Steatohepatitic Hepatocellular Carcinoma, a Morphologic Indicator of Associated Metabolic Risk Factors
|
|
- Lucas Mathews
- 6 years ago
- Views:
Transcription
1 Steatohepatitic Hepatocellular Carcinoma, a Morphologic Indicator of Associated Metabolic Risk Factors A Study From India Deepali Jain, MD, DNB; Nabeen C. Nayak, MD, FRCPath; Vinay Kumaran, MS, MCh; Sanjiv Saigal, MD, DM Context. The common risk factors for hepatocellular carcinoma (HCC) include persistent viral infection with either hepatitis B or C virus, alcohol abuse, hemochromatosis, and metabolic syndrome. Steatohepatitic (SH) HCC has been recently recognized as a special morphologic variant of HCC associated with metabolic risk factors. Objective. To assess the SH pattern in HCC cases of various etiologies in Indian patients and to further correlate this morphology with the presence of metabolic risk factors. Design. A total of 101 cases of HCC with various etiologies in explanted livers from adults were included in the study. Morphologic examination was performed to identify SH lesions within the tumor and in the nontumorous liver parenchyma. Correlation of nontumor and tumor SH morphology with clinically identifiable metabolic risk factors and with non-sh type of HCC was performed. Results. The SH variant of HCC was identified in 19 livers (18.8%). Most SH-HCC cases were associated with metabolic risk factors such as obesity, diabetes, hypertension, and hyperlipidemias. Comparison of SH-HCC with non SH-HCC was statistically significant in terms of presence of metabolic risk factors. Conclusions. Steatohepatitic morphology in HCC is frequent in nonalcoholic fatty liver disease associated cirrhosis (P ¼.009) and is significantly associated with metabolic risk factors (P ¼.03). By recognizing SH pattern, one may predict associated metabolic diseases and determine the prognosis both in pretransplant and posttransplant patients. (Arch Pathol Lab Med. 2013;137: ; doi: / arpa oa) Hepatocellular carcinoma (HCC) accounts for 85% to development of HCC in NAFLD, which include obesity, 90% of all primary liver cancers. 1 There is wide diabetes, and iron deposition. 7,8 Recently a new morphologic geographic variation of prevalence of HCC, with Asia and Africa having 40 times more cases than other parts of the variant of HCC named steatohepatitic hepatocellular carcinoma has been identified that relates to the presence of world. 2 However, the incidence of HCC has been rising metabolic syndrome. 9,10 The aim of the study is to recognize throughout the world, with particularly large increases seen in industrialized nations such as the United States and Denmark. 3 Nonalcoholic fatty liver disease (NAFLD) ranges steatohepatitic (SH) pattern in HCC cases of various etiologies in Indian patients and to further correlate this variant with the presence of metabolic risk factors. in severity from steatosis to steatohepatitis (NASH, nonalcoholic steatohepatitis) and finally to cirrhosis, which is MATERIALS AND METHODS known to be a risk factor for the development of HCC. 4 In Between January 2004 and January 2011, 450 adult patients Western and Asian countries, the prevalence of NAFLD in underwent living donor liver transplant for end-stage liver disease. the general population is increasing dramatically. 5 Genetic factors may in part contribute to the rise in NAFLD. Polymorphisms within various genes have been linked to For each patient a pre liver transplant diagnosis of the etiologic type of end-stage chronic liver disease was recorded, but the final diagnostic category of native liver disease was assigned only on the NAFLD in lean Indian men. 6 Emerging evidence has basis of a combination of pretransplant clinical data and established multiple independent risk factors for the morphologic findings in the explant liver. Among 450 patients, 101 underwent transplant for HCC secondary to chronic hepatitis C virus (HCV) infection (n ¼ 42), chronic hepatitis B virus (HBV) infection (n ¼ 32), alcoholic liver disease (ALD) (n ¼ 11), NAFLD (n Accepted for publication August 29, ¼ 12), and mixed (HBVþHCVþALD) etiology (n ¼ 4). Most (11 of From the Departments of Pathology (Drs Jain and Nayak) and Liver 12) NAFLD transplant cases were associated with the clinical Transplant (Dr Kumaran and Dr Saigal), Sir Ganga Ram Hospital, diagnosis of cryptogenic cirrhosis. The diagnosis of NAFLD was New Delhi, India. based on clinical history of nonalcoholism and established The authors have no relevant financial interest in the products or companies described in this article. histologic features such as steatosis, lobular inflammation, Mallory Reprints: Deepali Jain, MD, DNB, Department of Pathology, Sir hyaline, and hydropic change. Ganga Ram Hospital, Rajinder Nagar, New Delhi, India ( In all cases, information on pretransplant clinical and investiga- deepalijain76@gmail.com). tional data were analyzed. Basic demographics, body mass index, Arch Pathol Lab Med Vol 137, July 2013 Steatohepatitic Hepatocellular Carcinoma Jain et al 961
2 Clinical and Pathologic Differences Between 2 Groups of Steatohepatitic (SH) and Conventional Hepatocellular Carcinoma (HCC) Clinical Features SH-HCC (19) Conventional HCC (82) Total Cases (101) P Value Age, mean (range), y 54.8 (47 65) 51.2 (45 67) 52.3 (45 67)..99 Sex, M/F 17/2 74/8 91/10.99 Associated etiology HCV (9), NAFLD (6), HBV (2), HCV (35), HBV (26), ALD HCV (44), HBV (28), ALD.32 ALD (1), mixed a (1) (10), NAFLD (6), CC (2), mixed a (3) (11), NAFLD (12), CC (2), mixed a (4) Risk factors, b No. (%) 10/16 c (62.5) 22/64 c (34.3) 32/80 (40).03 NAFLD Tumor size, mean (range), cm d 3.38 (1 7) 3.17 (0.5 5) 3.58 (0.5 7)..99 No. of lesions, single/multiple 8/11 17/65 25/76.15 Differentiation, well/moderate/poor 6/13/0 20/55/7 26/68/7.74 Vessel invasion None None None Staging T1 T3a T1 T3a T1 T3a Abbreviations: ALD, alcoholic liver disease; CC, cryptogenic cirrhosis (no etiology could be determined even after clinical and histologic examination); HBV, hepatitis B virus; HCV, hepatitis C virus; NAFLD, nonalcoholic fatty liver disease; T, pathologic tumor stage. a Mixed etiology: HBVþHCVþALD. b Metabolic risk factors such as obesity (increase in body mass index), diabetes, hyperlipidemia, hypertension. c Risk factor information is available for 16 (SH-HCC) and 64 (conventional HCC) patients only. d The largest tumor size was taken in multifocal tumors for comparison. and presence of metabolic abnormalities, such as obesity, diabetes, hypertension, and hyperlipidemia, were particularly noted. Triglyceride levels of 150 mg/dl or higher and cholesterol levels of 250 mg/dl or higher were considered as hyperlipidemic. Body mass index (BMI) of more than 25 kg/m 2 was taken as increased BMI/ obesity. Patients carrying a previous clinical diagnosis of either hypertension or diabetes mellitus were identified as hypertensive and diabetic, respectively. Explant Liver Morphology Gross examination of the explant liver was done in respect of the size and location of the tumor. The number of lesions was recorded in cases of multicentric or multifocal tumors. Presence or absence of portal vein invasion was noted. Gross appearance of nontumorous