Review of outside material. The biopsy is small and fragmented. In most regions the normal lobular architecture appears intact, but slightly distorted because of mild portal expansion and vague intralobular regenerative changes. A few of the portal tracts show mild fibrosis and contain a mild mononuclear inflammatory cell infiltrate.
Bile ducts are intact.
Throughout the lobules, there is moderate to severe lobular disarray, Kupffer cell hypertrophy, mild mixed steatosis, numerous acidophilic bodies and hepatocellular swelling with regeneration. Several hepatocytes contain Mallory's-like hyaline. However, no significant lobular neutrophilia or steatotic degeneration of hepatocytes are seen. No viral inclusions, prominent pigment deposition or ground glass cells are seen. The prominent lobular component including hepatocellular swelling, spotty hepatocyte necrosis and focal Mallory's-like hyaline and the cholestatic liver injury tests suggest an acute or active lobular hepatitis, with a cholestatic component.