Contributed by Michael A. Nalesnik, M.D.
PATIENT HISTORY:
Per referral, the patient is a 45-year-old male. S/P liver transplant. Review of outside material.

Final Diagnosis (Case 73)


ALLOGRAFT LIVER, NEEDLE BIOPSY -
    CHRONIC DUCT INJURY WITH CHOLESTASIS AND EARLY DUCT LOSS, CONSISTENT WITH EARLY CHRONIC REJECTION.

Previous Biopsies on this Patient:
None

TPIS Related Resources:
Liver Transplant Topics

Gross Description (Case 73)


The specimen consists of nine (9) consult slides and one (1) paraffin block. No surgical pathology report is received with the specimen.

Microscopic Description (Case 73)


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 (X)YES ( )NO
2.4.1 If BD loss, total number of triads (15)
2.4.2 If BD loss, number of triads w/o ducts ( 6)
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 (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 (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 (X)YES ( )No
8.4 Central lobular ( )YES (X)No
9. Cholestasis (X)YES ( )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 ( )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) (0)
12.4 Total Score (RAI = 2/9)

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