background liver was documented. Histologic Analysis The analysis was performed on formalin-fixed, paraffin-embedded tissue sections stained with hematoxylin-eosin and Masson trichrome stains. A morphologic examination was performed to identify SH pattern within the tumor and in the nontumorous parenchyma. Correlation of SH morphology (tumor and nontumor) and non-sh type of HCC (conventional/standard HCC) with clinically identifiable metabolic risk factors was performed. In each case a minimum of 2 sections from the tumor were examined. More sections were studied when tumor was larger than 4 cm. The features of each tumor, including grade of differentiation and presence of vascular invasion, were noted. Presence of steatosis, fibrosis, inflammation, ballooning degeneration, and Mallory hyaline were recorded by 2 pathologists (D.J. and N.C.N.) without any knowledge of pretransplant clinical information for identifying SH variant of HCC. Hepatocellular carcinomas assigned as SH-HCC type showed steatohepatitic features in more than 5% of the tumor area 9 (including overall area in multiple HCCs), and displayed the combination of features described in steatohepatitis, including macrovesicular steatosis, ballooning degeneration, Mallory hyaline, fibrosis, and inflammation. The pattern of fibrosis was reported as trabecular (thick bundles of fibrous tissue within the tumor) or pericellular (thin strands of fibrosis). Inflammatory cells (neutrophils, mixed [neutrophils and lymphocytes]) were scored as þ (,2 foci of inflammatory cells under the 310 objective), þþ (2 to 5 foci), and þþþ (.5 foci). The degree of steatosis, presence of Mallory hyaline, and ballooning in the tumor were used to classify the cases as mild (5% 25%), moderate (25% 50%), or severe (more than 50%). Conventional and SH-HCC tumors were graded according to the Edmondson-Steiner classification into well-differentiated (grade I), moderately differentiated (grade II, III), and poorly differentiated (grade IV) types. Immunohistochemistry Glypican-3 immunostaining was performed to further confirm the diagnosis of HCC in SH variant. Immunohistochemical staining was carried out by using a mouse monoclonal antibody (B0134R, clone 1G12 isotype IgG1 human glypican-3, prediluted, BioMosaics Inc, Burlington, Vermont). Statistical Analysis For comparing categorical data, a Fisher exact test was used and for frequency distributions, a v 2 test was used. A difference was defined as significant at P.05. RESULTS Clinical features of all 101 patients with differences in SH and conventional HCC are summarized in the Table. Clinical Features and Metabolic Risk Factors The SH variant of HCC was identified in 19 livers (18.8%). In the SH-HCC group, there were 17 men and 2 women. Ages ranged from 47 to 65 years (mean, 54.8 years). Associated etiologies in these cases were HCV (9), NAFLD (6), HBV (2), ALD (1), and mixed (HBVþHCVþALD) infection (1). Age and sex were not found to be significantly different in the SH-HCC and the standard HCC groups. There was no difference in terms of size, location, number of lesions, overall tumor differentiation, and vascular invasion between SH and conventional HCC cases. Information about metabolic risk factors was available for 16 patients only. Of these, only 10 (62.5%) were associated with metabolic risk factors in the form of obesity, diabetes, hypertension, or hyperlipidemia. Four patients were obese, 4 were both obese and diabetic, and 2 were obese, hypertensive, and hyperlipidemic. Of these 10 patients, 4 were clinically and histologically diagnosed as having NAFLD, and 3 had associated HCV-related end-stage liver disease. The remaining 3 patients had underlying HBVrelated liver disease, ALD, and mixed etiology (HBVþHCVþALD). 962 Arch Pathol Lab Med Vol 137, July 2013 Steatohepatitic Hepatocellular Carcinoma Jain et al
3 Figure 1. A, Photomicrograph shows well-demarcated areas of steatohepatitic hepatocellular carcinoma (SH-HCC) (left side) in an otherwise welldifferentiated trabecular HCC (right side). B, The SH-HCC pattern merges into a more classical pseudoglandular region at lower left. C, Macrovesicular steatosis, inflammation, and ballooning are appreciated in SH-HCC area. D, Another case of SH-HCC illustrates prominent ballooning with conspicuous Mallory hyaline. E and F, Polymorphonuclear inflammatory infiltrate (E), and prominent Mallory hyaline and fibrosis (F) are seen in SH-HCC (hematoxylin-eosin, original magnifications 340 [A, B], 3200 [C, E, and F], 3400 [D]). In the conventional HCC group, 22 (22 of 64, 34.3%) patients had metabolic risk factors (Table). Fourteen patients were obese and 8 had both obesity and diabetes. Associated etiologies were as follows: HCV (9), NAFLD (6), HBV (4), ALD (2), and mixed HBVþHCVþALD infection (1). Comparison of SH-HCC with non SH-HCC was statistically significant (P ¼.03) in terms of presence of metabolic risk factors. Steatohepatitic morphology in HCC was frequent in NAFLD cirrhosis (P ¼.009) in comparison to non-nafld cases (Table). Gross Examination Grossly, tumors in both categories were either solitary or multiple. Size varied from 0.5 to 7 cm. Macroscopically, tumors were nodular and well demarcated from surrounding cirrhotic liver parenchyma. The color of the tumors was tan yellow to grey white. No vessel invasion was identified grossly. Histologic Analysis Most of the SH-HCC cases were moderately differentiated and showed trabecular and pseudoglandular patterns. Among the 19 SH-HCC cases, all showed macrovesicular steatosis, inflammation and ballooning degeneration, with Mallory hyaline in 16 of 19 cases (84.2%), and pericellular fibrosis in 18 of 19 cases (94.7%). Features of steatohepatitis were moderate to severe in intensity. All cases showed moderate (þþ) (10 of 19, 52.6%) to marked (þþþ)(9of19 cases, 47.3%) infiltration of the SH-HCC areas by neutrophils with admixed lymphocytes and plasma cells. Neutrophils were seen in the vicinity of ballooned hepatocytes. Lymphocytes and plasma cells were distributed through areas of tumor. Masson trichrome stain demonstrated characteristic pericellular fibrosis; associated trabecular thick bands of fibrosis were seen in some of these cases (Figures 1, A through F; 2, A through C). Glypican-3 immunostaining was performed in 18 cases. It showed strong cytoplasmic (11 of 13) and focal canalicular (2 of 13) positivity in 13 cases (Figure 2, D). Five cases showed negativity for this stain. Diagnosis of HCC was established in these 5 cases by recognizing paucireticulin pattern on reticulin staining and infiltrative margins of the tumor. Prevalence of Steatosis and NASH in the Adjacent Nonneoplastic Liver Background nontumorous liver was cirrhotic in all cases. Histologic analysis of the adjacent liver showed an increased prevalence of steatosis and steatohepatitis in explants of SH-HCC cases. Among these were 6 cases of NAFLD and 9 cases of HCV, which showed moderate steatohepatitis (Figure 3, A through C). Cases of HBV (2), ALD (1), and mixed etiology (1) also showed mild steatosis. Among the conventional HCC cases, metabolic risk factors were present in 22 cases. Of these 22 cases, background liver showed steatohepatitis in 3 NAFLD cases. Most cases of HCV (8 of 9) showed steatosis in addition to changes associated with viral hepatitis in the form of portalbased lymphoid aggregates and interface hepatitis (Figure 3, D). Three cases of HBV, with 1 case of mixed etiology and 1 other case of ALD, showed mild to moderate macrovesicular steatosis. One case each of HBV, HCV, and ALD and 3 cases of NAFLD did not show steatosis/steatohepatitis. The remaining cases of conventional HCC (60 of 82) showed variable features of end-stage liver disease with or without fatty change. Arch Pathol Lab Med Vol 137, July 2013 Steatohepatitic Hepatocellular Carcinoma Jain et al 963
