kw cases - hcv hbv fld

HCV

BS09-23653

Clinical: 60 year old woman with Hepatitis C, fibromyalgias.

BS09-23653

Dx: Chronic hepatitis, mildly active without significant scarring, compatible with hepatitis C

Corresponds to:Modified Ishak stage 0/4Metavir FO

BS08-12035

Clinical history: 26 yo, female. Hepatitis C.

BS09-12035

Dx: Chronic hepatitis, mildly active with focal fibrous septa, compatible with hepatitis C

Corresponds to:Modified Ishak stage 2/4Metavir F2

SS09-7396: Clinical history: 62 yo male.

Chronic hepatitis C.

SS09-7396

Dx: Chronic hepatitis, mildly active with transition to cirrhosis, compatible with hepatitis C

Corresponds to:Modified Ishak stage 3/4Metavir F3 to F4

RS09-11796 Clinical history: 65 yo male. Hepatitis C, staging/grading.

RS09-11796

Dx: Chronic hepatitis, mildly active with transition to cirrhosis, compatible with hepatitis C

Corresponds to:Modified Ishak stage 3/4Metavir F3-F4

BS09-23699 Clinical history: 57 yo, male.

Hepatitis C, USG: possible liver mass .

BS09-23699

Dx: 1. Chronic hepatitis, moderately active with cirrhosis,

compatible with hepatitis C2. 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 4/4Metavir F4

BS09-23598 Clinical history: 51 yo male. HIV

and Hepatitis C.

BS09-23598

Dx: 1. Chronic hepatitis, moderately active with transition to cirrhosis, compatible with hepatitis C2. 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

BS08-10708: Clinical history: 59 yo male.

HepatitisC.

BS08-10708

Dx: 1. Chronic hepatitis, mildly active with focal, mild portal fibrosis,

compatible with hepatitis C2. 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 1/4Metavir: F1

Hepatitis B

S-07-20393: 40 yo female with chronic

hepatitis B.

S07-20393

Dx: 1. 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 1/4Metavir: F1

92-03086: 47 yo male, 3.5 years s/p OLT

for Hepatitis B cirrhosis.

S07-20393

Dx: Liver Allograft: Needle BiopsyRecurrent 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 2/4Metavir: F2

RS09-11951: Clinical history: 68 yo female. Hepatitis B. AST 43, ALT 30.

Grade and stage.

S07-20393

Dx: Liver: Needle BiopsyChronic 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 1/4Metavir: F1

BS08-09913: Clinical history: 27 yo male.

Hepatitis B.

BS08-09913

Dx: Liver: Needle Biopsy1. Chronic hepatitis B, minimally active with without significant

scarring. 2. Small cell change (“dysplasia”)

Corresponds to:Modified Ishak stage 0/4Metavir: F0

Steatosis/Steatohepatitis

Case 91-2762: Clinical Hx: 34 yo, male, obese, with elevated LFTs (mild) and

elevated ferritin.

91-2762:

Dx: Steatosis, moderate, with rare foci of steatofibrosis (pericellular

fibrosis).

Comment: No histologic steatohepatitis or iron identified.

91-22789: Clinical hx: 61 yo, male. ALT 59,

Triglycerides 761, GGTP 240. R/O ETOH vs Fatty liver disease.

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.

93-02583:

Dx: Steatosis, moderate to severe, with marked steatohepatitis and

steatofibrosis (fibrous septa), compatible with hyperlipidemia-associated fatty liver disease.

S03-1683453 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.

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.

91-4979

54 yo, female with liver failure.

Explanted liver s/p orthotopic liver transplant

S03-16834

Dx:1. Well established cirrhosis with focal, mild steatohepatitis and

steatofibrosis compatible with alcohol-related fatty liver disease

2. Hemosiderosis, focal, compatible with cirrhosis associatedaccumulation.

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.

RFH case 2

Dx:Steatosis, severe, with moderate steatohepatitis and

steatofibrosis (established cirrhosis) compatible with obesity related fatty liver disease.