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Update and Application to Liver Biopsy Interpretation in Clinical Practice
Julia C. Iezzoni
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The patient, a 46-year-old African-American female,
presented with complaints of a 7-month history of intermittent lethargy and malaise. She denied ethanol
abuse and was not on any medications or herbal supplements. Liver function tests demonstrated moderately
elevated aminotransferases, and viral serologies were positive for hepatitis C. A liver biopsy was
performed.
The patient, a 36-year-old Caucasian female, was noted to
have mildly elevated aminotransferases during an examination performed to evaluate her as a possible
living-related-liver-donor for her mother, who suffered from end-stage liver disease due to cryptogenic
cirrhosis. Otherwise the patient was asymptomatic, denied alcohol abuse, and was not on any medications
or herbal supplements. Other laboratory values, including viral studies and autoantibodies, were
negative, and evaluation for inherited metabolic disorders detected no abnormalities. Physical
examination was remarkable for mild obesity and hepatomegaly. A liver biopsy was performed.
The patient, a 52-year-old
Caucasian female, presented with complaints of pruritis. Laboratory studies demonstrated markedly
elevated aminotransferases and moderately elevated alkaline phosphatase and gamma-glutamyltranspeptidase
(GGT). Viral serologies were negative, but anti-nuclear antibodies and anti-smooth muscle antibodies
were present at titers of 1:640 and 1:160, respectively. Anti-mitochondrial antibodies also were
detected. A liver biopsy was performed.
The patient, a 28-year-old Caucasian male, was noted to
have mildly elevated aminotransferases during a routine examination performed for insurance purposes.
While viral studies and autoantibodies were negative, his serum iron level was elevated. A fasting
transferrin saturation and serum ferritin level were obtained, and both were increased. Genetic testing
demonstrated C282Y homozygosity for the HFE gene. A liver biopsy was
performed.
The patient, a 44-year-old male who recently emigrated
from Saudi Arabia, presented with complaints of jaundice. Physical examination demonstrated mild right
upper quadrant pain, jaundice and mild ascites. Laboratory studies demonstrated markedly elevated
aminotransferases, alkaline phosphatase, and total bilirubin, and a prolonged prothrombin time. Viral
serologies, autoantibodies, and toxin screens were negative, and copper studies were normal. The patient
was on no prescription or over-the-counter medications. Upon further questioning, the patient described
that for several weeks he had regularly ingested large quantities of an "herbal tea" as a "health
tonic". The specific contents of this herbal formulation could not be determined at the time of the
patient's clinical presentation. A liver biopsy was performed.
The patient, a 56-year-old Caucasian male, underwent
orthotopic liver transplantation for end-stage liver disease due to alcohol abuse. The liver donor was a
50-year-old Caucasian male who had suffered a sudden, massive cerebral vascular accident. After
declaration of brain death, the donor remained hemodynamically stable, and vasopressor support was not
necessary to maintain organ perfusion. Organ harvest, transport, and transplantation were uneventful,
with a total cold ischemia time of approximately 12 hours. As per protocol, a post-perfusion biopsy of
the liver was performed immediately upon restoration of the allograft's blood supply once in the
recipient (Figure 19 – H&E). For the first day after transplantation, the patient's liver function
tests were characterized by markedly elevated aminotransferases and a high total bilirubin. By
post-transplant day 7, these values had diminished only slightly, and a liver biopsy was performed.
The patient, a 52-year-old African-American male,
underwent orthotopic liver transplantation for end-stage liver disease due to chronic hepatitis B. Two
weeks after transplantation, he developed a low-grade fever, malaise, and reduced bile output. Liver
function tests demonstrated mildly elevated aminotransferases and alkaline phosphastase, and a markedly
elevated total bilirubin. A liver biopsy was performed.
The patient, a 24-year-old Caucasian male, underwent and
emergency orthotopic liver transplantation for fulminant hepatic failure due to a Tylenol overdose taken
as a suicide attempt. Four weeks after transplantation, he developed moderate acute cellular rejection,
which only partially responded to immunosuppressive therapy. Over the next five months, the patient's
aminotransferases remained mildly elevated, but his alkaline phosphatase and total bilirubin continued to
rise. A liver biopsy was performed.
The patient, a 48-year-old African-American male,
underwent orthotopic liver transplantation for end-stage liver disease due to chronic hepatitis C. The
postoperative course was uneventful except for a single episode of biopsy-documented acute cellular
rejection 20 days after transplantation. Eight months post-transplantation liver function tests
demonstrated mildly increased animotransferases, and a liver biopsy was performed.
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