Virtual Slidebox
Presented by the MGH Pathology Service

Clinical history:

54 y/o male with severe abdominal pain

Special stains & Immunohistochemistry:

Molecular testing:

FISH testing was positive for a rearrangement involving MYC at 8q24.

MICROSCOPIC FEATURES

• Marked expansion of portal tracts by lymphocytic infiltrates. The extent of the infiltrate is beyond what is seen in chronic viral hepatitis, where portal tracts tend to have a relatively tight “cuff” of inflammation around them.
• The lymphocytic infiltrate is sheet-like and monotonous, rather than mixed and with a follicle-like architecture, as is usually seen in chronic viral hepatitis. In some cases, the lymphoid cells may show atypia.
• There is no interface hepatitis at the edge of the infiltrate, and there are no apoptotic hepatocytes in the lobule
• There is no associated periportal fibrosis, as is usually seen with the inflammatory infiltrates of chronic viral hepatitis

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MICROSCOPIC FEATURES

• Portal tracts are expanded by a mixed lymphoid infiltrate, which focally extends into the lobules
• The infiltrate contains lymphocytes, plasma cells, eosinophils, and scattered Reed-Stenberg cells
• The infiltrate may also involve bile ducts
• Sinusoidal dilatation and peliosis hepatis may also be present
• Epithelioid granulomas are found in ~10% of cases, usually in the portal tracts

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Clinical history

Female in her 70’s with history of DLBCL of tonsil s/p rx, now with duodenal obstruction.

Immunohistochemistry

80 y/o female with abdominal pain

Clinical history:

76 y/o male, surveillance colonoscopy. Three polyps removed from transverse colon

Immunohistochemistry:

59 y/o male with abdominal pain and renal failure