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Difference between revisions of "Autoimmune hepatitis"
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Autoimmune hepatitis (view source)
Revision as of 21:01, 30 September 2021
, 21:01, 30 September 2021PBC -> change to newer term
(PBC -> change to newer term) |
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| Micro = interface hepatitis with plasma cells, +/- bile duct injury | | Micro = interface hepatitis with plasma cells, +/- bile duct injury | ||
| Subtypes = | | Subtypes = | ||
| LMDDx = [[viral hepatitis]], [[primary biliary | | LMDDx = [[viral hepatitis]], [[primary biliary cholangitis]], AIH-[[PBC]] overlap, [[PSC]]-AIH overlap, [[drug reaction]] | ||
| Stains = | | Stains = | ||
| IHC = | | IHC = | ||
| Line 26: | Line 26: | ||
| Prognosis = poor without treatment | | Prognosis = poor without treatment | ||
| Other = | | Other = | ||
| ClinDDx = [[primary biliary | | ClinDDx = [[primary biliary cholangitis]], [[primary sclerosing cholangitis]] | ||
| Tx = corticosteroids, immunosuppression, liver transplant (end stage) | | Tx = corticosteroids, immunosuppression, liver transplant (end stage) | ||
}} | }} | ||
| Line 107: | Line 107: | ||
*[[Viral hepatitis]] - should have plasma cells. | *[[Viral hepatitis]] - should have plasma cells. | ||
*[[Drug-induced liver injury]] - milder changes than AIH, portal [[neutrophil]]s and [[cholestasis]].<ref>{{Cite journal | last1 = Suzuki | first1 = A. | last2 = Brunt | first2 = EM. | last3 = Kleiner | first3 = DE. | last4 = Miquel | first4 = R. | last5 = Smyrk | first5 = TC. | last6 = Andrade | first6 = RJ. | last7 = Lucena | first7 = MI. | last8 = Castiella | first8 = A. | last9 = Lindor | first9 = K. | title = The use of liver biopsy evaluation in discrimination of idiopathic autoimmune hepatitis versus drug-induced liver injury. | journal = Hepatology | volume = 54 | issue = 3 | pages = 931-9 | month = Sep | year = 2011 | doi = 10.1002/hep.24481 | PMID = 21674554 }}</ref> | *[[Drug-induced liver injury]] - milder changes than AIH, portal [[neutrophil]]s and [[cholestasis]].<ref>{{Cite journal | last1 = Suzuki | first1 = A. | last2 = Brunt | first2 = EM. | last3 = Kleiner | first3 = DE. | last4 = Miquel | first4 = R. | last5 = Smyrk | first5 = TC. | last6 = Andrade | first6 = RJ. | last7 = Lucena | first7 = MI. | last8 = Castiella | first8 = A. | last9 = Lindor | first9 = K. | title = The use of liver biopsy evaluation in discrimination of idiopathic autoimmune hepatitis versus drug-induced liver injury. | journal = Hepatology | volume = 54 | issue = 3 | pages = 931-9 | month = Sep | year = 2011 | doi = 10.1002/hep.24481 | PMID = 21674554 }}</ref> | ||
*[[Primary biliary | *[[Primary biliary cholangitis]]. | ||
*AIH-PBC overlap. | *AIH-PBC overlap. | ||
*PSC-AIH overlap. | *PSC-AIH overlap. | ||
===Images=== | ===Images=== | ||
Table show [[AIH-nonCIR]] | |||
{| | |||
[[File:1 AIH 2 680x512px.tif|Expanded portal regions with dull edges suggestive of interface hepatitis (40X).]] | |||
[[File:2 AIH 2 680x512px.tif|PAS without diastase shows interface hepatitis (200X).]] | |||
[[File:3 AIH 2 680x512px.tif|Abundant plasma cells seen at higher power (400X).]] | |||
[[File:4 AIH 2 680x512px.tif|PAS with diastase shows intense inflammation of portal triad stroma, with some reduplication of ductal epithelium. The patient’s vial serology and anti-microbial antibody were negative. (200X).]] | |||
|} | |||
Autoimmune hepatitis. Expanded portal regions with dull edges suggestive of interface hepatitis (UL 40X). PAS without diastase shows interface hepatitis (UR 200X). Abundant plasma cells seen at higher power (LL 400X). PAS with diastase shows intense inflammation of portal triad stroma, with some reduplication of ductal epithelium. The patient’s vial serology and anti-microbial antibody were negative. (LR 200X). | |||
Table show [[AIH-CIR]] | |||
{| | |||
[[File:CIrrhosis Mult Cause - 1 - 400X 1369x1024px shot 04.tif|Trichrome shows blue fibrosis about hepatocyte nodules]] | |||
[[File:CIrrhosis Mult Cause - 1 - 400X 1369x1024px shot 01.tif|Inflammation includes occasional plasma cells (yellow arrowhead)]] | |||
[[File:CIrrhosis Mult Cause - 1 - 400X 1369x1024px shot 02.tif|Ballooning degeneration is present]] | |||
[[File:CIrrhosis Mult Cause - 1 - 400X 1369x1024px shot 03.tif|PAS without diastase shows piecemeal necrosis (not very good on wedge biopsies in my experience)]] | |||
|} | |||
Chronic hepatitis with changes of autoimmune hepatitis and with cirrhosis and steatosis. Trichrome shows blue fibrosis about hepatocyte nodules with steatosis (UL, 40X). Inflammation includes occasional plasma cells (UR, 400X, yellow arrowhead at plasma cell), consistent with history of autoimmune hepatitis. Ballooning degeneration is present (LL, 400X). PAS without diastase shows piecemeal necrosis, (LR, 400X). The patient had also had diabetes. | |||
<gallery> | <gallery> | ||
Image:Autoimmune_hepatitis_-_low_mag.jpg | AIH - low mag. (WC) | Image:Autoimmune_hepatitis_-_low_mag.jpg | AIH - low mag. (WC) | ||
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serology is suggested, if not done. | serology is suggested, if not done. | ||
The histology is not suggestive of primary biliary | The histology is not suggestive of primary biliary cholangitis. | ||
</pre> | </pre> | ||