Contributed by A.J. Demetris, M.D.
PATIENT HISTORY: The patient is a middle-aged female with end-stage liver disease due to hepatitis C, status post orthotopic liver transplant approximately 6 months ago. Currently, her hepatitis C viral load is markedly elevated and a current biopsy shows definite features of acute rejection as well as worsening hepatocellular changes.

Final Diagnosis (Case 103)

PART 1: LIVER ALLOGRAFT, NEEDLE BIOPSY -
  1. CHANGES MOST CONSISTENT WITH THE LOBULAR PHASE OF RECURRENT HEPATITIS C (See microscopic description).
  2. INDETERMINATE FOR ACUTE REJECTION (RAI = 2/9).


Microscopic Description - (Case 103)

(1 H&E, 1 Trichrome)
The specimen consists of several long needle core biopsies of liver. The normal lobular architecture is intact. Some of the portal tracts are mildly expanded because of a mild mononuclear inflammatory cell infiltrate. No portal or central venulitis is seen. Bile ducts show some evidence of damage, but many are relatively unremarkable and do not show reactive changes.

There is mild focal interface activity.

Throughout the lobules there is prominent Kupffer' s cell hypertrophy, mild lobular disarray, a noticeable increase in sinusoidal inflammatory cells and spotty acidophilic necrosis of hepatocytes. Mild hepatocellular swelling is also seen. No viral inclusions or ground glass cells are seen.

Overall, the histopathological changes are most consistent with the lobular phase of recurrent hepatitis C. This contention is based on the time after transplantation, the relatively high levels of virus in the blood, and the histopathological features. More specifically, the lobular changes predominate over those seen in the portal tracts. While portal tract inflammation is present and there is focal bile duct damage, many other ducts are relatively normal in appearance, and particularly, they do not show reactive changes as might be observed with a more significant rejection reaction. While I cannot exclude a mild component of rejection, it is my opinion that the hepatitic component is the more significant finding at this time.

TPIS Related Resources:
Hepatitis C in the Liver Allograft Recipient


Gross Description - (Case 103)

Received for consultation two (2) consult slides along with an accompanying surgical pathology report and cover letter.


Photomicrographs - (Case 103)

Trichrome overview PAS


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