KW Cases - HCV HBV FLD

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  • 1. HCV
  • 2. BS09-23653 Clinical: 60 year old woman with Hepatitis C, fibromyalgias.
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  • 9. BS09-23653 Dx: Chronic hepatitis, mildly active without significant scarring, compatible with hepatitis C Corresponds to: Modified Ishak stage 0/4 Metavir FO
  • 10. BS08-12035 Clinical history: 26 yo, female. Hepatitis C.
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  • 16. BS09-12035 Dx: Chronic hepatitis, mildly active with focal fibrous septa, compatible with hepatitis C Corresponds to: Modified Ishak stage 2/4 Metavir F2
  • 17. SS09-7396: Clinical history: 62 yo male. Chronic hepatitis C.
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  • 22. SS09-7396 Dx: Chronic hepatitis, mildly active with transition to cirrhosis, compatible with hepatitis C Corresponds to: Modified Ishak stage 3/4 Metavir F3 to F4
  • 23. RS09-11796 Clinical history: 65 yo male. Hepatitis C, staging/grading.
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  • 28. RS09-11796 Dx: Chronic hepatitis, mildly active with transition to cirrhosis, compatible with hepatitis C Corresponds to: Modified Ishak stage 3/4 Metavir F3-F4
  • 29. BS09-23699 Clinical history: 57 yo, male. Hepatitis C, USG: possible liver mass .
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    • BS09-23699
    • Dx:
    • 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.
    • Corresponds to:
    • Modified Ishak stage 4/4
    • Metavir F4
  • 39. BS09-23598 Clinical history: 51 yo male. HIV and Hepatitis C.
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    • BS09-23598
    • Dx:
    • Chronic hepatitis, moderately active with transition to
    • cirrhosis, compatible with hepatitis C
    • Hemosiderosis, grade 1/4, ? Hereditary vs. secondary
    • hemochromatosis.
    • 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.
    • Corresponds to:
    • Modified Ishak stage 34/
    • Metavir: F3 to F4
  • 47. BS08-10708: Clinical history: 59 yo male. HepatitisC.
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    • BS08-10708
    • Dx:
    • 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.
    • Corresponds to:
    • Modified Ishak stage 1/4
    • Metavir: F1
  • 52. Hepatitis B
  • 53. S-07-20393: 40 yo female with chronic hepatitis B.
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    • S07-20393
    • Dx:
    • Chronic hepatitis B, mildly active with focal, mild portal fibrosis.
    • Comment: Ground glass cells confirm chronic hepatitis B virus infection.
    • Corresponds to:
    • Modified Ishak stage 1/4
    • Metavir: F1
  • 59. 92-03086: 47 yo male, 3.5 years s/p OLT for Hepatitis B cirrhosis.
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  • 64. S07-20393 Dx: Liver Allograft: Needle Biopsy Recurrent hepatitis B, mildly active with focal fibrous septa. Comment: Immunostain for hepatitis B surface antigen confirms recurrent hepatitis B infection. Positive stain for core antigen confirms active viral replication. Corresponds to: Modified Ishak stage 2/4 Metavir: F2
  • 65. RS09-11951: Clinical history : 68 yo female. Hepatitis B. AST 43, ALT 30. Grade and stage.
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  • 70. 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
  • 71. BS08-09913: Clinical history: 27 yo male. Hepatitis B.
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  • 79. BS08-09913 Dx: Liver: Needle Biopsy 1. Chronic hepatitis B, minimally active with without significant scarring. 2. Small cell change (“dysplasia”) Corresponds to: Modified Ishak stage 0/4 Metavir: F0
  • 80. Steatosis/Steatohepatitis
  • 81. Case 91-2762: Clinical Hx: 34 yo, male, obese, with elevated LFTs (mild) and elevated ferritin.
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  • 87. 91-2762: Dx: Steatosis, moderate, with rare foci of steatofibrosis (pericellular fibrosis). Comment: No histologic steatohepatitis or iron identified.
  • 88. 91-22789: Clinical hx: 61 yo, male. ALT 59, Triglycerides 761, GGTP 240. R/O ETOH vs Fatty liver disease.
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  • 94. 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.”
  • 95. 93-02583 42 yo, male with hyperlipidemia. No history of alcohol, diabetes or obesity.
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  • 101. 93-02583: Dx: Steatosis, moderate to severe, with marked steatohepatitis and steatofibrosis (fibrous septa), compatible with hyperlipidemia-associated fatty liver disease.
  • 102. S03-16834 53 yo male ALT elevation (1.5 – 2x upper limit of normal). 20 years of alcohol (2-3 daily, more on the weekend). USG: fatty liver.
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  • 109. 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.
  • 110. 91-4979 54 yo, female with liver failure. Explanted liver s/p orthotopic liver transplant
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    • S03-16834
    • Dx:
    • 1. Well established cirrhosis with focal, mild steatohepatitis and steatofibrosis compatible with alcohol-related fatty liver disease
    • Hemosiderosis, focal, compatible with cirrhosis associated
    • accumulation.
    • 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!!!]
  • 117. 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.
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  • 123. RFH case 2 Dx: Steatosis, severe, with moderate steatohepatitis and steatofibrosis (established cirrhosis) compatible with obesity related fatty liver disease.