(Special thanks to my GI attending, Dr. Jessica Tracht, for her lovely synopsis)
(Pictures/examples coming soon...)
Vascular pattern on Liver Biopsy
This is probably the most difficult to recognize and ranges from very subtle to the more recognizable features associated with congestive hepatopathy. It can also share some features in common with biliary processes. If fibrosis is present, it will occur in a centrizonal pattern.
Features of a Vascular Process
Portal venopathy: atrophic and branching portal vasculature.
Sinusoidal changes- fibrosis or central vein occlusion (Think sinusoidal obstructive syndrome) , dilatation and/or sinusoidal congestion
Reactive bile ducts.
Nodular regenerative hyperplasia
Centrizonal hepatocyte atrophy.
Centrizonal fibrosis.
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FINAL DIAGNOSIS:
Liver, native, core biopsy:
Centrizonal sinusoidal dilatation and congestion.
Patchy centrizonal hepatocyte atrophy and hepatocyte regeneration.
Mild portal and centrizonal fibrosis.
See comment.
PATHOLOGIST'S COMMENT:
The parenchyma shows centrizonal-based sinusoidal dilation with patchy congestion, patchy hepatocyte atrophy, and patchy hepatocyte regeneration. There is no significant steatosis. A trichrome stain shows centrizonal sinusoidal fibrosis and patchy mild portal fibrosis. A PAS-D stain illustrates bile ducts and shows no PAS-D-positive globules within hepatocytes. An iron stain detects mild iron deposition (1+ of 4+) predominantly within hepatocytes.
Overall, the centrizonal-based sinusoidal dilation with patchy congestion, centrizonal sinusoidal fibrosis, and mild portal fibrosis are consistent with the clinical impression of congestive hepatopathy. The liver does not appear cirrhotic and there is no bridging fibrosis but there is centrizonal sinusoidal fibrosis and patchy mild portal fibrosis. In a scoring system proposed for congestive hepatic fibrosis, this case would be considered score 2A out of 4 [Reference].
Reference:
- Dai DF, Swanson PE, Krieger EV, Liou IW, Carithers RL, Yeh MM. Congestive hepatic fibrosis score: a novel histologic assessment of clinical severity. Mod Pathol. 2014 Dec;27(12):1552-8. PubMed PMID: 24925051.