fatty change of hepatocytes. The portal tracts have an irregular outline focally and occasional delicate periportal fibrous septae (Laennec fibrosis Stage I/IV).

Final diagnosis

Liver, core biopsy - Focal bile duct abnormalities without cholestasis and no significant inflammation, see comment.

Comment

The bile ducts have focal non-specific abnormalities without cholestasis that are not sufficient to diagnose primary sclerosing cholangitis (PSC). It is possible that this represents PSC, which is often patchy, and may have not been sampled in the relatively small number of portal tracts present in this biopsy. The histomorphologic findings are not compatible with autoimmune hepatitis.