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Liver Pathology
Monday, March 26, 2007, 7:30 PM
Convention Center 10Liver Biopsy: Let's Make the Most of It!
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Moderator:
ELIZABETH M. BRUNT
St. Louis University Hospital
St. Louis, MO
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Submitted by: Linda D. Ferrell - University of California, San Francisco, CA
- 12 year old male
- Diabetes, Type 1, poorly controlled
- Presented with ketoacidosis
- PE: Hepatomegaly, RUQ pain
- Lab: Increased ALT/AST 2x normal, Glucose 635; HbA1c 13.5 (nl<6)
- Ultrasound suggested fatty liver
- Liver biopsy performed
- Referred to UCSF to exclude glycogen storage disorder
- Patient treated for ketoacidosis, hyperglycemia
- Transaminases returned to normal, and liver decreased in size
- No known long-term sequelae
Submitted by: Maria Isabel Fiel - Mt. Sinai Medical Center, New York, NY
A 52 year old man of Italian heritage is found to have abnormal liver chemistry tests when he undergoes an insurance physical. Aside from non-insulin dependent diabetes of 2 years duration he has no significant medical history. He does have increasing fatigue and some problems with erectile dysfunction which he has ascribed to the long hours he has been working at his new job. The patient drinks two cocktails with every dinner. His father died of liver cancer. There is no other significant family history; he is married with 2 teenage sons.
Liver chemistry tests:
- ALT -- 52 U/L
- AST -- 61 U/L
- AP -- 199 U/L
- BR -- 1.1 mg/dl
- GGTP -- 201 U/L
- Ferritin -- 1800 ug/l
- Platelets -- 129, 000
- INR -- 1.1
Further blood testing reveals:
- Transferrin saturation -- 99 %
Serological testing for viral hepatitis is unremarkable
Genetic testing reveals homozygosity for the C282Y gene mutation. An abdominal U/S demonstrates a heterogeneous liver parenchyma and a slightly enlarged spleen. The patient starts a phlebotomy schedule of one unit every 2 weeks so as to bring his ferritin down to 100. An EGD is performed to evaluate GERD-type symptoms and Grade 1 esophageal varices are found.
Case 2 - Slide 1
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Submitted by: Dina Tiniakos - University of Athens, Athens, Greece
The patient, a lean 39-year-old woman from the Philippines, was found to be HBsAg positive 14 years prior when she immigrated to Greece. There was no other significant past medical history. In The spring of 2005, during evaluation for employment, there was an an abdominal ultrasound examination which showed signs of chronic liver disease and focal fatty change. At that time liver tests were normal. Viral hepatitis panel showed: HBsAg +, HBeAg -, anti-HBe +, anti-HBs -, anti-HAV IgG +, HCV and HDV markers -. Her HBV DNA was 131,500 copies/ml.
Six months later, the patient presented with acute exacerbation of chronic viral hepatitis with AST 2399 IU/L, ALT 2682 IU/L and γ-GT 251 IU/L. One month later when liver tests had rapidly begun to resolve, a percutaneous liver biopsy was performed, and is submitted for review. At the time of the biopsy the liver tests were : AST 61 IU/L, ALT 129 IU/L, alkaline phosphatase 74 U/L , γ-GT 211 U/L, total bilirubin 0.8 mg/dl, direct bilirubin 0.5 mg/dl and albumin 4.0 mg/dl. There was no change in her viral hepatitis markers. The liver biopsy is submitted for review.
Case 3 - Slide 1
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Submitted by: Julia Iezzoni - University of Virginia, Charlottesville, VA
The patient, a 42-year-old African-American male, underwent a cholecystectomy for cholelithiasis. During the surgical procedure, a liver biopsy was performed. [Figure 4-1 (H&E, 200X), Figures 4-2, 4-3, 4-4 (H&E, 400X), Figure 4-5 (Trichrome, 200X), Figure 4-6 (Prussian blue, 200X).
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room in the Manchester Grand Hyatt (Betsy A-C) for participants who wish to review them prior to the
evening session.
Handouts for all Specialty Conferences will be accessible via the
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copies of the handout will not be available at the meeting. However, we will provide a booklet at the
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