Liver, "caudate lesion"
Microscopic description
Sections of the liver biopsy show altered architecture. There is bridging fibrosis, evident on H&E stain, with vague nodularity. There is moderate macrovesicular, large droplet steatosis, involving approximately 50 to 60% of the liver parenchyma (grade 2). Ballooning hepatocytes is prominent (grade 2), with abundant poorly-formed Mallory-Denk bodies. Satellitosis is seen. Acidophil bodies are also noted. Lobular inflammation is diffusely present (severe, grade 3), composed of a mixed infiltrate of neutrophils, eosinophils, as well as lymphohistiocytic infiltrate. Canalicular cholestasis is present. Special stains are performed on section A1. Trichrome stain highlights complex perisinusoidal fibrosis with bridging fibrosis and focal nodule formation. The PAS stain with diastase highlights increased macrophages in the areas of lobular inflammation, but is negative for diastase resistant alpha-1 antitrypsin globules and hepatocytes. The iron stain is negative for hepatocellular iron accumulation, but highlights scattered, rare reticuloendothelial iron accumulation. The reticulin stain is not informative due to technical problems.
Impression
- Steatohepatitis (NAS score 7/8) and acute cholestasis
- Complex perisinusoidal and bridging fibrosis with focal nodule formation (Stage 3-4)
- No tumor identified