Allograft Liver, Needle Biopsy - Case 57

<HTML>  <HEAD><title>Consult Report - Case 57</title></HEAD> <body bgcolor=#ffffff link="darkblue" vlink="006666"> <IMG SRC="/tpis/icons/purpball.gif"><i> Contributed by Anthony J. Demetris, M.D.</A></i> <HR> <b>PATIENT HISTORY:</b> <BR> Per referral report, the patient is a 40 year-old female who was transplanted for fulminant hepatitis 3 years ago. The etiology of her original disease was never clarified. Review of outside material. <hr><P> <a name="final"></a> <H4>Final Diagnosis (Case 57) [S97-7970, S97-10590]</H4> <b>PART 1</b>: ALLOGRAFT LIVER, NEEDLE BIOPSY (OSS S97-7970) -<BR> <ol type=A> <li>MODERATE ACUTE CELLULAR REJECTION WITH PROMINENT CENTRAL VENULITIS (RAI 2+2+2=6/9). <li>NO PREVIOUS BIOPSIES AVAILABLE FOR COMPARISON. </ol> <b>PART 2</b>: ALLOGRAFT LIVER, NEEDLE BIOPSY (OSS S97-10590) -<BR> <ol type=A> <li>MILD ACUTE CELLULAR REJECTION WITH PROMINENT CENTRAL VENULITIS (RAI 2+1+2=5/9). <li>SIMILAR OR SLIGHTLY IMPROVED IN COMPARISON TO PREVIOUS BIOPSY. <li>FOCAL BILE DUCT LOSS IN FOUR OF FOURTEEN (4/14) PORTAL TRIADS. </ol><P> <b><i>Previous Biopsies on this Patient:</b></i><br> None <p> <i><b>TPIS Related Resources:</b></i><br> <a href="/tpislibrary/schema/BanffRej.html">Liver Allograft Rejection Grading</a><br> <a href="/tpislibrary/liver/index.html">Liver Transplant Topics</a><P> <a name="gross"></a> <hr><H4>Gross Description - Case 57 [S97-7970, S97-10590]</H4><BR> The specimen consists of four (4) consult slides labeled S97-7970 and seven (7) consult slides labeled S97-10590 from Emory University Hospital, 1364 Clifton Road, NE, Atlanta, Georgia 30322 with accompanying surgical pathology reports. <P> <a name="micro"></a> <HR><H4>Microscopic Description - Case 57 [S97-7970, S97-10590]</H4><BR> <A HREF="/tpis/images/H00094a.jpg"><IMG SRC="/tpis/images/tnails/H00094a.jpg" width=133 height=100></a> <A HREF="/tpis/images/H00094b.jpg"><IMG SRC="/tpis/images/tnails/H00094b.jpg" width=133 height=100></a> <A HREF="/tpis/images/H00094c.jpg"><IMG SRC="/tpis/images/tnails/H00094c.jpg" width=133 height=100></a> <A HREF="/tpis/images/H00094d.jpg"><IMG SRC="/tpis/images/tnails/H00094d.jpg" width=133 height=100></a> <P> (S97-7970: 2 HE, 1 Trichrome, 1 PAS/D)<BR> The normal lobular architecture is distorted by mild to moderate portal expansion because of fibrosis and a moderate mononuclear inflammatory cell infiltrate. Duct damage is clearly appreciated in half or more of the triads. Focal duct loss may be developing in approximately four of ten triads. There is also mild interface activity.<P> Throughout the lobules, there is Kupffer cell hypertrophy and occasional acidophilic bodies. Occasional foam cell clusters are also seen. However, the most striking change is the prominent central venulitis with perivenular hepatocellular dropout. No definite viral inclusions or ground glass cells are seen. The PAS/D stain nicely shows the bile duct infiltration and damage, with lymphocytes located inside the basement membrane.<P> <A HREF="/tpis/images/H00094e.jpg"><IMG SRC="/tpis/images/tnails/H00094e.jpg" width=133 height=100></a> <A HREF="/tpis/images/H00094f.jpg"><IMG SRC="/tpis/images/tnails/H00094f.jpg" width=133 height=100></a> <A HREF="/tpis/images/H00094g.jpg"><IMG SRC="/tpis/images/tnails/H00094g.jpg" width=133 height=100></a> <A HREF="/tpis/images/H00094h.jpg"><IMG SRC="/tpis/images/tnails/H00094h.jpg" width=133 height=100></a> <P> (S97-10590: 2 HE, 1 PAS, 1 PAS/D, 1 Iron, 1 Reticulin) The normal lobular architecture is slightly distorted secondary to mild to moderate portal expansion because of mild fibrosis and a mild, predominantly mononuclear inflammatory cell infiltrate. Focal bile duct infiltration and damage are easily seen.<P> Throughout the lobules, there is Kupffer cell hypertrophy and occasional acidophilic bodies. However, there is little evidence of disarray. The most striking lobular change is the presence of centrilobular hepatocellular inflammation, dropout and hemorrhage. This is associated with a perivenular mononuclear inflammatory cell infiltrate containing lymphocytes, plasma cells and pigmented macrophages. No definite viral inclusions or ground glass cells are seen.<P> Overall, the histopathologic changes in both biopsies are most consistent with an active cellular rejection with prominent central venulitis. Bile duct damage and focal bile duct loss are also easily seen.<P>  <hr> <font size=3> Please mail comments, corrections or suggestions to the <a href="mailto:harperth@upmc.edu"> <i>TPIS administration</i></a> at the UPMC.<p> This page and its contents are Copyright © 1996, 1997 <A HREF="http://www.upmc.com/Pages/default.aspx">University of Pittsburgh</a>. All rights reserved. Unauthorized redistribution prohibited.<p> </body> </html>