The liver biopsy shows intact hepatic architecture with slight fibrosis and expansion of the portal tracts. The portal tracts demonstrate atrophic bile ducts with loss in a rare portal tract. There is a mixed inflammatory infiltrate including neutrophils, focal lymphocytes and rare eosinophils. Subendothelial infiltration is not seen, and lymphocytic duct damage is not a prominent feature. The hepatocytes are swollen and there is foci of canalicular cholestasis with cholestatic rosetting of liver cells.
Lobular inflammation is minimal other than an occasional neutrophil and a rare focal necrosis.
No viral inclusions are identified and no central venulitis is seen. Overall, the changes suggest an ongoing cholestatic process. Given the portal alterations, a bile duct problem should initially be excluded and the possibility of early chronic rejection or an evolving fibrosing cholestatic hepatitis C can also be considered. All rights reserved. Unauthorized redistribution prohibited.