Autoimmune hepatitis

BS09-1045355 yo, female. Clinical history:

Elevated ALT/AST.Viral serologies negative.

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 1/4Metavir F1

BS09-2234649 yo, female. Clinical history: Acute

hepatitis. Mild elevation of IgG, ANA. Viral serologies negative. No drug/toxin exposure

history. AIH?

BS09-10453:

Dx:Chronic hepatitis, with severe activity (perivenular confluent necrosis) and focal fibrous septa, compatible with autoimmune hepatitis.

Corresponds to:Modified Ishak stage 2/4Metavir F2

LS08-10290

Abnormal LFT, negative for Hepatitis A, B, C. Sono: heterogeneous liver.

BS09-10453:

Dx:Chronic hepatitis, with severe activity (focal parenchymal collapse) and cirrhosis, suggestive of autoimmune hepatitis.

Corresponds to:Modified Ishak stage 4/4Metavir F4

PBC

BS09-15303 Clinical history: 56 yo, female. elevated

transaminase and anti-mitochondrial antibody.

BS09-15303

Dx:Primary biliary cirrhosis, Scheuer stage 1/4 (Diagnostic biopsy).

07-R-1192

Middle aged female with intractable pruritis.

S07-9238

Dx:Features compatible with primary biliary cirrhosis, Scheuer stage 1/4.

91-182447 yo female, with AMA positive.

Transplanted for portal hypertensive decompensation.

91-1824

Dx:Primary biliary cirrhosis, Scheuer stage 3/4 to 4/4, with features of nodular regenerative hyperplasia.

S07-9238female, 45 yo. AMA:1/160, alkaline phosphatase 1700, bilirubin normal,

ALT/AST: 195/255.

S07-9238

Dx:Primary biliary cirrhosis, Scheuer stage 4/4 (diagnostic biopsy), with features of nodular regenerative hyperplasia.

AIH and PBCOverlap Syndromes

BS08-26823Clinical history: 67 yo, male. H/O PBC

and cirrhosis, elevated gamma globulin.

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).

BS08-12291

36 yo, female. Clinical history: AMA 1:1280, rule out PBC.

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.

PSC

1206/82

54 yo women with Ulcerative Colitis.

LS 1206/82

Dx:Bile duct injury and paucity compatible with primary sclerosing cholangitis

Comment: There is focal, marked portal expansion by ductular reactions, inflammatory infiltrates and fibrosis.

RFH case 338 yo, female. Section from an explant

specimen. The patient was transplanted for end stage liver disease.

RFH 3

Dx:Liver: Explant- Primary sclerosing cholangitis.

MSH 2A 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.

MSH 2

Dx:Liver: Explant - Primary sclerosing cholangitis.

Comment: Cannot exclude features of concomitant alcoholic liver injury.