DZI20-206-Case-13

liver tx bx #1 (Part A) (frozen slides 1, permanent slide 2) liver tx bx #2 (Part B) (frozen slide 3, permanent slide 4)

Frozen Part A: Liver with <10% macrovesicular steatosis and <20% macrovesicular steatosis. Note that tissue was placed in formalin prior to freezing; assessment might not be accurate.

Permanent Part A: Liver with patchy sinusoidal fibrosis (see note). Note: The biopsy demonstrates hepatic parenchyma with <10% macrovesicular steatosis. Evaluation of microvesicular steatosis is limited by frozen artifact. Diagnostic features of steatohepatitis are not present. Occasional portal tracts demonstrate mild expansion. No necrosis is present. A trichrome stain highlights patchy mild sinusoidal fibrosis throughout the lobules. Iron stain is negative for stainable iron, and a PAS/D stain is negative for PAS-positive globules.

Frozen Part B: Liver with <10% macrovesicular steatosis and <10% microvesicular steatosis, midzonal cholestasis, focal mild lymphocytic inflammation, bile ductular proliferation, and broad portal expansion with foci s/f bridging fibrosis.

Permanent Part B: Liver with cholestatic features, focal hepatocyte degeneration, and variable fibrosis (see note). Note: The biopsy demonstrates hepatic parenchyma with variable amounts of fibrosis, ranging from mild sinusoidal pericellular fibrosis to irregular expansion of portal tracts and areas of at least bridging fibrosis (trichrome stain examined). Cholestatic features are present. The portal tracts demonstrate a bile ductular reaction and accompanying non-specific mononuclear inflammation. A focus of hepatocyte degeneration is noted. Minimal (<5%) macrovesicular steatosis is present, without diagnostic features of steatohepatitis.

Comparison of H&E permanent sections and trichrome stains confirms that this biopsy (part B) demonstrates significantly more fibrosis than the initial biopsy (part A). These findings raise the possibility of global and regional differences in the extent of fibrosis within the liver.

December 31, 1969 7:00:00 PM

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Clinical history

liver tx bx #1 (Part A) (frozen slides 1, permanent slide 2) liver tx bx #2 (Part B) (frozen slide 3, permanent slide 4)

Diagnosis

Frozen Part A: Liver with <10% macrovesicular steatosis and <20% macrovesicular steatosis. Note that tissue was placed in formalin prior to freezing; assessment might not be accurate. Permanent Part A: Liver with patchy sinusoidal fibrosis (see note). Note: The biopsy demonstrates hepatic parenchyma with <10% macrovesicular steatosis. Evaluation of microvesicular steatosis is limited by frozen artifact. Diagnostic features of steatohepatitis are not present. Occasional portal tracts demonstrate mild expansion. No necrosis is present. A trichrome stain highlights patchy mild sinusoidal fibrosis throughout the lobules. Iron stain is negative for stainable iron, and a PAS/D stain is negative for PAS-positive globules. Frozen Part B: Liver with <10% macrovesicular steatosis and <10% microvesicular steatosis, midzonal cholestasis, focal mild lymphocytic inflammation, bile ductular proliferation, and broad portal expansion with foci s/f bridging fibrosis. Permanent Part B: Liver with cholestatic features, focal hepatocyte degeneration, and variable fibrosis (see note). Note: The biopsy demonstrates hepatic parenchyma with variable amounts of fibrosis, ranging from mild sinusoidal pericellular fibrosis to irregular expansion of portal tracts and areas of at least bridging fibrosis (trichrome stain examined). Cholestatic features are present. The portal tracts demonstrate a bile ductular reaction and accompanying non-specific mononuclear inflammation. A focus of hepatocyte degeneration is noted. Minimal (<5%) macrovesicular steatosis is present, without diagnostic features of steatohepatitis. Comparison of H&E permanent sections and trichrome stains confirms that this biopsy (part B) demonstrates significantly more fibrosis than the initial biopsy (part A). These findings raise the possibility of global and regional differences in the extent of fibrosis within the liver.

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