Contributed by Michael A. Nalesnik, M.D.
Per referral patient history, the patient is a 42-year-old male with a chief complaint of bloating x 1 1/2 weeks. The patient has a history of psoriasis and seizures complaining of occasional lower abdominal pain and abdominal bloating beginning approximately one and a half weeks ago. The patient reports a decreased appetite for the same amount of time. Possible yellow skin per patient's mother, times one week. Positive dark, red urine, times one and a half weeks. Positive lower extremity swelling to hips on both sides for about the same amount of time. The patient denies any shortness of breath, nausea, vomiting, fever, chills, or night sweats. The patient is on Dilantin, 200 mg po BID and occasional Advil. He is allergic to codeine and penicillin. He smokes one pack per day x 24 years. The patient admits to eight beers a day x two years, but has a drinking history for the past 25 years. He has been in rehab once, not on his own accord. He denies shakes or withdrawal. He has periods of no ETOH. He denies IV drug use, but states he has used marijuana, cocaine and LSD in his adolescence. Review of outside material.

Final Diagnosis (Case 66)


The histologic features suggest cirrhosis secondary to steatohepatitis. A possible etiology of this patient's steatohepatitis is alcohol use as documented in his clinical history. Additional underlying biliary disease is less likely but cannot be entirely ruled out and clinical evaluation would be necessary to document this. The florid ductular proliferation appears to be associated with the underlying liver injury and does not appear to represent a neoplasm.

Previous Biopsies on this Patient:

TPIS Related Resources:
Liver Transplant Topics

Gross Description - Case 66

The specimen consists of one (1) consult slide and one (1) paraffin block with an accompanying surgical pathology report and patient history.

Microscopic Description - Case 66

(1 HE) The liver needle core biopsy shows distortion by nodules surrounded by extensive fibrosis. The fibrous septae show mild mixed inflammation consisting of neutrophils, lymphocytes, rare histiocytes and rare plasma cells. The septae show extensive cholangiolar proliferation. There is mild interface activity. Cholestasis is present near the limiting plate. The lobules show pericellular fibrosis and scattered neutrophils. These neutrophils in some areas surround swollen degenerating hepatocytes. Some of the swollen hepatocytes show Mallory's hyaline. Some areas suggestive of scar like fibrosis are seen within the fibrous septae.

Please mail comments, corrections or suggestions to the TPIS administration at the UPMC.