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Cellular and Molecular ( Pathology Case Study Assignment) - Essay Example

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Cellular and Molecular Pathology (Case Study Assignment) Tissue histopathological studies have become the gold standard for the diagnosis of a variety of liver diseases. According to the generally accepted criteria, following are the indications for liver biopsy: chronic hepatitis, Wilson`s disease, alcoholic hepatitis, non-alcoholic steatohepatitis, primary biliary cirrhosis, cholestatic liver disease, fever of unknown origin, liver mass, status of liver post-transplantation and of donor pre-transplantation (Bravo et al, 2001) Though it is generally accepted that liver biopsy specimen is no more than 1/150,000 part of the whole liver mass, but this is considered to be adequately representati…
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Cellular and Molecular ( Pathology Case Study Assignment)
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Cellular and Molecular ( Pathology Case Study Assignment)

In the given case study, the MRI scan confirms the presence of solid mass lesion in the right middle lobe of liver. In this scenario the possible etiology of the lesion might be one of the following: Haemangioma, Adenoma, Liver abscess (amebic or pyogenic), Focal nodular hyperplasia, Fatty infiltration, Rare primary liver neoplasms, Hepatocellular cancer, Cholangiocarcinoma, and metastatic lesions. Various studies have focused on the quality of liver biopsy samples with regards to sampling errors, length of specimen, potential heterogeneity of diseased liver, needle size and the methods of biopsy (Cholongitas et al, 2006). In one review, sampling errors have been reported all over the world to be the limiting factor for an adequate liver biopsy specimen, further increasing the inter-observer and the intra-observer variation for the chronic liver disease biopsy evaluation (Cholangitas et al, 2006). However, newly devised scoring systems lessen these chances. Bedossa et al (2003) have concluded that increasing the size of biopsy and multiple specimens can lower the sampling variability and overcome effects ofheterogeneity in diffuse liver disease. Anotherreview reported that adequate sample should be ?25 mm rather than ?15 mm and the number of CPTs should be ?11 rather than ?6-8. This criterion is difficult to achieve but it has been shown to be associated with adequate information in the biopsy sample(Cholangitas et al, 2006). The same review stated that samples obtained with Mahingini needles were associated with longer samples, but the Tru cut needle`s large shaft must decrease the discrepancy, if any. Most of the above mentioned criteria for quality of liver biopsy sample are generally for the diffuse liver diseases, but in our case study the lesion is focal, thus the most optimum quality of sample will be the one that visualizes enough cellular architecture and their details to identify type of cell from which it is arising. Liver masses or focal lesions are especially difficult to evaluate on biopsy; this may be because of the cystic or vascular nature of the mass and therefore imaging remains an important pre-requisite for such focal lesions and ultrasound guidance must be also provided. Another important aspect is the presence of diseased background parenchyma e.g: cirrhosis, which necessitates taking another biopsy tissue from distant site as well as from the actual mass lesion (Rockey et al, 2009). The most widely used method of sampling is the Percutaneous Liver biopsy, which is undertaken only after comparing the risk factors with the disease morbidity. It can be further specified by ultrasound guided undertaking of the procedure and plugging the site of biopsy afterwards (Mayoral & Lewis, 2001). It takes only few seconds though number of passes increase complications after 2 attempts. The mortality of 0.01%- 0.1% and morbidity due to small complications of 5.9% has been reported in text books. It might be complicated by hemorrhage and pain. Percutaneous Liver Biopsy is absolutely contraindicated in uncooperative patient, bleeding tendency, ... Read More
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