approach to medical liver biopsies dr behrang mozayani consultant histopathologist southmead...

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