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Difference between revisions of "Talk:Medical liver disease"
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Talk:Medical liver disease (view source)
Revision as of 17:39, 2 December 2013
, 17:39, 2 December 2013→Minimal activity - hepatitis C
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====Comment==== | ====Comment==== | ||
The histomorphologic findings (cholestasis, fibrosis and steatosis) are compatible changes seen in total parenteral nutrition (TPN). | The histomorphologic findings (cholestasis, fibrosis and steatosis) are compatible with changes seen in total parenteral nutrition (TPN). | ||
== Glycogen storage disease == | == Glycogen storage disease == | ||
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====Comment==== | ====Comment==== | ||
The periportal predominant fibrosis, diffuse hepatocyte distension with whispy and pale cytoplasm, and non-membrane bound electron dense (glycogen-like) material, are suggestive of glycogen storage disease type III (Cori disease). | The periportal predominant fibrosis, diffuse hepatocyte distension with whispy and pale cytoplasm, and non-membrane bound electron dense (glycogen-like) material, are suggestive of glycogen storage disease type III (Cori disease). | ||
== Possibly PSC == | |||
===Microscopic=== | |||
The specimen has an adequate length (>2.0 cm) but contains only six complete portal tracts (11-15 desired). | |||
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 (Laennec inflammation Grade 0/IV). 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. | |||
==Steatohepatitis & viral hepatitis== | |||
===Microscopic=== | |||
<pre> | |||
Size of biopsy: Adequate | |||
Fragmentation: Absent | |||
Fibrosis: Stage 2-3/4, mostly stage 2 | |||
Fibrous septa: Present | |||
Septa with curved contours: Present – focally only | |||
Large droplet steatosis (% of hepatocytes): Present, moderate 60% | |||
Ballooning of hepatocytes: Present, rare | |||
Mallory-Denk bodies: Present, rare | |||
Portal inflammation: Present | |||
Interface activity: Minimal (0-1/4) | |||
Lobular necroinflammation: Minimal | |||
Ducts: Present in normal numbers | |||
Duct injury: Absent | |||
Ductular reaction: Absent | |||
Cholestasis: Absent | |||
Terminal hepatic venules: Present | |||
Iron stain: Absent | |||
Ground glass cells with routine stains: Absent | |||
PASD for alpha-1 antitrypsin droplets: Negative | |||
</pre> | |||
===Final diagnosis=== | |||
<pre> | |||
Liver (random) medical core biopsies: | |||
- Liver with minimal chronic hepatitis (grade 0-1/4), with moderate fibrosis (stage 2-3/4). | |||
- Minimal steatohepatitis. | |||
- Moderate steatosis. | |||
</pre> | |||
== Possible drug-induced hepatitis == | |||
===Final diagnosis=== | |||
Liver (random) medical core biopsies: <br> | |||
- Liver with mild steatosis. <br> | |||
- Marked fibrosis (stage 3 of 4). <br> | |||
- Negative for steatohepatitis. <br> | |||
- Scattered eosinophils in the portal tracts, see comment. <br> | |||
====Comment==== | |||
The findings are consistent with a resolving steatoheptitis. | |||
The eosinophils in the portal tracts raise the possibility of a drug-induced or herbal-induced hepatitis. The use of ibuprofen is noted in the clinical history; however, this is not typically associated with steatosis. | |||
==Minimal activity - hepatitis C== | |||
<pre> | |||
LIVER, CORE BIOPSIES: | |||
- LIVER WITH MINIMAL CHRONIC HEPATITIS (GRADE 0-1/4), WITH | |||
MILD FIBROSIS (STAGE 1-2/4). | |||
- MINIMAL STEATOSIS. | |||
</pre> | |||