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Liver, needle core biopsy

-- Diffuse moderate to severe acute hepatitis with plasma cell-rich portal and central lobular infiltrates, consistent with auto-immune hepatitis (see note)

-- Mild to focally moderate cytoplasmic cholestasis

-- No geographic hepatocellular necrosis, steatosis or bile stasis

Note:

Sections reveal multiple biopsy cores with adequate portal triads for evaluation.  There is diffuse moderate hepatocellular degeneration associated with mixed inflammatory infiltrates that are rich in plasma cells in both portal triads and focally in the centrilobular area.  Scattered single hepatocellular necrosis is noted.  No geographic hepatocellular necrosis is present.  Portal inflammatory infiltrates consist of plasma cells, lymphocytes, some neutrophils and eosinophils with periportal extension (piecemeal necrosis or interface hepatitis).  Cytoplasmic cholestasis is readily noted.  No portal granuloma, bile duct inflammation or bile stasis is noted. 

The patient is noted to have markedly elevated igg (=2380, dated 6/8/2015).  The direct bilirubin = 6.0 (6/4/2015) and abnormal liver function tests (ast = 1600, alt = 1938, dated 6/3/2015).  The combined histological and laboratory findings support the above diagnosis.  The presence of a significant number of eosinophils may also raise the possibility of a concurrent/coexistent drug reaction.

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