4 Figure 2. A through C, Photomicrographs of steatohepatitic hepatocellular carcinoma (SH-HCC). Fibrosis is better appreciated in Masson trichrome stain. Trichrome stain shows characteristic pericellular fibrosis in (A) and thick fibrous bands in (B) and (C). D, Glypican-3 immunostain shows strong cytoplasmic positivity in SH-HCC (original magnifications 3400 [A, C, and D] and 3200 [B]). Of a total of 19 patients with SH-HCC, 16 were alive and disease-free at last follow-up of 24 to 72 months. Three patients died, with one death due to recurrence of tumor (HBV-associated HCC) after 30 months of diagnosis. Two other patients died (NAFLD-associated HCC) at the time of diagnosis after surgery owing to sepsis and multiorgan dysfunction. Follow-up information was available for 76 patients with conventional HCC. Of these, 16 patients died with 6 deaths due to recurrence of HCC. COMMENT Available evidence in the literature indicates that NAFLD is responsible for a large proportion of cases of cryptogenic cirrhosis and cryptogenic HCC. 11,12 Development of HCC in the setting of NAFLD/NASH supports the association of diabetes and obesity, as well as age, hepatic iron deposition, and advanced fibrosis, as a significant risk factor. 7,8,13 Since published literature on NAFLD in India is sparse, it is not clear whether these risk factors are similar in this part of the world. In general, differences in Indian patients include a lower frequency of metabolic syndrome. 14,15 Despite having a lower average BMI, Asians have a higher percentage of body fat compared to whites and African Americans. It has been suggested that the BMI limits for overweight and obesity should be lower for Asian Indians. 16,17 This explains why we have taken a BMI of 25 kg/m 2 or higher as a cutoff for obesity. Multiple case reports and reviews of HCC in the setting of NAFLD have been published. These suggest a prevalence of 4% to 27% of HCC after the development of cirrhosis, although the overall occurrence of HCC in the setting of NAFLD remains a rare complication. 5 Salomao et al 9 identified a distinctive histologic variant named steatohepatitic hepatocellular carcinoma in patients with HCV with associated NAFLD/NASH. They raised the question of altered biologic/morphologic characteristics of HCC in presence of risk factors for NAFLD and NASH. Recently, the same group of authors 10 has identified SH- HCC in 13.5% of HCCs with various etiologies in a span of 3.5 years. Steatohepatitic HCC is characterized by a constellation of SH features such as fatty change, ballooning degeneration, neutrophilic inflammation, perisinusoidal fibrosis, and Mallory bodies. Mallory bodies are known to occur in hepatocellular carcinoma and these were earlier considered as cellular markers for liver cell preneoplasia and 964 Arch Pathol Lab Med Vol 137, July 2013 Steatohepatitic Hepatocellular Carcinoma Jain et al
5 Figure 3. A through C, Case of nonalcoholic fatty liver disease (NAFLD) with steatohepatitic hepatocellular carcinoma (SH-HCC). Background liver shows macrovesicular steatosis with prominent ballooning and lobular inflammation. Mallory hyaline is seen in (C). D, A case of hepatitis C virus infection with conventional HCC. Photomicrograph shows cirrhosis with macrovesicular steatosis and portal-based chronic inflammation (hematoxylin-eosin, original magnifications 3100 [A and D], 3200 [B], and 3400 [C]). neoplastic change. 18,19 Nakanuma and Ohta 19 found a positive correlation between the presence of Mallory bodies in HCC tissue and the presence of Mallory bodies in the associated nonneoplastic hepatocytes in cryptogenic cirrhotic livers. It might be the process of steatohepatitis in HCC and nonneoplastic hepatocytes that has recently been identified by Salomao et al. 9,10 Overall, we found SH variant of HCC in approximately 19% of cases during a period of 7 years and in 50% of cases of NAFLD-HCC. The remaining 50% of SH-HCC cases were largely of HCV etiology. Hepatitis C virus infection itself induces insulin resistance and is associated with a 2- to 3-fold risk of developing type 2 diabetes 20 ; this may explain the higher association of metabolic risk factors and SH- HCC morphology in HCV cases. However, it is not known whether SH morphology in these patients is associated with metabolic syndrome or is due to viral steatosis related to HCV. Since HCV genotype 3 is predominant in India (genotyping not done in this study) and is associated with macrovesicular steatosis, 21 the SH morphology may possibly be due to the viral infection in some of these cases. This may explain the difference with the recent study by Salomao et al, 10 as these authors found a strong relationship between SH-HCC and background steatohepatitis; however, we found a significant association of SH-HCC with metabolic risk factors and NAFLD. Identifying SH pattern in HCC is important as it may indirectly hint toward metabolic dysfunction even if background liver overshadows underlying steatohepatitis due to end-stage liver disease. Steatohepatitis was seen only in 50% (3 of 6) of NAFLD cases It is known that steatosis, which is prominent and universal in the established stage of NAFLD/NASH, is inconspicuous or even absent in the advanced/cirrhotic stage of the disease This may be the reason for not finding features of fatty liver disease in half of the NAFLD cases. For patients with HCV, HBV, and ALD, steatosis was the only feature, which may represent a spectrum of fatty liver disease. Although it is difficult to determine the prognosis of SH- HCC owing to the small number of cases examined, it can be predicted that these tumors behave better, as only 1 patient died from tumor recurrence on follow-up, which also was associated with HBV. Certainly metabolic risk factors were present in a large number of cases (32 of 80, 40%) including SH and conventional HCC groups. This observation denotes that Arch Pathol Lab Med Vol 137, July 2013 Steatohepatitic Hepatocellular Carcinoma Jain et al 965
