Contributed by Anthony J. Demetris, M.D.
PATIENT HISTORY:
This patient is a 68-year-old white female. Status post orthotopic liver transplant 12/92 for PNCC. Now with increased liver function tests and renal failure. PRE-OP DIAGNOSIS: Not given. POST-OP DIAGNOSIS: Not given. PROCEDURE: Not given.

Final Diagnosis (Case 62)


ALLOGRAFT LIVER, NEEDLE BIOPSY -
  1. CHANGES SUGGESTIVE OF LARGE DUCT OBSTRUCTION OR STRICTURING.
  2. SPOTTY ACIDOPHILIC NECROSIS OF HEPATOCYTES (report of CMV stain to follow).
  3. MINIMAL TO NO EVIDENCE OF ACUTE REJECTION (RAI 1/9).

Previous Biopsies on this Patient:
None

TPIS Related Resources:
Liver Transplant Topics

Gross Description - Case 62


The specimen is received in formalin labeled "liver biopsy". Received are three cores of yellow-orange rubbery tissue 0.3, 0.9, and 2.3 cm. in length. Each is 0.1 cm. in diameter. The cores are placed in a biopsy bag and entirely submitted for stat processing labeled ALB.

Microscopic Description - Case 62


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 ( )YES (X)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 (X)None ( )Mild ( )Moderate ( )Severe
5.2 Location (X)N/A ( )Portal ( )Central ( )Both
6. Fibrosis (check one under each category)
6.1 Portal ( )None (X)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 ( )None (X)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 (X)YES ( )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 ( )None (X)Mild ( )Moderate ( )Severe
11.2 Location ( )N/A ( )Perivenular (X)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) (0)
12.3 Venous endothelial inflammation (0-3) (0)
12.4 Total Score (RAI = 1/9)

Mild portal edema with portal eosinophilia and spotty acidophilic necrosis of hepatocytes with ceroid-laden macrophages.

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