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Chronic Hepatitis: Grading and Staging

Abbreviations ALT alanine aminotransferase AST aspartate aminotransferase AUC area under the curve CPA collagen proportionate area HAI histologic activity index HCV hepatitis C virus MIA morphometric image analysis The concepts of grading and staging have been borrowed from the world of clinical oncology, where they give an idea of how quickly, or aggressively, a tumor is growing (its grade of differentiation) and how far it has…

Hepatitis C

Abbreviations ALD alcoholic liver disease HCC hepatocellular carcinoma HBV hepatitis B virus HCV hepatitis C virus HIV human immunodeficiency virus ISC incomplete septal cirrhosis LCC large cell change NASH nonalcoholic steatohepatitis SCC small cell change SVR sustained virologic response Incidence and Demographics Hepatitis C virus (HCV) is a parenterally transmitted ribonucleic acid (RNA) virus. The global estimate of infected individuals is more than 185 million, with…

Hepatitis B

Abbreviations cccDNA covalently closed circular deoxyribonucleic acid HBcAg hepatitis B core antigen HBeAg hepatitis B e antigen HBsAg hepatitis B surface antigen HBV hepatitis B virus HCC hepatocellular carcinoma HCV hepatitis C virus HDAg hepatitis delta antigen HDV hepatitis delta virus LCC large cell change mRNA messenger ribonucleic acid SCC small cell change Incidence and Demographics Hepatitis B is a widespread infection, with more than 350…

Acute Viral Hepatitis

Abbreviations AIDS acquired immunodeficiency syndrome ALF acute liver failure CDC Centers for Disease Control and Prevention CMV cytomegalovirus DENV Dengue virus DHF/DSS dengue hemorrhagic fever/dengue shock syndrome EBER Epstein-Barr virus encoded RNA EBV Epstein-Barr virus HBV hepatitis B virus HCV hepatitis C virus HDV hepatitis D virus HEV hepatitis E virus HHV human herpesvirus HIV human immunodeficiency virus HSV herpes simplex virus IgM immunoglobulin M IL…

Nonalcoholic Fatty Liver Disease

Abbreviations AASLD American Association for the Study of the Liver ALD alcoholic liver disease ALT alanine aminotransferase AP alkaline phosphatase ASH alcoholic steatohepatitis AST aspartate aminotransferase BMI body mass index CAB chromotrope aniline blue CASH chemotherapy-associated steatohepatitis CD celiac disease CHB chronic hepatitis B CHC chronic hepatitis C CRN Nonalcoholic Clinical Research Network CT computed tomography DIA digital image analysis DISH drug-induced steatohepatitis EASL European Association…

Liver Disease in Iron Overload

Abbreviations A1AT alpha-1 antitrypsin DIOS dysmetabolic iron overload syndrome DMT1 divalent metal transporter 1 FPN ferroportin HH hereditary hemochromatosis HIC hepatic iron concentration HII hepatic iron index HJV hemojuvelin IRIDA iron-refractory iron-deficient anemia MHC major histocompatibility complex NAFLD nonalcoholic fatty liver disease NASH nonalcoholic steatohepatitis NTBI nontransferrin-bound iron RES reticuloendothelial system ROS reactive oxygen species TF transferrin TFR1 transferrin receptor 1 TFR2 transferrin receptor 2 In…

Liver Disease in Cystic Fibrosis

Abbreviations ABC ATP-binding cassette CF cystic fibrosis CFTR cystic fibrosis transmembrane conductance regulator MBL2 mannose-binding lectin 2 PH prolyl hydroxylase TGFβ transforming growth factor β TIMP tissue inhibitor of matrix metalloproteinase TNFα tumor necrosis factor α UDCA ursodeoxycholic acid Cystic fibrosis (CF) is a lethal autosomal recessive disease resulting from mutations in the gene coding for cystic fibrosis transmembrane conductance regulator (CFTR), a membrane glycoprotein found…

Liver Disease in Alpha-1 Antitrypsin Deficiency

Abbreviations AAT alpha-1 antitrypsin ER endoplasmic reticulum PAS periodic acid–Schiff Pi protease inhibitor Alpha-1 antitrypsin (AAT) is the most abundant protease inhibitor and the second most abundant protein in plasma. It is produced predominantly by the liver and in smaller quantities by macrophages as well as by other cells in the lung, small intestine, and kidney. AAT is an acute phase reactant, and although it is…

Liver in Wilson Disease

Abbreviations ALT alanine aminotransferase AMA antimitochondrial antibody ANA antinuclear antibody AST aspartase aminotransferase FDA Federal Drug Administration HAV hepatitis A virus HBV hepatitis B virus HCV hepatitis C virus ICC Indian childhood cirrhosis PCR polymerase chain reaction SMA smooth muscle antibody Wilson disease is an autosomal recessive inherited disorder of copper transport that leads to toxic accumulation of copper in the liver, with subsequent release of…

Histologic Patterns of Metabolic Liver Diseases

Abbreviations ALF acute liver failure BASD bile acid synthetic defect CDG congenital disorders of glycosylation CoA coenzyme A FAO fatty acid oxidation mDNA mitochondrial DNA nDNA nuclear DNA OTC ornithine transcarbamylase PAS periodic acid–Schiff PFIC progressive familial intrahepatic cholestasis PH perinatal hemochromatosis RS Reye syndrome UCD urea cycle disorder ZSS Zellweger syndrome spectrum Metabolic liver diseases result from genetically determined malfunction of enzymes, transporters, structural proteins,…

