Surgical Pathology Report
- The following is an abridged pathology report on my "explanted" liver. The findings can be summarized as advanced cirrhosis, changes associated with PSC, and stage 4 liver disease. Note that a pre-transplant biopsy and pathology report are not normally performed on the donor liver unless it is suspect. However, a "reperfusion" biopsy is done on the donor liver near the end of the transplant surgery. In the case of the explanted liver, the entire old liver serves as the biopsy sample.
- "The liver weighs 1100 grams and measures 22 by 17 by 9 cm. There is no gallbladder. The capsule is tan-green and multinodular and has focal areas of erythema. Scattered punctate white nodules measuring less than one cm are most prominent on the left inferior surface. Cross-sectioning reveals the parenchyma is tan-green and congested, and has a mixed nodular pattern. Areas of tan fibrosis exist within the right lobe of the liver, which correspond to pale areas on the capsule. No masses or areas of necrosis are noted grossly.
- Sections obtained for microscopic study: lateral left lobe with capsule, medial left lobe, lateral right lobe, medial right lobe, peripheral right lobe with capsule, hilum, and deep hilum.
- The first five sections show advanced cirrhosis. The liver has been divided into nodules by irregular bands of connective tissue. Within these there is mild ongoing chronic inflammation with activity along the edge of the developing nodules. Bile ductules are present. There is no indication of granulomatous reaction. Many medium sized bile ducts are present that show definite sclerosis of their wall. Many times this have the usual onion-ring fibrosis appearance. Active inflammation within the ducts, however, is not present. Completely scarred ducts are not present. The pattern of cirrhosis is both micro- and macro-nodular with some areas not having completely broken down into nodules. The remaining parenchyma shows some disarray of the hepatic cords and severe cholestasis. A few scattered small bowel infarcts are also present.
- The two sections from the hilum show the large vessels to have no remarkable changes. The larger bile ducts have fairly prominent sclerosis within their walls as well as active inflammation in the larger of the hepatic ducts. This inflammation is diffuse mononuclear infiltrates of the wall and adjacent connective tissues with no granulomas."