6 metabolic syndrome has now become an important risk factor directly in addition to playing an additive role in hepatic carcinogenesis. This is the first study of patients of Asian (Indian) origin that identifies SH-HCC originating in the setting of ALD, NAFLD, and viral hepatitis on both clinical and pathologic grounds. Further, correlation of SH-HCC with identifiable metabolic risk factors is discussed, which represents additional evidence to suggest a possible role of NAFLD in liver carcinogenesis. This study includes a cohort from an overall North Indian population and spans a 7-year period. However, it is limited by the selection of cases, as all of our patients had end-stage disease and needed a liver transplant. To know the exact prevalence of SH-HCC for all the recognized causes of liver disease, and its association with metabolic dysfunction, a further large-scale study of differently staged cases with inclusion of HCV genotyping may be required. CONCLUSION Nonalcoholic fatty liver disease has become an important cause of liver transplant in India. Prevalence of HCC in NAFLD is almost similar to that for ALD, signifying the important role of metabolic syndrome in liver carcinogenesis. Steatohepatitic morphology in HCC is frequent in NAFLD cirrhosis and has a significant association with metabolic risk factors. By recognizing SH pattern in HCC, one may predict associated metabolic syndrome and associated outcome of patients. Steatohepatitic pattern among HCCs may be considered as a prototype of metabolic dysfunction. References 1. El-Serag HB, Rudolph KL. Hepatocellular carcinoma: epidemiology and molecular carcinogenesis. Gastroenterology. 2007;132(7): Bosch FX, Ribes J, Cléries R, Diaz M. Epidemiology of hepatocellular carcinoma. Clin Liver Dis. 2005;9(2): Jepsen P, Vilstrup H, Tarone RE, Friis S, Srensen HT. Incidence rates of hepatocellular carcinoma in the U.S. and Denmark: recent trends. Int J Cancer. 2007;121(7): Starley BQ, Calcagno CJ, Harrison SA. Nonalcoholic fatty liver disease and hepatocellular carcinoma: a weighty connection. Hepatology. 2010;51(5): Siegel AB, Zhu AX. Metabolic syndrome and hepatocellular carcinoma: two growing epidemics with a potential link. Cancer. 2009:115(24): Petersen KF, Dufour S, Hariri A, et al. Apolipoprotein C3 gene variants in nonalcoholic fatty liver disease. N Engl J Med. 2010;362(12): Regimbeau JM, Colombat M, Mogol P, et al. Obesity and diabetes as a risk factor for hepatocellular carcinoma. Liver Transpl. 2004;10(2 suppl 1):S69 S Sorrentino P, D Angelo S, Ferbo U, Micheli P, Bracigliano A, Vecchione R. Liver iron excess in patients with hepatocellular carcinoma developed on nonalcoholic steato-hepatitis. J Hepatol. 2009;50(2): Salomao M, Yu WM, Brown RS Jr, Emond JC, Lefkowitch JH. Steatohepatitic hepatocellular carcinoma (SH-HCC): a distinctive histological variant of HCC in hepatitis C virus-related cirrhosis with associated NAFLD/NASH. Am J Surg Pathol. 2010;34(11): Salomao M, Remotti H, Vaughan R, Siegel AB, Lefkowitch JH, Moreira RK. The steatohepatitic variant of hepatocellular carcinoma and its association with underlying steatohepatitis. Hum Pathol. 2011;43(5): Bugianesi E, Leone N, Vanni E, et al. Expanding the natural history of nonalcoholic steatohepatitis: from cryptogenic cirrhosis to hepatocellular carcinoma. Gastroenterology. 2002;123(1): Marrero JA, Fontana RJ, Su GL, Conjeevaram HS, Emick DM, Lok AS. NAFLD may be a common underlying liver disease in patients with hepatocellular carcinoma in the United States. Hepatology. 2002;36(6): Hashimoto E, Yatsuji S, Tobari M, et al. Hepatocellular carcinoma in patients with nonalcoholic steatohepatitis. J Gastroenterol. 2009;44(suppl 19): Duseja A, Sharma B, Kumar A, et al. Nonalcoholic fatty liver in a developing country is responsible for significant liver disease. Hepatology. 2010; 52(6): Duseja A. Nonalcoholic fatty liver disease in India a lot done, yet more required! Indian J Gastroenterol. 2010;29(6): Steering Committee of the Western Pacific Region of the World Health Organization, The International Association for the Study of Obesity, the International Study Task Force. The Asia-Pacific Perspective: Redefining Obesity and Its Treatment. Melbourne, Australia: Health Communications Australia; 2000: Dhiman RK, Duseja A, Chawla Y. Asians need different criteria for defining obesity. Arch Intern Med. 2005;165(9): Nakanuma Y, Ohta G. Small hepatocellular carcinoma containing many Mallory bodies. Liver. 1984;4(2): Nakanuma Y, Ohta G. Is Mallory body formation a preneoplastic change: a study of 181 cases of liver bearing hepatocellular carcinoma and 82 cases of cirrhosis. Cancer. 1985;55(10): Hui JM, Sud A, Farrell GC, et al. Insulin resistance is associated with chronic hepatitis C virus infection and fibrosis progression. Gastroenterology. 2003;125(6): Mihm S. Hepatitis C virus, diabetes and steatosis: clinical evidence in favor of a linkage and role of genotypes. Dig Dis. 2010;28(1): Brunt EM. Nonalcoholic steatohepatitis: pathologic features and differential diagnosis. Semin Diagn Pathol. 2005;22(4): Nayak NC, Vasdev N, Saigal S, Soin AS. End-stage nonalcoholic fatty liver disease: evaluation of pathomorphologic features and relationship to cryptogenic cirrhosis from study of explant livers in a living donor liver transplant program. Hum Pathol. 2010;41(3): Harrison SA, Torgerson S, Hayashi PH. The natural history of nonalcoholic fatty liver disease: a clinical histopathological study. Am J Gastroenterol. 2003; 98(9): Vasdev N, Kakati AG, Saigal S, Nayak NC. Spectrum of histological features in non-alcoholic fatty liver disease. Natl Med J India. 2007;20(6): Nayak NC, Jain D. End stage chronic liver disease yesterday, today and tomorrow. In: Michelli ML, ed. Liver Cirrhosis Causes, Diagnosis and Treatment. New York, NY: Nova Science Publishers; 2011: Arch Pathol Lab Med Vol 137, July 2013 Steatohepatitic Hepatocellular Carcinoma Jain et al
Linda Ferrell, MD Distinguished Professor Vice Chair Director of Surgical Pathology Dept of Pathology
Linda Ferrell, MD Distinguished Professor Vice Chair Director of Surgical Pathology Dept of Pathology Nonalcoholic steatohepatitis and Fatty Liver Disease Liver manifestations of the obesity epidemic Changes
More informationLiver Pathology in the 0bese
Liver Pathology in the 0bese Rob Goldin Centre for Pathology, Imperial College r.goldin@imperial.ac.uk Ludwig et al. Non-alcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease.
More informationFat, ballooning, plasma cells and a +ANA. Yikes! USCAP 2016 Evening Specialty Conference Cynthia Guy
Fat, ballooning, plasma cells and a +ANA. Yikes! USCAP 2016 Evening Specialty Conference Cynthia Guy Goals Share an interesting case Important because it highlights a common problem that we re likely to
More informationBasic patterns of liver damage what information can a liver biopsy provide and what clinical information does the pathologist need?
Basic patterns of liver damage what information can a liver biopsy provide and what clinical information does the pathologist need? Rob Goldin r.goldin@imperial.ac.uk Fatty liver disease Is there fatty
More informationSteatotic liver disease
Steatotic liver disease Fatty liver disease Prof. Dr. ANNE HOORENS Non-Neoplastic Liver Pathology December 8th 2018 Working Group of Digestive Pathology Belgian Society of Pathology OUTLINE NAFLD = Non-Alcoholic
More informationRelationship between Serum Iron Indices and Hepatic Iron Quantitation in Patients with Fatty Liver Disease
International Journal of Business, Humanities and Technology Vol. 2 No. 5; August 2012 Relationship between Serum Iron Indices and Hepatic Iron Quantitation in Patients with Fatty Liver Disease Dr. Mariana
