Contributed by Randall G. Lee, M.D.
PATIENT HISTORY: Per referral report, the patient is a 67-year-old female with abnormal liver enzymes. S/P liver transplant. Review of outside material.

Final Diagnosis (Case 8)

ALLOGRAFT LIVER, NEEDLE BIOPSY -
  1. FOCAL MILD PORTAL INFLAMMATION AND BILE DUCT INJURY.

COMMENT:

The changes are minor and could be consistent with minimal acute rejection or with a bile duct stricture or other biliary problem. Correlation with clinical and laboratory data is necessary.

Previous Biopsies on this Patient:
NONE

TPIS Related Resources:
Liver Allograft Biopsy Rejection Criteria
Liver Transplant Topics

Gross Description - Case 8

The specimen consists of two (2) consult slides with an accompanying surgical pathology report.

Microscopic Description - Case 8

BANFF SCORING OF LIVER ALLOGRAFT BIOPSIES

1. Histological Evaluation
1.1 More than 4 portal triads (X)YES ( )NO
1.2 Specimen o/w adequate (X)YES ( )NO
2. Portal Tract (check one uner each category)
2.1 Overall Inflammatory Intensity ( )None (X)Mild ( )Moderate ( )Severe
2.2 Bile duct inflammation / damage (X)YES ( )NO
2.3 Granuloma(s) ( )YES (X)NO
2.4 Bile duct loss ( )YES (X)NO
2.4.1 If BD loss, total number of triads ( )
2.4.2 If BD loss, number of triads w/o ducts ( )
2.5 Bile duct / cholangiolar proliferation (in any portal tract) ( )YES (X)NO
3. Inflammatory or Necrotizing Arteritis ( )YES (X)NO
4. Obliterative Arteriopathy ( )YES (X)NO
5. Subendothelial Inflammation
5.1 Severity ( )None (X)Mild ( )Moderate ( )Severe
5.2 Location ( )N/A (X)Portal ( )Central ( )Both
6. Fibrosis (check one under each category)
6.1 Portal (X)None ( )Mild ( )Moderate ( )Severe (bridging)
6.2 Central (X)None ( )Mild ( )Moderate ( )Severe (bridging)
6.3 Arch. dist. (X)None ( )Mild ( )Moderate ( )Severe
7. Lobular Disarray / Ballooning (X)None ( )Mild ( )Moderate ( )Severe
8. Necrosis (check one under each category)
8.1 Piecemeal or bridging (X)None ( )Mild ( )Moderate ( )Severe
8.2 Infarct (ischemia) ( )YES (X)No
8.3 Other necrosis ( )YES (X)No
8.4 Central lobular ( )YES (X)No
9. Cholestasis ( )YES (X)NO
10. Fat (X)None ( )Mild ( )Moderate ( )Severe
10.1 Type ( )Micro ( )Macro ( )Mixed (X)N/A
11. Lobular Inflammation (check one under each category)
11.1 Severity (X)None ( )Mild ( )Moderate ( )Severe
11.2 Location ( )N/A ( )Perivenular ( )Panlobular ( )Random / Focal
11.3 Granulomatous ( )YES (X)NO
12. Rejection Activity Index (RAI) Range Score
12.1 Portal inflammation (0-3) (1)
12.2 Bile duct inflammation / damage (0-3) (1)
12.3 Venous endothelial inflammation (0-3) (0)
12.4 Total Score (RAI = 2/9)

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