Contributed by Randall G. Lee, M.D.
PATIENT HISTORY:
Per referral letter, the patient is a middle aged woman with elevated alkaline phosphatase and minor elevation of transaminases. Mitochondrial antibodies are negative. No medications, history of hepatitis, or known malignancy. Review of outside material.

Final Diagnosis (Case 71)


LIVER, NEEDLE BIOPSY -
  1. PROMINENT BILE DUCTULAR PROLIFERATION AND ASSOCIATED PORTAL INFLAMMATION, CONSISTENT WITH LOW GRADE BILIARY OBSTRUCTION.
  2. PORTAL AND PERIPORTAL FIBROSIS.

    Comment:
    The portal tract changes strongly suggest low grade biliary obstruction, such as with primary sclerosing cholangitis or a duct stricture. If clinically indicated, cholangiography should consequently be performed to clarify the presence and level of obstruction and establish the diagnosis.

Previous Biopsies on this Patient:
None

TPIS Related Resources:
Liver Transplant Topics

Gross Description (Case 71)


The specimen consists of two (2) consult slides and one (1) paraffin block with an accompanying surgical pathology report.

Microscopic Description (Case 71)


The liver biopsy shows hepatic architecture distorted by expanded fibrotic portal tracts with early portal/portal fibrous bridges forming. There is a mixed inflammatory infiltrate that includes patchy mononuclear cells together with numerous eosinophils and neutrophils. This is associated with prominent ductular proliferation. No duct loss is identified and no florid duct lesions are seen. Two medium sized bile ducts are sampled and these show mild accentuation of the periductal fibrous tissue, but are not indicative of a fibroobliterative lesion. The lobules show a mild reactive lobular inflammation.

The changes suggest low grade biliary obstruction such as resulting from primary sclerosing cirrhosis or bile duct stricturing. Cholangiography should establish the diagnosis. Primary biliary cirrhosis is a much less likely possibility given the histologic features.

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