Contributed by Randall G. Lee M.D.
PATIENT HISTORY: Per referral report, the patient is a 40-year-old male with history of alcoholism. High ANA levels; now with jaundice. R/O alcoholic liver disease versus autoimmune chronic hepatitis. Jaundice and abnormal liver tests. Review of outside material.

Final Diagnosis (Case 35)

  2. NO SPECIFIC ETIOLOGIC CLUES IDENTIFIED (see microscopic description).

Previous Biopsies on this Patient:

TPIS Related Resources:
Knodell Scoring
Liver Transplant Topics

Gross Description - Case 35

The specimen consists of four (4) consult slides and one (1) paraffin block with an accompanying surgical pathology report.

Microscopic Description - Case 35

The liver biopsy shows a well-established cirrhosis with generally small parenchymal nodules bounded by dense zones of collapse and fibrosis. The fibrous septa contain minor, predominantly mononuclear infiltrate, together with dense zones of proliferated ductules; plasma cells are rare. In addition are several areas of paucicellular fibrosis, some of which are associated with apparent obliterated central veins, and rare interlobular bile ducts appear sclerotic. The parenchymal nodules show mild hepatocyte swelling with occasional focal necrosis, and minor piecemeal necrosis. Occasional nodules show slight swelling of the periseptal hepatocytes with interdigitating loose connective tissue. No steatosis, active steatohepatitis, ground glass hepatocytes, viral inclusions, cytoplasmic globules, or pigment deposition is seen.

Overall, the changes are those of an end-stage cirrhosis, and there are few clues to its etiology. On the basis of the micronodularity and foci of dense paucicellular fibosis, inactive alcoholic cirrhosis would be a likely diagnosis. The lack of substantial inflammation argues against autoimmune hepatitis, assuming that the patient has not been receiving immunosuppressive therapy. Finally, some of the features raise the possibility of an underlying biliary obstruction, and, if clinically indicated, biliary imaging might be useful in excluding this possibility.

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