Medical Genetics and Biochemistry in Diagnosis and Management

Abbreviations CDG congenital disorders of glycosylation CE-ESI-MS capillary electrophoresis–electrospray ionization–mass spectrometry GC-MS gas chromatography–mass spectrometry HPLC high-performance liquid chromatography MALDI matrix-assisted laser desorption/ionization MCAD medium chain acyl-CoA dehydrogenase MS/MS tandem mass spectrometry MSUD maple syrup urine disease mtDNA mitochondrial DNA TOF time of flight The diagnosis of inborn errors of metabolism is a complex process that necessitates a multidisciplinary approach involving the integration of a wide…

Liver Diseases of Childhood

Abbreviations AIH autoimmune hepatitis ALGS Alagille syndrome CMV cytomegalovirus ERK extracellular signal-regulated kinases GGT gamma glutamyltransferase HIDA hepatobiliary iminodiacetic acid JAG1 jagged-1 LCH Langerhans cell histiocytosis MAPK mitogen-activated protein kinases MAP2K1 mitogen-activated protein kinase kinase 1 NISCH neonatal sclerosing cholangitis NOTCH2 notch homolog 2 PILBD paucity of interlobular bile ducts PSC primary sclerosing cholangitis TORCH toxoplasmosis, other agents, rubella, cytomegalovirus, herpes simplex UDCA ursodeoxycholic acid This…

Investigative Imaging of the Liver

Abbreviations CT computed tomography FDG fluorodeoxyglucose FNH focal nodular hyperplasia HCC hepatocellular carcinoma HVTT hepatic vein transit time IVIM intravoxel incoherent motion MRE magnetic resonance elastography MRI magnetic resonance imaging MRS magnetic resonance spectroscopy PET positron emission tomography RF radiofrequency Investigative imaging of the liver is performed for the assessment of both focal lesions as well as diffuse parenchymal processes such as fibrosis and fatty infiltration;…

Laboratory Tests in Liver Disease

Abbreviations AAT alpha-1 antitrypsin AIH autoimmune hepatitis ALP alkaline phosphatase ALT alanine aminotransferase AMA antimitochondrial antibodies ANA antinuclear antibodies anti-ASGPR antibodies to asialoglycoprotein receptor anti-HBc antibody to hepatitis B core antigen anti-LCA1 antibody to liver-specific cytosol antigen type 1 anti-LKM1 antibodies to liver/kidney microsome type 1 anti-SLA/LPA antibody to soluble liver antigen/liver pancreas antigen APRI AST-to-platelet ratio index ASMA anti–smooth muscle antibody AST aspartate aminotransferase BD…

Clinical Features of Liver Disease

Abbreviations ALF acute liver failure ALFSG Acute Liver Failure Study Group APACHE Acute Physiology and Chronic Health Evaluation HAV hepatitis A virus HBeAg hepatitis B e antigen HBV hepatitis B virus HCV hepatitis C virus HE hepatic encephalopathy HELLP hemolysis, elevated liver levels, and low platelet count HEV hepatitis E virus HPS hepatopulmonary syndrome HRS hepatorenal syndrome INR international normalized ratio MELD model for end-stage liver…

Microscopic Anatomy, Basic Terms, and Elemental Lesions

Abbreviations H&E hematoxylin and eosin HMS hepatic microcirculatory subunit K keratin ∗ ∗ Although the prefix CK is widely used in surgical pathology to designate human cytokeratins, consensus nomenclature recommends the replacement of “cytokeratin” with “keratin” and the prefix “CK” with “K.” (Schweizer J, Bowden PE, Coulombe PA, et al. New consensus nomenclature for mammalian keratins. J Cell Biol . 2006;174:169–174). NADPH nicotinamide adenine dinucleotide phosphate It…

Intraoperative Cytology of Central Nervous System Lesions: A Diagnostic Approach Based on Pattern Recognition

Cytologic methods for the diagnosis of central nervous system (CNS) lesions have been used for about 50 years. Despite this, intraoperative consultation in most centers employs only traditional frozen section analysis as the sole means to render an intraoperative diagnosis. Although frozen section analysis, in general, has the advantage of architectural preservation, the superimposed artifacts of freezing tissue occasionally limit and distort important diagnostic features of…

Fine Needle Aspiration Biopsy Cytology of Soft Tissue: A Diagnostic Approach Based on Pattern Recognition

Primary soft tissue lesions pose a challenge to many cytopathologists because of the relative rarity of these lesions in comparison with those of other organ systems, the lack of familiarity with soft tissue tumors on fine needle aspiration biopsy (FNAB) and tissue biopsy, and the limitations of FNAB in subclassifying some soft tissue tumors. However, although subclassification of these lesions may be diagnostically challenging, it is…

Fine Needle Aspiration Biopsy Cytology of Kidney: A Diagnostic Approach Based on Pattern Recognition

Fine needle aspiration biopsy (FNAB) of the kidneys is a safe procedure with an excellent diagnostic yield based on established criteria for primary lesions with a sensitivity of 80% to 92% and specificity of 83% to 100% in diagnosing malignancy. The use of rapid on-site evaluation of the FNAB can reduce the need for core biopsy. But there are benefits to using a combined fine needle…

Fine Needle Aspiration Biopsy Cytology of Lung and Mediastinum: A Diagnostic Approach Based on Pattern Recognition

Currently, fine needle aspiration biopsy (FNAB) is the first diagnostic procedure used in patients presenting with a mass in the lung, mediastinum, or chest wall on chest x-ray (CXR) or computed tomography (CT) or CT positron emission tomography (PET) scan, which may have been performed as a routine screening procedure or as a part of the workup in patients with chest-related symptoms, pneumonia, malignancy in another…