More informationDetection and Characterization of Hepatocellular Carcinoma by Imaging
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2005;3:S136 S140 Detection and Characterization of Hepatocellular Carcinoma by Imaging OSAMU MATSUI Department of Imaging Diagnosis and Interventional Radiology,
More informationChallenges in the Diagnosis of Steatohepatitis
The Bugaboos of Fatty Liver Disease: Ballooning and Fibrosis Hans Popper Hepatopathology Society Companion Meeting San Antonio, Tx March, 2017 David Kleiner, M.D., Ph.D. NCI/Laboratory of Pathology Challenges
More informationNew insights into fatty liver disease. Rob Goldin Centre for Pathology, Imperial College
New insights into fatty liver disease Rob Goldin Centre for Pathology, Imperial College r.goldin@imperial.ac.uk Prevalence of NASH Global prevalence of NAFLD is 25% with highest prevalence in the Middle
More informationLiver Cancer: Epidemiology and Health Disparities. Andrea Goldstein NP, MS, MPH Scientific Director Onyx Pharmaceuticals
Liver Cancer: Epidemiology and Health Disparities Andrea Goldstein NP, MS, MPH Scientific Director Onyx Pharmaceuticals 1. Bosch FX, et al. Gastroenterology. 2004;127(5 suppl 1):S5-S16. 2. American Cancer
More informationUpdate on Non-Alcoholic Fatty Liver Disease. Timothy R. Morgan, MD Chief, Hepatology, VA Long Beach Professor of Medicine, UCI
Update on Non-Alcoholic Fatty Liver Disease Timothy R. Morgan, MD Chief, Hepatology, VA Long Beach Professor of Medicine, UCI February 3, 2018 Disclosure Clinical trials: Genfit Speaker s Bureau: none
More informationImproving Access to Quality Medical Care Webinar Series
Improving Access to Quality Medical Care Webinar Series Presented by The Arizona Telemedicine Program and the Southwest Telehealth Resource Center 2015 UA Board of Regents Welcome AZ, UT, CO, NM & NV FLEX
More informationNon-Alcoholic Fatty Liver Disease An Update
Non-Alcoholic Fatty Liver Disease An Update Stefan Hübscher, School of Cancer Sciences, University of Birmingham Dept of Cellular Pathology, Queen Elizabeth Hospital, Birmingham First described in 1980
More informationNAFLD/NASH. Definitions. Pathology NASH. Vicki Shah PA-C, MMS Rush University Hepatology
NAFLD/NASH Vicki Shah PA-C, MMS Rush University Hepatology Definitions NAFLD Evidence of hepatic steatosis by histology (5%) or imaging No causes for secondary fat accumulation EtOH, Drugs, hereditary
More informationPathological Classification of Hepatocellular Carcinoma
3 rd APASL Single Topic Conference: HCC in 3D Pathological Classification of Hepatocellular Carcinoma Glenda Lyn Y. Pua, M.D. HCC Primary liver cancer is the 2 nd most common cancer in Asia HCC is the
More informationNON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) NON-ALCOHOLIC STEATOHEPATITIS (NASH) ADDRESSING A GROWING SILENT EPIDEMIC
NON-ALCOHOLIC FATTY LIVER DISEASE () & NON-ALCOHOLIC STEATOHEPATITIS () ADDRESSING A GROWING SILENT EPIDEMIC PREVALENCE OF / USA Prevalence in Middle Age Patients San Antonio, Texas (Williams et al., Gastroenterology
More informationNON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) NON-ALCOHOLIC STEATOHEPATITIS (NASH) ADDRESSING A GROWING SILENT EPIDEMIC
NON-ALCOHOLIC FATTY LIVER DISEASE () & NON-ALCOHOLIC STEATOHEPATITIS () ADDRESSING A GROWING SILENT EPIDEMIC PREVALENCE OF / USA Prevalence in Middle Age Patients San Antonio, Texas (Williams et al., Gastroenterology
More information6 Riunione Monotematica A.I.S.F NASH malattia epatica, oncologica e cardiovascolare
6 Riunione Monotematica A.I.S.F. 2015 NASH malattia epatica, oncologica e cardiovascolare Modena, 9 ottobre 2015 Massimo Colombo NAFLD e HCC: caratteristiche distintive Chairman Department of Liver, Kidney,
More informationOriginal Article. Significance of Hepatic Steatosis in Chronic Hepatitis B Infection INTRODUCTION
Original Article Bhanthumkomol P, et al. THAI J GASTROENTEROL 2013 Vol. 14 No. 1 Jan. - Apr. 2013 29 Bhanthumkomol P 1 Charatcharoenwitthaya P 1 Pongpaiboon A 2 ABSTRACT Background: Significance of liver
More informationNAFLD & NASH: Russian perspective
NAFLD & NASH: Russian perspective Vasily Isakov, MD, PhD Professor, Chief, Department Gastroenterology & Hepatology, Federal Research Center of nutrition, biotechnology and food safety Disclosures Received
More informationUMHS-PUHSC JOINT INSTITUTE
Role of Visceral Adiposity in the Pathogenesis of Non-Alcoholic Fatty Liver Disease in Lean versus Obese Patients: A Comparative Study between Patients at UMHS versus PUHSC Lai WEI and Anna LOK W Zhang,
More informationBasic patterns of liver damage what information can a liver biopsy provide and what clinical information does the pathologist need?
Basic patterns of liver damage what information can a liver biopsy provide and what clinical information does the pathologist need? Rob Goldin r.goldin@imperial.ac.uk @robdgol FATTY LIVER DISEASE Brunt
More informationPancreatic exocrine insufficiency: a rare cause of nonalcoholic steatohepatitis
Pancreatic exocrine insufficiency: a rare cause of nonalcoholic steatohepatitis Naoki Tanaka 1, Akira Horiuchi 2, Takahide Yokoyama 3, Shigeyuki Kawa 1, and Kendo Kiyosawa 1 1 Department of Gastroenterology,
More informationJose D Sollano, MD Professor of Medicine University of Santo Tomas Manila, Philippines. University of Santo Tomas
Jose D Sollano, MD Professor of Medicine Manila, Philippines International Variation in Age-Standardized Liver Cancer Incidence Rates in Both Sexes, 2008 Global Age-Standardized Liver Cancer Incidence
More informationAAIM: GI Workshop Follow Up to Case Studies. Non-alcoholic Fatty Liver Disease Ulcerative Colitis Crohn s Disease
AAIM: GI Workshop Follow Up to Case Studies Non-alcoholic Fatty Liver Disease Ulcerative Colitis Crohn s Disease Daniel Zimmerman, MD VP and Medical Director, RGA Global October 2015 Non-alcoholic Fatty
More informationRole of Liver Biopsy. Role of Liver Biopsy 9/3/2009. Liver Biopsies in Viral Hepatitis: Beyond Grading and Staging
Liver Biopsies in Viral Hepatitis: Beyond Grading and Staging for further reference: Liver biopsy assessment in chronic viral hepatitis: a personal, practical approach Neil Theise, MD. Depts of Pathology
More informationPITFALLS IN THE DIAGNOSIS OF MEDICAL LIVER DISEASE WITH TWO CONCURRENT ETIOLOGIES I HAVE NOTHING TO DISCLOSE CURRENT ISSUES IN ANATOMIC PATHOLOGY 2017
CURRENT ISSUES IN ANATOMIC PATHOLOGY 2017 I HAVE NOTHING TO DISCLOSE Linda Ferrell PITFALLS IN THE DIAGNOSIS OF MEDICAL LIVER DISEASE WITH TWO CONCURRENT ETIOLOGIES Linda Ferrell, MD, UCSF THE PROBLEM
More informationBritish Liver Transplant Group Pathology meeting September Leeds cases
British Liver Transplant Group Pathology meeting September 2014 Leeds cases Leeds Case 1 Male 61 years Liver transplant for HCV cirrhosis with HCC in January 2014. Now raised ALT and bilirubin,? acute
More informationMost hepatocellular carcinoma (HCC) arises on a background
Does Nonalcoholic Fatty Liver Disease Predispose Patients to Hepatocellular Carcinoma in the Absence of Cirrhosis? Grace Guzman, MD; Elizabeth M. Brunt, MD; Lydia M. Petrovic, MD; Gregorio Chejfec, MD;
More informationSlide 7 demonstrates acute pericholangitisis with neutrophils around proliferating bile ducts.
