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Drug-induced liver disease (view source)
Revision as of 18:45, 27 December 2016
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Focal hepatocyte necrosis. Drug induced liver injury (DILI) In 44 yo woman with normal bilirubin, elevated alkaline phopatase (323), slightly increased ALT (87). The patient had been taking antidepressants, which are known to have a low risk of liver injury, most commonly idiosyncratic,. A Low power shows normal triads (green arrows), in contrast to the spot of inflammation (cyan arrow).B. The spot at higher power is a granuloma not in a triad, the only such granuloma identified. C. Occasional triads show inflammation comprising mostly eosinophils. D. Occasional other foci of spotty necrosis were identified. E. Reticulin stain showed rare foci of regeneration (arrows), but no piecemeal necrosis. | Focal hepatocyte necrosis. Drug induced liver injury (DILI) In 44 yo woman with normal bilirubin, elevated alkaline phopatase (323), slightly increased ALT (87). The patient had been taking antidepressants, which are known to have a low risk of liver injury, most commonly idiosyncratic,. A Low power shows normal triads (green arrows), in contrast to the spot of inflammation (cyan arrow).B. The spot at higher power is a granuloma not in a triad, the only such granuloma identified. C. Occasional triads show inflammation comprising mostly eosinophils. D. Occasional other foci of spotty necrosis were identified. E. Reticulin stain showed rare foci of regeneration (arrows), but no piecemeal necrosis. | ||
[[File:4 40824578186586 sl 1.png|Intrahepatic, nonobstructive cholestasis in a 9 week old, premature baby boy, due presumably to TPN]] | |||
[[File:4 40824578186586 sl 2.png|Intrahepatic, nonobstructive cholestasis in a 9 week old, premature baby boy, due presumably to TPN]] | |||
[[File:4 40824578186586 sl 3.png|Intrahepatic, nonobstructive cholestasis in a 9 week old, premature baby boy, due presumably to TPN]] | |||
[[File:4 40824578186586 sl 4.png|Intrahepatic, nonobstructive cholestasis in a 9 week old, premature baby boy, due presumably to TPN]] | |||
[[File:4 40824578186586 sl 5.png|Intrahepatic, nonobstructive cholestasis in a 9 week old, premature baby boy, due presumably to TPN]] | |||
[[File:4 40824578186586 sl 6.png|Intrahepatic, nonobstructive cholestasis in a 9 week old, premature baby boy, due presumably to TPN]] | |||
Intrahepatic, nonobstructive cholestasis in a 9 week old, premature baby boy with 9.7 mg/dl bilirubin. Most likely due to total parenteral nutrition required for his sustenance. A. Slightly edematous triad with somewhat dilated sinusoids, without inflammatory or neoplastic aggregates at low power. B. Bile filled cholangiolar spaces (green arrows) and pseudoacini (blue arrows). C. Foci of extramedullary hematopoiesis. D. Triads did not show the edema and peripheral bile ductular proliferation normally seen with obstructive cholestasis. E. CK7 shows preservation of bile duct plates. F. Reticulin shows interruption and disorganization of liver plates, consistent with isolated cell necrosis (at this age, the inflammatory foci responding to spotty necrosis on H&E are not seen). | |||
===Specific patterns=== | ===Specific patterns=== | ||