Contributed by Parmjeet S. Randhawa, M.D.
PATIENT HISTORY:
Per referral report, the patient is a 55-year-old male. S/P liver transplant four years ago. Now with abnormal liver function tests. R/O rejection versus Hepatitis C. Review of outside material.

Final Diagnosis (Case 80)

ALLOGRAFT LIVER, NEEDLE BIOPSY-
  1. RECURRENT HEPATITIS C, WITH MILD TO MODERATE INFLAMMATORY ACTIVITY, AND MILD PORTAL FIBROSIS (HAI = 10/22).
  2. FOCAL DUCT ATROPHY AND DUCT LOSS (2/16 PORTAL TRIADS); CHANGES INSUFFICIENT FOR THE DIAGNOSIS OF ACUTE REJECTION, BORDERLINE ACTIVITY, BANFF GRADE 0;(REJECTION ACTIVITY INDEX 1-2/9).

Previous Biopsies on this Patient:
None

TPIS Related Resources:
Liver Transplant Topics

Gross Description - Case 80

The specimen consists of six (6) consult slides labeled (3 HE, 1 trichrome, 1 reticulin, 1 iron) with an accompanying surgical pathology report.

Microscopic Description - Case 80

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 (X)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 (16)
2.4.2 If BD loss, number of triads w/o ducts ( 2)
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 (X)Mild ( )Moderate ( )Severe
5.2 Location ( )N/A (X)Portal (X)Central ( )Both
6. Fibrosis (check one under each category)
6.1 Portal ( )None (X)Mild (X)Moderate ( )Severe (bridging)
6.2 Central ( )None ( )Mild ( )Moderate ( )Severe (bridging)
6.3 Arch. dist. ( )None (X)Mild (X)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 ( )YES (X)No
9. Cholestasis ( )YES (X)NO
10. Fat ( )None (X)Mild ( )Moderate ( )Severe
10.1 Type (X)Micro ( )Macro ( )Mixed ( )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) (0-1)
12.3 Venous endothelial inflammation (0-3) (0-1)
12.4 Total Score (RAI = 1-2/9)

13. OTHER FINDINGS
Focal areas of early portal to portal bridging fibrosis present; trichrome staining technically suboptimal; iron stain essentially negative; single focus of central venulitis; prominent portal lymphoid aggregates with germinal center formation.

KNODELL'S HISTOLOGY ACTIVITY INDEX
Feature RANGE SCORE
Periportal and bridging necrosis (0-10) 2
Intralobular degeneration and necrosis (0-4) 3
Portal inflammation (0-4) 3
Fibrosis (0-4) 2
TOTAL (0-22) 10/22

The numerical scoring system of histologic activity index (HAI) has been developed to grade the liver biopsies of chronic active hepatitis. This is based on four categories of periportal and bridging necrosis, intralobular degeneration and necrosis, portal inflammation and fibrosis, with total score of up to 22. This scoring system is correlated well with the severity of disease. A copy of the original paper published by the American Association for the Study of Liver Disease [Hepatology 1:431, 1981] is available at the Department of Pathology upon request.

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