Many of the histologic images and the tables are from MacSween s Pathology of the Liver (5 th Edition). Other images were used from an online source called PathPedia.com. A few images from other sources
More informationPathology of Fatty Liver Disease
1 Fatty Liver Disease - Causes Pathology of Fatty Liver Disease Role of Liver Biopsy in (Non-Alcoholic) Fatty Liver Disease Stefan Hübscher, Institute of Immunology & Immunotherapy, University of Birmingham
More informationLiver transplant: what is left after the viruses
Riunione Monotematica A.I.S.F. 2016 The Future of Liver Disease: Beyond HCV is there a Role for Hepatologist? Milan 15 th 2016 Liver transplant: what is left after the viruses Stefano Ginanni Corradini
More informationThe role of non-invasivemethods in evaluating liver fibrosis of patients with non-alcoholic steatohepatitis
The role of non-invasivemethods in evaluating liver fibrosis of patients with non-alcoholic steatohepatitis Objectives: Liver biopsy is the gold standard for diagnosing the extent of fibrosis in NAFLD/NASH;
More informationNONALCOHOLIC FATTY LIVER DISEASE. Non-Alcoholic Fatty Liver Disease (NAFLD) Primary NAFLD. April 13, 2012
NONALCOHOLIC FATTY LIVER DISEASE Kiran Bambha, MD University of Colorado Denver April 13, 2012 Non-Alcoholic Fatty Liver Disease (NAFLD) Primary NAFLD Simple Steatosis Fatty hepatocytes Intracellular fat
More informationPathological Analysis of Small Hepatocellular Carcinoma with Poor Prognosis
Pathological Analysis of Small Hepatocellular Carcinoma with Poor Prognosis Haeryoung Kim, M.D., Ph.D. Department of Pathology Seoul National University Bundang Hospital Small HCC Definition: HCC < 2cm
More informationLiver disease is a major cause of mortality and morbidity
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2011;9:524 530 Changes in the Prevalence of the Most Common Causes of Chronic Liver Diseases in the United States From 1988 to 2008 ZOBAIR M. YOUNOSSI,*, MARIA
More informationFATTY LIVER DISEASE (NAFLD) (NASH) A GROWING
NON ALCOHOLIC FATTY LIVER DISEASE () & NON ALCOHOLIC S T E ATO H E PAT I T I S () ADDRESSING A GROWING SILENT EPIDEMIC Prevalence of & USA Prevalence in Middle Age Patients San Antonio, Texas (Williams
More informationNonalcoholic Fatty Liver Disease: Definitions, Risk Factors, and Workup
REVIEW REVIEW Nonalcoholic Fatty Liver Disease: Definitions, Risk Factors, and Workup Puneet Puri, M.B.B.S., M.D. and Arun J. Sanyal, M.B.B.S., M.D. Nonalcoholic fatty liver disease (NAFLD) is defined
More informationEnterprise Interest Nothing to declare
Enterprise Interest Nothing to declare 29 th European Congress of Pathology, Amsterdam, Sept 2 nd -6 th, 2017 What s new in alcohol-mediated liver injury? Carolin Lackner Institute of Pathology Medical
More informationLIVER PATHOLOGY. Thursday 28 th November 2013
LIVER PATHOLOGY Thursday 28 th November 2013 Liver biopsy assessment of steatosis Amar Paul Dhillon Royal Free Hospital RIBA, London Thursday 28th November 2013 NAFLD didn t exist before 2001 and liver
More informationHepatocellular Carcinoma: Can We Slow the Rising Incidence?
Hepatocellular Carcinoma: Can We Slow the Rising Incidence? K.Rajender Reddy M.D. Professor of Medicine Director of Hepatology Medical Director of Liver Transplantation University of Pennsylvania Outline
More informationNON-ALCOHOLIC STEATOHEPATITIS AND NON-ALCOHOLIC FATTY LIVER DISEASES
NON-ALCOHOLIC STEATOHEPATITIS AND NON-ALCOHOLIC FATTY LIVER DISEASES Preface Zobair M. Younossi xiii Epidemiology and Natural History of NAFLD and NASH 1 Janus P. Ong and Zobair M. Younossi Understanding
More informationFirst European NAFLD-NASH Summit European Parliament, Brussels, May 31 st NAFLD/NASH : an expanding burden on liver health
First European NAFLD-NASH Summit European Parliament, Brussels, May 31 st 2017 NAFLD/NASH : an expanding burden on liver health Vlad Ratziu, Université Pierre et Marie Curie, Hôpital Pitié Salpêtrière,
More informationPREVALENCE OF NAFLD & NASH
- - PREVALENCE OF & USA Prevalence in Middle Age Patients San Antonio, Texas (Williams et al., Gastroenterology 2011; 140:124-31) Dallas Heart Study Prevalence Numbers (Browning et al., Hepatology 2004;40:1387-95)
More informationPitfalls in the diagnosis of well-differentiated hepatocellular lesions
2013 Colorado Society of Pathology Pitfalls in the diagnosis of well-differentiated hepatocellular lesions Sanjay Kakar, MD University of California, San Francisco Outline Hepatocellular adenoma: new WHO
More informationThe role of Hepatitis C Virus in hepatocarcinogenesis
The role of Hepatitis C Virus in hepatocarcinogenesis Laura Beretta Fred Hutchinson Cancer Research Center l8 Incidence and mortality of the five most common cancers worldwide, 2000 Incidence Lung Breast
More informationEarly life determinants of Non-Alcoholic Fatty Liver Disease and NASH DR JULIANA MUIVA-GITOBU KENYA PAEDIATRIC ASSOCIATION CONFERENCE APRIL 2016.
Early life determinants of Non-Alcoholic Fatty Liver Disease and NASH DR JULIANA MUIVA-GITOBU KENYA PAEDIATRIC ASSOCIATION CONFERENCE APRIL 2016. Outline Definition NAFLD and NASH Magnitude of the problem
More informationLiver Cancer. Su Jong Yu, M.D. Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine
Liver Cancer Su Jong Yu, M.D. Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine Primary Liver Cancer Hepatocellular carcinoma (HCC) : > 80% Derived
More informationHepatocellular carcinoma
Hepatocellular carcinoma Mary Ann Y. Huang, M.D., M.S., FAASLD Transplant hepatologist Peak Gastroenterology Associates Porter Adventist Hospital Denver, Colorado Background - Worldwide Hepatocellular
More informationNon-Alcoholic Fatty Liver Diseasean underestimated epidemic
Non-Alcoholic Fatty Liver Diseasean underestimated epidemic Amir Shlomai MD,PhD Head, Department of Medicine D The Liver Institute Rabin Medical Center, Beilinson Hospital The IASLD semi-annual meeting-
More informationPrognosis of NASH VII Workshop Intenracional de Actualizaçao em Hepatologia, Aug 29th 2014
Prognosis of NASH VII Workshop Intenracional de Actualizaçao em Hepatologia, Aug 29th 2014 Vlad Ratziu, Université Pierre et Marie Curie, Hôpital Pitié Salpêtrière, Paris, France NASH : a severe hepatic
More informationInvited Re vie W. Analytical histopathological diagnosis of small hepatocellular nodules in chronic liver diseases
Histol Histopathol (1 998) 13: 1077-1 087 http://www.ehu.es/histoi-histopathol Histology and Histopathology Invited Re vie W Analytical histopathological diagnosis of small hepatocellular nodules in chronic
More informationThe impact of the treatment of HCV in developing Hepatocellular Carcinoma
The impact of the treatment of HCV in developing Hepatocellular Carcinoma Paul Y Kwo, MD Professor of Medicine Medical Director, Liver Transplantation Gastroenterology/Hepatology Division Indiana University
More informationSTOP Hepatocellular Carcinoma
STOP Hepatocellular Carcinoma Laura Tenner MD MPH, Amit G. Singal MD MS, Mamta Jain MD, Barbara Turner MD, Barbara Riske MS ReACH Center and Dept of Medicine UT Health San Antonio Dept of Medicine UT Southwestern
More informationDoes hepatocellular carcinoma in non-alcoholic steatohepatitis exist in cirrhotic and non-cirrhotic patients?
