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1. Chronic hepatitis, moderately active with cirrhosis, compatible with hepatitis C
Large cell change (“dysplasia”)
Comment: Consensus opinion holds that the cytologic alteration of large cell change is at least malignancy associated, if not directly pre-malignant, and indicates a patient at increased risk for development of hepatocellular carcinoma. Increased surveillance for emergence of distinctive nodules may be of clinical value.
Modified Ishak stage 4/4
BS09-23598 Clinical history: 51 yo male. HIV and Hepatitis C.
Chronic hepatitis, moderately active with transition to
cirrhosis, compatible with hepatitis C
Hemosiderosis, grade 1/4, ? Hereditary vs. secondary
Comment: This small amount of iron does not exclude the possibility of hereditary hemochromatosis given the variable penetrance of that disease. If there is a high index of clinical suspicion of familial liver disease genetic testing may be of value.
Modified Ishak stage 34/
Metavir: F3 to F4
BS08-10708: Clinical history: 59 yo male. HepatitisC.
Chronic hepatitis, mildly active with focal, mild portal fibrosis, compatible with hepatitis C
Small cell change (“dysplasia”)
Comment: Small cell change is considered to be a pre-malignant lesion and indicative of significantly increased risk for hepatocellular carcinoma even in the absence of advanced scarring and cirrhosis. Radiologic screening for emergence of distinctive nodules in this patient may be clinically useful.
S07-20393 Dx: Liver: Needle Biopsy Chronic hepatitis B, minimally active with focal portal fibrosis. Comment: Immunostain for hepatitis B surface antigen confirms recurrent hepatitis B infection. The absence of staining for core antigen may relate to spontaneous or post-therapeutic clearance of virus, co-infection by hepatitis C or D, or sampling; clinical correlation required. Corresponds to: Modified Ishak stage 1/4 Metavir: F1
BS08-09913: Clinical history: 27 yo male. Hepatitis B.
91-2762: Dx: Steatosis, severe, with marked steatohepatitis and steatofibrosis (transition to cirrhosis), ? alcoholic vs. non-alcoholic fatty liver disease. In kuwait….? “ Fatty liver disease, clinical correlation required for assessment of cause.”
93-02583 42 yo, male with hyperlipidemia. No history of alcohol, diabetes or obesity.
S03-16834 Dx: Steatosis, severe, with mild steatohepatitis (see comment) and focal, mild steatofibrosis (perivenular and acinar zone 3 pericellular fibrosis, compatible with alcohol-related fatty liver disease. Comment: While the classical forms of steatohepatitis (i.e. hepatocyte ballooning, Mallory bodies, neutrophilic infiltrates) are not identified, the presence of focal, lobular and portal mononuclear infiltrates are probably indicative of some degree of steatohepatitis.
1. Well established cirrhosis with focal, mild steatohepatitis and steatofibrosis compatible with alcohol-related fatty liver disease
Hemosiderosis, focal, compatible with cirrhosis associated
Comment: While minimal, focal steatosis is present, there is also histologic steatohepatitis in the forms of focal hepatocyte ballooning and Mallory body formation.
[Call the transplant team about abstinence issues!!!]
RFH case 2: 59 yo woman, obese, with abnormal liver tests for 2 years. She has non-insulin requiring DM. Hepatitis A, B and C negative. ANA and AMA negative. CT scan shows changes consistent with fatty changes.