Microscopic Description -- Liver Transplant


Glucagon Insulin Chromogranin

Part 1 consists of an allograft hepatectomy demonstrating extensive coagulative necrosis involving almost 100% of the sampled parenchyma. No viable hepatocytes and only ghost cells and debris are seen. Some smaller branches of the hepatic artery and portal veins show thrombosis, probably as a secondary effect. In section 1D (superficial hilum), the portal vein is almost totally occluded by a fresh hemorrhagic thrombus. The bile duct shows hemorrhage and the surrounding fibroadipose tissue demonstrates fat necrosis and hemorrhage. Focal areas of organizing granulation tissue with calcifications are seen. In section 1E and 1F, the arterial branches contain fresh thrombi.

In part 2, sections through the pancreas show hemorrhage and fat necrosis. Otherwise, the pancreatic parenchyma is minimally fibrotic. A small islet cell tumor (0.2 cm in diameter) is incidentally noted, and several enlarged islets are additionally seen. In section 2B from the hilum, the splenic vein and the splenic artery contain fresh hemorrhagic thrombi. The pancreatic resection margin shows mild hemorrhage and necrosis, but it is mostly viable.

Part 3, from the right lobe of the liver, consists of a needle core of liver parenchyma. The hepatic architecture is intact and approximately six to seven portal tracts are recognized, which are unremarkable. The lobules demonstrate mild centrilobular hepatocellular necrosis and minimal sinusoidal neutrophilia. No viral inclusions are seen and no evidence of rejection is appreciated.

In part 4, from the left lobe, there is a needle liver biopsy. Coagulative necrosis involving approximately 50% of the sampled parenchyma is present. The viable hepatocytes show mild regenerative changes. Mild sinusoidal neutrophilia is seen.

Final Diagnosis


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