Talk:Medical liver disease

TPN

Microscopic description

The specimen consists of liver cores with at least twelve partial portal tracts. There is a moderate macrovesicular steatosis without clear zonation. There are no mallory bodies.

There is marked cholestasis and focal hepatocyte enlargement with nuclear pyknosis and karyolysis (feathery degeneration). There is no interface inflammation or lobular inflammation and only mild portal inflammation, that is predominantly mononuclear. There is a suggestion of scant, mild iron deposition at high power and mild-to-moderate periportal copper deposition. There is no obvious bile duct injury on routine stains. Cytokeratin staining (panker) demonstrates bile ductular proliferation. There is marked fibrotic portal expansion, with thick fibrous septa. There are rare rounded septa, suggestive of focal nodule formation; Laennec fibrosis stage is II-III / IV. The PAS and PAS-D stains are non-contributory.

Final diagnosis

Liver, core biopsy -
i) Macrovesicular steatosis, moderate.
ii) Cholestasis with bile ductule proliferation.
iii) Moderate-to-marked fibrosis, periportal; Laennec fibrosis stage II-III / IV.

See diagnosis comment.

Comment

The histomorphologic findings (cholestasis, fibrosis and steatosis) are compatible changes seen in total parenteral nutrition (TPN).