ISSN 0100-879X Volume 42 (10) 870-992 October 2009 BIOMEDICAL SCIENCES AND CLINICAL INVESTIGATION Braz J Med Biol Res, October 2009, Volume 42(10) 958-962 Does hepatocellular carcinoma in non-alcoholic
More informationPrevalence of non-alcoholic fatty liver disease in type 2 diabetes mellitus patients in a tertiary care hospital of Bihar
Original Research Article Prevalence of non-alcoholic fatty liver disease in type 2 diabetes mellitus patients in a tertiary care hospital of Bihar Naresh Kumar 1, Jyoti Kumar Dinkar 2*, Chandrakishore
More informationFocus on Dysplastic Nodules and Early Hepatocellular Carcinoma: An Eastern Point of View. Masamichi Kojiro
Focus on Dysplastic Nodules and Early Hepatocellular Carcinoma: An Eastern Point of View Masamichi Kojiro Although increasing numbers of equivocal nodular lesions have been detected in patients with liver
More informationUse of Ultrasound in NAFLD
Institute for Liver and Digestive Health Use of Ultrasound in NAFLD Dr. Davide Roccarina Specialist in General Medicine Specialist Doctor in Clinical Ultrasound and non-invasive liver assessment Hepatology
More informationHepatitis C wi w t i h Ju J dy y W y W a y t a t t
Hepatitis C with Judy Wyatt Hepatitis C and the histopathologist Pre-2006 biopsy based treatment of moderate-severe chronic hepatitis Now biopsy for: Watchful waiting, to confirm mild disease? Cirrhosis
More informationNAFLD/NASH in Sub- Saharan Africa
NAFLD/NASH in Sub- Saharan Africa Corné Kruger Gastroenterologist Durbanville Mediclinic Cape Town Liver Interest group meeting: Cape Town 2015 Introduction NAFLD is the most common liver disease disease
More informationIS THERE A DIFFERENCE IN LIVER CANCER RATES IN PATIENTS WHO RECEIVE TREATMENT FOR HEPATITIS?
IS THERE A DIFFERENCE IN LIVER CANCER RATES IN PATIENTS WHO RECEIVE TREATMENT FOR HEPATITIS? Dr. Sammy Saab David Geffen School of Medicine, Los Angeles, USA April 2018 DISCLAIMER Please note: The views
More informationEnd Stage Liver Disease & Disease Specific Indications for Liver Transplant. Susan Kang, RN, MSN, ANP-BC
End Stage Liver Disease & Disease Specific Indications for Liver Transplant Susan Kang, RN, MSN, ANP-BC Introduction (https://www.srtr.org) What does the liver do? STORAGE METABOLIC DETOXIFICATION SYNTHETIC
More informationEnd Stage Liver Disease & Disease Specific Indications for Liver Transplant Susan Kang, RN, MSN, ANP BC
End Stage Liver Disease & Disease Specific Indications for Liver Transplant Susan Kang, RN, MSN, ANP BC Introduction (https://www.srtr.org) 1 What does the liver do? STORAGE METABOLIC DETOXIFICATION SYNTHETIC
More informationNonalcoholic Fatty Liver Disease in Children: Typical and Atypical
Nonalcoholic Fatty Liver Disease in Children: Typical and Atypical Disclosure Naim Alkhouri, MD discloses the following relationships with commercial companies: Membership in the Speakers Bureau for Alexion
More informationThe Efficacy of Corticosteroid Therapy in a Patient with Nonalcoholic Steatohepatitis Overlapping Autoimmune Hepatitis: A Case Report
doi: 10.2169/internalmedicine.8887-17 Intern Med Advance Publication http://internmed.jp CASE REPORT The Efficacy of Corticosteroid Therapy in a Patient with Nonalcoholic Steatohepatitis Overlapping Autoimmune
More informationHepatocellular Carcinoma: Epidemiology and Screening
Hepatocellular Carcinoma: Epidemiology and Screening W. Ray Kim, MD Professor and Chief Gastroenterology and Hepatology Stanford University School of Medicine Case A 67 year old Filipino-American woman
More informationSteatosi epatica ed HCV
Steatosi epatica ed HCV Malattie delle vie biliari ed Epatologia Rho, Auditorium Padri Oblati, 11 Novembre 2006 Piero L. Almasio Università di Palermo HISTOPATHOLOGY Steatosis and accelerated fibrogenesis:
More informationA Modification of the Brunt System for Scoring Liver Histology of Patients with Non-Alcoholic Fatty Liver Disease
Arch Iran Med 2010; 13 (1): 38 44 Original Article A Modification of the Brunt System for Scoring Liver Histology of Patients with Non-Alcoholic Fatty Liver Disease Shahin Merat MD*, Farzaneh Khadem-Sameni
More informationNon alcoholic fatty liver and Non alcoholic Steatohepatitis. By Dr. Seham Seif
Non alcoholic fatty liver and Non alcoholic Steatohepatitis By Dr. Seham Seif Definition NAFL describe a common clinicopathological conditions characterized by significant lipid deposition in the hepatocytes
More informationPATHOLOGY OF LIVER TUMORS
PATHOLOGY OF LIVER TUMORS Pathobasic, 31.05.2016 WHO Classification Approach to a Liver Mass Lesion in a patient with chronic liver disease? Lesion in a patient without chronic liver disease? Malignant
More informationNonalcoholic fatty liver disease in India a lot done, yet more required!
Indian J Gastroenterol (2010) 29:217 225 DOI 10.1007/s12664-010-0069-1 REVIEW ARTICLE Nonalcoholic fatty liver disease in India a lot done, yet more required! Ajay Duseja Received: 1 August 2010 / Accepted:
More informationLiver Transplant Pathology a general view
Liver Transplant Pathology a general view Dr S E Davies Addenbrooke s Hospital Cambridge University Hospitals NHS Trust ACP/BSG Meeting Leeds 2012 Liver transplantation When and where? Who and why? How?
More informationPresented by: Dr. Giuseppe Molinaro Dr. Davide De Biase
Presented by: Dr. Giuseppe Molinaro Dr. Davide De Biase Dog Spayed Female LABRADOR RETRIEVER 3 Years old VACCINATIONS ANTIPARASITIC COMMERCIAL DIET VOMITING FOR A MONTH DULLNESS WEIGHT LOSS INAPPETANCE
More informationFrequency and Outcomes of Liver Transplantation for Nonalcoholic Steatohepatitis in the United States
GASTROENTEROLOGY 2011;141:1249 1253 Frequency and Outcomes of Liver Transplantation for Nonalcoholic Steatohepatitis in the United States MICHAEL R. CHARLTON,* JUSTIN M. BURNS, RACHEL A. PEDERSEN, KYMBERLY
More informationViral Hepatitis (I) Luigi Terracciano Department of Pathology University Hospital Basel. Basel,
Viral Hepatitis (I) Luigi Terracciano Department of Pathology University Hospital Basel Basel, 19. 04. 2016 Definition Hepatitis means inflammation of the liver characterized by a variable combination
More information«STEATOSI EPATICA ED EPATOPATIE METABOLICHE» Ester Vanni Division of Gastroenterology University of Turin
«STEATOSI EPATICA ED EPATOPATIE METABOLICHE» Ester Vanni Division of Gastroenterology University of Turin OUTLINE NAFLD overview NAFLD and menarche NAFLD and pregnancy NAFLD and menopause Other metabolic
More informationHepatocellular carcinoma in Sri Lanka - where do we stand?
