Contributed by Michael Nalesnik, M.D.
PATIENT HISTORY: Per referral report, the patient is a 69-year-old female. S/P liver transplant. Review of outside material.

Final Diagnosis (Case 33)

ALLOGRAFT LIVER, NEEDLE BIOPSY -
  1. LOBULAR REACTIVITY AND SPOTTY NECROSIS, COMPATIBLE WITH PRIOR HISTORY OF CMV HEPATITIS.
    1. NO VIRAL INCLUSIONS SEEN ON ROUTINE HISTOLOGIC PREPARATION OR BY IMMUNOHISTOCHEMISTRY STAINING.
  2. MINIMAL COMPONENT OF ACUTE CELLULAR REJECTION (RAI 2-3/9).

Previous Biopsies on this Patient:
None

TPIS Related Resources:
Liver Allograft Rejection Grading
Liver Transplant Topics

Gross Description - Case 33

The specimen consists of a vial of liver tissue in formalin, approximately 2.0 cm. in length with an accompanying surgical pathology report.

Microscopic Description - Case 33

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) (X)YES ( )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 ( )Portal ( )Central (X)Both
6. Fibrosis (check one under each category)
6.1 Portal ( )None (X)Mild ( )Moderate ( )Severe (bridging)
6.2 Central ( )None (X)Mild ( )Moderate ( )Severe (bridging)
6.3 Arch. dist. (X)None ( )Mild ( )Moderate ( )Severe
7. Lobular Disarray / Ballooning ( )None (X)Mild ( )Moderate ( )Severe
8. Necrosis (check one under each category)
8.1 Piecemeal or bridging ( )None (X)Mild ( )Moderate ( )Severe
8.2 Infarct (ischemia) ( )YES (X)No
8.3 Other necrosis (X)YES ( )No
8.4 Central lobular (X)YES ( )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 ( )None ( )Mild (X)Moderate ( )Severe
11.2 Location ( )N/A ( )Perivenular ( )Panlobular (X)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) (1)
12.4 Total Score (RAI = 3/9)

Scattered single Councilman-type bodies are seen. Viral inclusions are not appreciated on routine stain. Focal spotty inflammation is also noted. Portal inflammation shows minimal involvement of portal structures with prominent ductular proliferation at sites. Some piecemeal necrosis is seen, evidenced as single Councilman bodies at the limiting plate area.

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