Liver Biopsy Interpretation: Patterns and Clinical Correlations-Slides

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The document outlines the key considerations in liver biopsy interpretation, focusing on the patterns of liver injury and their clinical correlations. The primary goals are to understand the histological patterns in liver injuries, recognize specific changes, and formulate differential diagnoses based on histology.<br /><br />Liver biopsy interpretation is a multi-step process that begins with a morphologic review, both blinded and informed by clinical data such as notes, laboratory results, and imaging studies. An effective biopsy sample typically measures around 2.0 cm with 10-15 tracts, preferably a core biopsy rather than a wedge or EUS. The clinical context determines the adequacy and need for stains like C4d in allografts.<br /><br />The document categorizes liver injury patterns into hepatitis, biliary, necrosis, vascular, regenerative, and steatosis/steatohepatitis. Hepatitis-related injuries can present as inflammation or hepatocellular damage, and may include other findings such as cholestasis or fibrosis. These are graded and staged based on established terminologies like CPH/CAH, HAI, and METAVIR.<br /><br />The causes of hepatitis patterns include infections, drugs, and immune reactions. In particular, autoimmune hepatitis and hepatitis C are highlighted, along with discussions on chronic hepatitis and the grading and staging of conditions.<br /><br />Biliary patterns involve ductal proliferations and obstructions, while vascular patterns examine microanatomy impairments like portal hypertension. Conditions such as granulomatous hepatitis, ischemic necrosis, and various forms of non-cirrhotic portal hypertension are detailed.<br /><br />The document emphasizes the importance of integrating clinical information for accurate interpretation and acknowledges that neoplastic processes can mimic non-neoplastic conditions. Publications and historical references are cited to provide context for grading schemes and terminology evolution in chronic hepatitis evaluation. Overall, the essence of liver biopsy interpretation lies in recognizing these injury patterns and understanding their clinical contexts.

Keywords

liver biopsy

histological patterns

clinical correlations

differential diagnoses

hepatitis

biliary patterns

vascular patterns

steatosis

autoimmune hepatitis

portal hypertension