SCIENTIFIC ARTICLE Hepatocellular carcinoma in Sri Lanka - where do we stand? R.C. Siriwardana 1, C.A.H. Liyanage 1, M.B. Gunethileke 2 1. Specialist Gastrointestinal and Hepatobilliary Surgeon, Senior
More informationAutoimmune Hepatitis Events Easl
Autoimmune Hepatitis Events Easl 1 / 6 2 / 6 3 / 6 Autoimmune Hepatitis Events Easl INTRODUCTION. Autoimmune hepatitis is a chronic, inflammatory disease of the liver that is characterized by circulating
More informationNON-ALCOHOLIC FATTY LIVER DISEASE:
NON-ALCOHOLIC FATTY LIVER DISEASE: ROLE OF THE PRIMARY PROVIDER Archita P. Desai, MD Assistant Professor of Medicine University of Arizona 25 th Annual Southwestern Conference on Medicine Outline Pathophysiology
More informationPEDIATRIC FOIE GRAS: NON-ALCOHOLIC FATTY LIVER DISEASE
PEDIATRIC FOIE GRAS: NON-ALCOHOLIC FATTY LIVER DISEASE Updates on New insights into NAFLD and NASH pathophysiology New AASLD/AGA/ACG guidelines for NAFLD and NASH, as pertains to pediatrics Evidence-based
More informationCDHNF & NASPGHAN A Partnership for Research and Education for Children s Digestive and Nutritional Health
CDHNF & NASPGHAN A Partnership for Research and Education for Children s Digestive and Nutritional Health Obesity and NAFLD Definitions: Nonalcoholic steatohepatitis (NASH) and nonalcoholic fatty liver
More information/ FIB4 Index , simple steatosis. FIB4 Index. FIB4 Index. FIB4 Index FIB4 Index. Sterling FIB4 Index. FIB4 Index AST AST ALT
原 著 29 34-41, 2014 FIB4 Index 1 1 1 1 2 1 1 FIB4 Index FIB4 Index cut off 2.67 2.67 12,059 FIB4 IndexFIB4 Index 2.67 / FIB4 Index AST ALT FIB4 Index 2.67 161 1.3% FIB4 Index 5 FIB4 Index 1.1 5 1.6 FIB4
More informationNAFLD: evidence-based management. Curso de residentes AEEH Salvador Augustin, MD Liver Unit Vall d Hebron Hospital Barcelona, Spain
NAFLD: evidence-based management Curso de residentes AEEH 2017 Salvador Augustin, MD Liver Unit Vall d Hebron Hospital Barcelona, Spain Clinical case - 55 yo female - Sent for incidental steatosis at abdominal
More informationHepatocellular Carcinoma in Qatar
Hepatocellular Carcinoma in Qatar K. I. Rasul 1, S. H. Al-Azawi 1, P. Chandra 2 1 NCCCR, 2 Medical Research Centre, Hamad Medical Corporation, Doha, Qatar Abstract Objective The main aim of this study
More informationNon-Alcoholic Fatty Liver Disease (NAFLD)
HEPATO-PANCREATO-BILIARY STOMACH CANCER PROGRAM Non-Alcoholic Fatty Liver Disease (NAFLD) Steatosis and Non-Alcoholic Steatohepatitis (NASH) Management Recommendations UCSF Fresno Department of Surgery
More informationThere are approximately 1 million new cases of primary hepatocellular
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2009;7:800 806 Liver Transplantation in Patients With Nonalcoholic Steatohepatitis-Related Hepatocellular Carcinoma SHAHID M. MALIK,* PARIJAT A. GUPTE,* MICHAEL
More informationThe role of ARFI and APRI in diagnosis of liver fibrosis on patients with common chronic liver diseases
RESEARCH ARTICLE The role of ARFI and APRI in diagnosis of liver fibrosis on patients with common chronic liver diseases Objective: This study aimed to investigate the value of liver fibrosis assessment
More informationCase #1. Digital Slides 11/6/ year old woman presented with abnormal liver function tests. Liver Biopsy to r/o autoimmune hepatitis
45 year old woman presented with abnormal liver function tests Liver Biopsy to r/o autoimmune hepatitis Further down. ANA 1: 160; ASMA 1:80 ANA 1: 160; ASMA 1:80 IgG = 14.5 g/l (upper normal range: 16)
More informationDiagnostic problems in uterine smooth muscle tumors
Diagnostic problems in uterine smooth muscle tumors Marina Kos Ljudevit Jurak Clinical Department of Pathology, Clinical Hospital Center Sestre milosrdnice, Zagreb Institute of Pathology, University of
More informationCorrelation between bright echogenic liver, elevated liver enzymes and liver histology.
Original Article Correlation between bright echogenic liver, elevated liver enzymes and liver histology. Dr. Iqbal Murshed Kabir, Dr. Mahbub Alam, Dr. Mohammad Mahmuduzzaman, Dr. Abdullah Al Mamoon, Dr.
More informationLiver Specialty Evening Conference. Matthew M. Yeh, MD, PhD Professor of Pathology Adjunct Professor of Medicine University of Washington, Seattle
Liver Specialty Evening Conference Matthew M. Yeh, MD, PhD Professor of Pathology Adjunct Professor of Medicine University of Washington, Seattle Case History A 65 year-old man presents with abdominal
More informationSurveillance for HCC Who, how Diagnosis of HCC Surveillance for HCC in Practice
Surveillance for Hepatocellular Carcinoma Hashem B. El-Serag, MD, MPH Dan L. Duncan Professor of Medicine Chief, Gastroenterology and Hepatology Houston VA & Baylor College of Medicine Houston, TX Outline
More informationBSG/ACP annual course Royal College of Pathologists Infections and Inflammations of the Hepato-Biliary System Hepatitis B and D
BSG/ACP annual course Royal College of Pathologists Infections and Inflammations of the Hepato-Biliary System Hepatitis B and D Amar Paul Dhillon Royal Free & University College Medical School Thurs 10
More informationLIVER, PANCREAS, AND BILIARY TRACT
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2012;10:1028 1033 LIVER, PANCREAS, AND BILIARY TRACT Prevalence and Indicators of Portal Hypertension in Patients With Nonalcoholic Fatty Liver Disease FLAVIA D.
More informationHEPATOCELLULAR CARCINOMA: SCREENING, DIAGNOSIS, AND TREATMENT
HEPATOCELLULAR CARCINOMA: SCREENING, DIAGNOSIS, AND TREATMENT INTRODUCTION: Hepatocellular carcinoma (HCC): Fifth most common cancer worldwide Third most common cause of cancer mortality In Egypt: 2.3%
More informationPathology of Non-Alcoholic Fatty Liver Disease
The Hong Kong College of Pathologists, Incorporated in Hong Kong with Limited Liability Volume 10, Issue 1 January 2015 Editorial note: Non-alcoholic fatty liver disease (NAFLD) is the commonest metabolic
More information-sheet 3. -Waseem Alhaj. Maha Shomaf
-sheet 3 -Basheer egbaria -Waseem Alhaj Maha Shomaf 1 P a g e Viral hepatitis have many types each type is associated with different outcomes complication, some can result in acute one,others result in
More informationAutoimmune Hepatitis: Histopathology
REVIEW Autoimmune Hepatitis: Histopathology Stephen A. Geller M.D.*, Autoimmune hepatitis (AIH), a chronic hepatic necroinflammatory disorder, occurs mostly in women. AIH is characterized by prominent
More informationLIVER DISEASES. Pathology Department, Zhejiang University School of Medicine,
LIVER DISEASES Pathology Department, Zhejiang University School of Medicine, 马丽琴,maliqin198@zju.edu.cn Viral Hepatitis Cirrhosis of liver Liver cancer Viral Hepatitis DEFINITION Primary hepatic infections
More informationNash with cirrhosis icd 10
Free, official coding info for 2018 ICD-10-CM K75.81 - includes detailed crosswalks, DRG grouping and more. Free, official coding info for 2018 ICD-10-CM K74.69 - includes detailed crosswalks, DRG grouping
More information