Kw - Cases - Aih Pbc Psc

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  • 1. Autoimmune hepatitis

2. BS09-10453 55 yo, female.Clinical history:Elevated ALT/AST. Viral serologies negative. 3. 4. 5. 6. 7. 8. BS09-10453:Dx: Chronic hepatitis, with severe activity (bridging necrosis) and portal fibrosis, ? autoimmune hepatitis vs. drug/toxin mediated injury. Corresponds to: Modified Ishak stage 1/4 Metavir F1 9. BS09-22346 49 yo, female.Clinical history:Acute hepatitis.Mild elevation of IgG, ANA.Viral serologies negative.No drug/toxin exposure history.AIH? 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. BS09-10453:Dx: Chronic hepatitis, with severe activity (perivenular confluent necrosis) and focal fibrous septa, compatible with autoimmune hepatitis. Corresponds to: Modified Ishak stage 2/4 Metavir F2 20. LS08-10290 Abnormal LFT, negative for Hepatitis A, B, C.Sono: heterogeneous liver. 21. 22. 23. 24. 25. 26. 27. BS09-10453:Dx: Chronic hepatitis, with severe activity (focal parenchymal collapse) and cirrhosis, suggestive of autoimmune hepatitis. Corresponds to: Modified Ishak stage 4/4 Metavir F4 28. PBC 29. BS09-15303Clinical history: 56 yo, female. elevated transaminase and anti-mitochondrial antibody. 30. 31. 32. 33. 34. BS09-15303Dx: Primary biliary cirrhosis, Scheuer stage 1/4 (Diagnostic biopsy). 35. 07-R-1192 Middle aged female with intractable pruritis. 36. 37. 38. 39. 40. 41. 42. 43. S07-9238Dx: Features compatible with primary biliary cirrhosis, Scheuer stage 1/4. 44. 91-1824 47 yo female, with AMA positive. Transplanted for portal hypertensive decompensation. 45. 46. 47. 48. 49. 91-1824Dx: Primary biliary cirrhosis, Scheuer stage 3/4 to 4/4, with features of nodular regenerative hyperplasia. 50. S07-9238 female, 45 yo.AMA:1/160, alkaline phosphatase 1700, bilirubin normal, ALT/AST:195/255. 51. 52. 53. 54. 55. 56. S07-9238Dx: Primary biliary cirrhosis, Scheuer stage 4/4 (diagnostic biopsy), with features of nodular regenerative hyperplasia. 57. AIH and PBC Overlap Syndromes 58. BS08-26823 Clinical history:67 yo, male.H/O PBC and cirrhosis, elevated gamma globulin. 59. 60. 61. 62. 63. 64. 65. BS08-26823: Dx with known biopsy and clinical history of PBC: Cirrhosis with features of overlap autoimmune hepatitis (with severe activity) and primary biliary cirrhosis. Dx without prior documented PBC: Chronic hepatitis, with severe activity (focal parenchymal collapse) and probable cirrhosis, compatible with autoimmune hepatitis; cannot exclude overlap primary biliary cirrhosis (focal duct paucity). 66. BS08-12291 36 yo, female.Clinical history:AMA 1:1280, rule out PBC. 67. 68. 69. 70. 71. 72. 73. BS08-12291 Dx: Primary biliary cirrhosis (diagnostic biopsy), Scheuer stage 2/4; cannot exclude overlap autoimmune hepatitis. Comment: Bile duct paucity and active, diagnostic duct destructive lesions are identified.Some portal tracts are expanded by a prominent ductular reaction.Significant scarring is not seen.The degree of interface and lobular hepatitis is focally more severe than is typical for primary biliary cirrhosis and suggests the possibility of overlap autoimmune hepatitis; clinical correlation required. 74. PSC 75. 1206/82 54 yo women with Ulcerative Colitis. 76. 77. 78. 79. 80. LS 1206/82Dx: Bile duct injury and paucity compatible with primary sclerosing cholangitis Comment: There is focal, marked portal expansion by ductular reactions, inflammatory infiltrates and fibrosis. 81. RFH case 3 38 yo, female.Section from an explant specimen.The patient was transplanted for end stage liver disease. 82. 83. 84. 85. 86. 87. RFH 3Dx: Liver: Explant - Primary sclerosing cholangitis. 88. MSH 2 A 73 yo man, heavy alcohol drinker, had liver and kidney failure (hepatorenal syndrome)and received liver and kidney grafts.Sections are from the explanted liver. 89. 90. 91. 92. 93. 94. MSH 2Dx: Liver: Explant - Primary sclerosing cholangitis. Comment: Cannot exclude features of concomitant alcoholic liver injury.