Biopsy of liver

Tot T, Samii S. The clinical relevance of cytokeratin phenotyp-ing in needle biopsy of liver metastasis. APMIS. 2003 111 1075-1082. 

Luning M et al. (1984) [Analysis of the results of 96 CT-guided fine needle biopsies of liver masses.] (In German) Rofo 141 267-725... 

Polysaccharide Analysis of Liver Biopsy Specimens Obtained at Laparotomy, D. J. Tipper, M. Stacey, and S. A. Barker, Clin. Chim. Acta, 4 (1959) 861-866. 

Review the liver biopsy report (if available) to determine the severity of liver damage and need for chronic hepatitis B or C treatment. 

Liver biopsy plays a central role in the diagnosis and staging of liver disease. 

Treatment for HCV infection is necessary because a high percentage of acutely infected patients develop chronic infections. Treatment is indicated in patients previously untreated who have chronic HCV, circulating HCV RNA, increased alanine transaminases levels, evidence on biopsy of moderate to severe hepatic grade and stage, and compensated liver disease. 

The presence of disulfoton and/or its metabolites in the liver appears to be a sensitive indicator of disulfoton exposure, despite the limited data. Supporting evidence from animal studies indicates that disulfoton exposure will result in detectable levels in the liver (Bull 1965 Puhl and Fredrickson 1975). However, monitoring of liver levels would require biopsy, which is not practical. 

Vulnerability of the liver to injury necessitates routine evaluation of hepatic function in patients and asymptomatic individuals to avert or control adverse clinical conditions. Thus, a plethora of methods has been developed for the diagnosis of liver diseases and dysfunctions. One such method uses physical palpation to determine alterations or changes in the orientation of the liver, which provides valuable information about the organ status but the quality of information is subjective and imprecise [3]. Another common method for the diagnosis of more serious hepatic injuries involves liver biopsies coupled with biochemical tests to determine the extent of liver injury and prognosis [4-7]. However, in acute and some chronic hepatic disorders, dynamic and continuous hepatic function monitoring would be advantageous. 

Case D The patient is lethargic, her liver is enlarged, and a biopsy of the liver shows large amounts of excess glycogen. She also has a lower than normal blood glucose level. What is the reason for the low blood glucose in this patient ... 

Assurance of good renal and hepatic function is mandatory before beginning treatment with the fibrates (22). Serum transaminase changes are regularly seen and hepatitis occurs (23). Several cases of hepatitis due to fenofibrate have been reviewed (24) and it has also been observed with etofibrate (25). One case of liver failure, probably due to beclobrate, has been reported (SEDA-13, 1324 26). Liver biopsies showed a lymphoplasmacytic infiltrate in all of five cases of chronic hepatitis associated with fibrates (27). 

Hepatic Effects. No studies were located regarding hepatic effects in humans after oral exposure to DEHP. Limited information on hepatic effects in humans exposed to DEHP is available from studies of dialysis patients and cultured human hepatocytes. In one individual there was an increased number of liver peroxisomes after 1 year, but not after 1 month of treatment (Ganning et al. 1984, 1987). A serious limitation of this observation is that repeat biopsies were not obtained from the same patient, so that an appropriately controlled analysis is not possible. Additionally, analysis of liver biopsies from patients receiving other kinds of hypolipidemic drugs has not yielded any evidence for peroxisomal proliferation (Doull et al. 1999). Recognizing some limitations of using primary hepatocytes in vitro because of their tendency to lose some metabolic capabilities (Reid 1990), in cultured human hepatocytes there were no changes in the activities of peroxisomal palmitoyl-CoA oxidase and/or carnitine acetyltransferase when... 

Based on the animal data, the most consistent effect of exposure to DEHP is the increase in the concentration of liver peroxisomes. This effect occurs to varying degrees in all species that have been evaluated. However, evidence for an effect of DEHP exposure on human liver peroxisomes is weak. Limited data regarding biopsies from human livers, under circumstances in which DEHP was present in the hemodialysis equipment, did not lead to meaningful conclusions (Ganning et al. 1984, 1987). Therefore, a liver biopsy with subsequent histopathological examination of the cells would seldom if ever be justified as a test for the long-term effects of DEHP exposure due to the difficulties associated with this procedure. 

Isolate hepatocytes by collagenase perfusion of liver biopsy... 

Figure 29-4. Stellate cell lipid droplets present in a biopsy obtained from the liver of a patient experiencing vitamin A toxicity. Image obtained from electron microscopy of a biopsied human liver showing the characteristic lipid droplets (LD) found in hepatic stellate cells (SC).These lipid droplets are highly enriched in vitamin A, and the size and number of lipid droplets is influenced by dietary vitamin A intake and nutritional status. In this image of a human stellate cell, the nucleus (N) is compressed by the surrounding lipid droplets, and very little cell cytoplasm within the stellate cell can be seen in this view.Adjoining the stellate cell are two hepatocytes (H).

A biopsy is often required to make a diagnosis of most types of liver disease. A specimen of liver can be used to identify fibrosis, cirrhosis, cholestasis and hepatitis, both acute and chronic, and tumours. Biochemical measurements can also be taken from a biopsy specimen to determine iron and copper content, virology, microbiology and haematology (e.g. increased numbers of eosinophils in a drug-induced cause). The biopsy can give an indication of the extent of the liver damage. See Chapter 3 for slides of liver biopsies. 

Diagnosis may be confirmed by the absence of glucose 6-phosphatase on liver biopsy. The liver cells are full of glycogen and fat. Also, the normal elevation in blood glucose from infusion of glucagon, epinephrine or galactose is absent. 

---