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2015 Annual Meeting
Evening Specialty Conference - Liver Pathology
Monday, March 23, 2015 - 7:30pm to 9:30pm
CC Auditorium
Clinical histories are printed below. For the fastest viewing of virtual slides, click:

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Case title: Plasma cell infiltrates: significance post-liver transplantation and in chronic liver disease
Clinical Summary:
•A 57 yo man, 7 months post-liver transplant for hepatitis C cirrhosis, presented with abnormal liver enzymes:
  • ALT = 158 U/L
  • AST = 79   U/L
  • Alk phos = 250 U/L
•A liver biopsy of the allograft showed recurrent hepatitis C and concomitant mild acute cellular rejection.
•He was then started on interferon and ribavirin treatment.
•The prograf (FK506) dose was increased to maintain levels >5ng/mL.
•HCV-RNA became negative 3 months after starting treatment with normalization of liver enzymes
•Six months after starting treatment, liver tests showed:
  • ALT = 150 U/L
  • AST = 113 U/L
  • Alk Phos    = 258 U/L
  • T bilirubin = 2.9 mg/dL
  • Prograf level  = 4.4 ng/mL
•A repeat biopsy was performed.
•The following photomicrographs are representative areas from the allograft biopsy specimen.
Confluent necrosis
Confluent necrosis
Representative portal tract
Representative portal tract
Centrilobular area
Centrilobular area
Portal tract with dense inflammatory infiltrate
Portal tract with dense inflammatory infiltrate
High power magnification of the type of infiltrate
High power magnification of the type of infiltrate
High power view showing the type of periportal infiltrate
High power view showing the type of periportal infiltrate
Overall picture of confluent necrosis and dense portal infiltrate
Overall picture of confluent necrosis and dense portal infiltrate
Case title: Cryptogenic cirrhosis in a young female
Clinical Summary:

Patient is 16 years old female. She presented a year ago with fatigue and was found to have esophageal varices, splenomegaly and mild thrombocytopenia. Liver transaminases and alkaline phosphatase were mildly elevated. Hepatitis A, B and C serologies were negative. Serum immunoglobulin levels were normal and autoantibody screen was also negative. Further testing showed increased 24h urine copper [> 100 mcg], but there were no Kayser–Fleischer (KF) rings and ceruloplasmin level was normal. Liver biopsy showed chronic hepatitis with moderate inflammatory activity, bridging fibrosis, moderate bile duct proliferation and a markedly elevated hepatic copper content (1471 μg/g). A diagnosis of Wilson’s disease with cirrhosis was made and she was started on zinc therapy, but was switched to trientine due to gastrointestinal side effects. Though treated with trientine for >12 months, her transaminase levels did not improve and urine copper remained elevated. Another liver biopsy was performed at this time, which is being presented. 






Case title: A biphenotypic malignant tumor of the liver
Clinical Summary:

§53-year old woman
§HBV infection, treated with Tenofovir

Biological tests revealed recent increase in Alkalin Phosphatase (2 N) and GGT (5 N)

§On Imaging,  Liver nodule of 11 cm without underlying cirrhosis
§Biopsy consistent with cholangiocarcinoma






Case title: AThis 46 year old male with obstructive jaundice
Clinical Summary:

This 46 year old male presented to his primary care physician with fatigue and yellow appearing skin. The liver function tests suggested obstructive jaudice. An MRI revealed a perihilar mass, and was considered to represent a hilar bile duct carcinoma. The cholangiogram showed a beaded appearance, an appearance consistent with sclerosing cholangitis. A needle biopsy was negative for carcinoma. A liver transplant was performed and the slide are from the explant specimen.

Case title: Case 5Anorexia and acute liver injury
Clinical Summary:
Ø17 y.o. female presents to E.R. with hypothermia, nausea, weakness, dizziness and fatigue
Previously an all star gymnast
History of chronic weight loss
Oral temp 93.7, HR 47, BP 102/75
EKG - Sinus bradycardia, septal infarct, age undetermined
BMI 10.5 (0%),
low power H&E
low power H&E
40x H&E
40x H&E
low power reticulin
low power reticulin