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====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. | 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> |
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