Approach to medical liver biopsies Dr Behrang Mozayani Consultant Histopathologist Southmead hospital Bristol
Dec 24, 2015
Approach to medical liver biopsies
Dr Behrang MozayaniConsultant HistopathologistSouthmead hospitalBristol
Indications for biopsy
Abnormal unexplained liver function tests
Evaluation of diagnosis, grade and stage of disease
Unexplained cholestatic liver disease FUO Suspected hepatic tumour Post transplantation
Size of biopsy
…biopsy of at least 2-3 cm in length and 16-gauge in calibre is recommended (AASLD position paper)
Current UK standard: minimum 15mm and 6 portal tracts. Often 18 gauge
Cases
Most common diagnosis Should be straight forward Not always one answer without
clinical information
Case 1
68 year old female Abnormal lfts Episodes of pruritus AMA positive Raised alk phos and IgM
diagnosis
Primary biliary cirrhosis
Case 2
57 year old male Episodes of Jaundice and pruritus High alk phos, low GGT ALTs 200s Abnormal hepatic duct on MRCP
diagnosis
Chronic large duct obstruction Wider differential
Case 3
61 year old male Generally unwell ALTs 300s On hormone therapy for prostate
cancer
diagnosis
Central perivenulitis/acute hepatitis
Case 4
80 year old male Sudden onset of jaundice Acutely unwell Autoantibodies negative
diagnosis
Acute hepatitis
Case 5
25 year old male Known UC Abnormal LFTs
diagnosis
Primary sclerosing cholangitis
Case 6
54 year old male Ultrasound suggests cirrhosis ?cause
diagnosis
Steatohepatitis and incomplete cirrhosis
Case 7
61 year old female Feeling tired, poor appetite ALT 500s IgG raised ANA+ Viral serology negative No drug history
diagnosis
Autoimmune hepatitis
Case 8
60 year old male High ferritin in work up C282Y homocygote Normal lft’s
diagnosis
Genetic haemochromatosis
Case 9
64 year old female Cirrhosis Heart failure Abnormal lft’s
diagnosis
Cirrhosis ? Aetiology A1AT deficiency
Case 10
22 year old female Abnormal lfts and fibroscan Low caeruloplasmin, high serum
copper Chromosome 13 mutation
diagnosis
Wilson’s disease